Scott is a 47-year-old gay man who lives in Miami Beach. He's single, on PrEP and enjoys casual sex with younger gay men.
"For years and years and years, I was living in a manner that was pretty much fear-based in what I could and couldn't do sexually because of HIV," said Scott, who asked that his last name not be used due to his profession.
"Now, it's changed. What was dangerous is seemingly now not."
Despite recommendations from public health agencies, Scott prefers not to use condoms.
"It's kind of along the lines that they have to say that," he said. "I'm not talking about having someone cum in me, or a gang bang. I'm just talking about having sex, pulling out and cumming."
Scott doesn't ask about someone's status, or take their word for it. Rather, he requires them to go get tested with him at a free testing site near where he lives.
Scott had a conversation with his doctor and friends before getting on PrEP to make sure it was right for him. Many of his friends are on the drug, he said.
In February, the Centers for Disease Control and Prevention (CDC) released new research showing that reaching the National HIV/AIDS Strategy targets for HIV testing and treatment and expanding the use of pre-exposure prophylaxis (PrEP) could prevent 185,000 new HIV infections in the U.S. by 2020, a 70 percent reduction in new infections.
The CDC also reported recently that condomless sex had increased by 20 percent over the past decade amongst gay men.
PrEP, which is not a vaccine, is when people at very high risk for HIV take HIV medicines daily to lower their chances of getting infected, according to the CDC.
A combination of two HIV medicines (tenofovir and emtricitabine), sold under the name Truvada, is approved for daily use as PrEP to help prevent an HIV-negative person from getting HIV from a sexual or injection-drug-using partner who’s positive.
Studies have shown that PrEP is highly effective for preventing HIV if it is used as prescribed. PrEP is much less effective when it is not taken consistently, the CDC reports.
The February CDC study estimates that, between 2015 and 2020:
- Reaching the nation’s goal of ensuring 90 percent of people living with HIV are diagnosed, and 80 percent of people diagnosed achieve viral suppression could prevent 168,000 new HIV infections.
- By also increasing the use of PrEP, a daily anti-HIV pill, among people who are uninfected but at high risk, an additional 17,000 infections could be prevented.
- If HIV testing and treatment remained the same, expanded use of PrEP among high-risk populations alone could prevent more than 48,000 new infections.
In Miami-Dade County, there are more than 27,000 people living with HIV or AIDS, and two-thirds are gay men or men who have sex with other men, according to Care Resource, a nonprofit and health center for uninsured and under-insured LGBT patients in Miami-Dade and Broward counties.
Community outreach and education is one method that local public health agencies, such as Care Resource, utilize to help decrease the number of new HIV and AIDS infections.
"Since 2011, we've seen a 32.5 percent increase in HIV among men who have sex with men," Paul Seligmann, PrEP educator with Care Resource, told a group of gay men gathered at the LGBT Visitor Center in Miami Beach last week.
"One pill a day keeps HIV away," Seligmann said before educating the men on the basics of sex, and reminding them to treat it with some thought and attention.
"Why do we have sex?" He asked the audience, receiving answers like procreation, pleasure and basic needs. "Yes, it's a fundamental requirement."
What people say and what they do are very different, Seligmann warned.
"People might say they are on PrEP but be HIV-positive or attend crystal meth parties on the weekend. People might say they are negative but haven't been tested for seven years...Share your mojo wisely."
Seligmann said that PrEP should be a consideration for gay men, particularly due to statistics that show 74 percent of all new HIV infections in Miami-Dade County were presented with syphilis.
Syphilis is an STD that can cause long-term complications if not treated correctly. Symptoms in adults are divided into stages – primary, secondary, latent, and late syphilis – according to the CDC.
Syphilis can be contracted through direct contact with a syphilis sore during vaginal, anal or oral sex. Sores can be found on the penis, vagina, anus, in the rectum or on the lips and in the mouth.
Seligmann encourages gay men to do their own research on PrEP, which has minimal side effects, including kidney, liver or bone density problems. He said PrEP, which is the only FDA-approved HIV prevention drug, is about 92-99.9 percent effective.
For those without insurance, there are nonprofits, like Care Resource, that can assist those who would like to be on PrEP. And, for those with insurance, many insurance companies will approve and pay for use of the drug, Seligmann said.
"They learned HIV costs them a lot more than someone who is on PrEP," he said.
Scott said he appreciates community outreach events like this, and would like to see a local support group started for gay men who are on PrEP.
"We should be communicating about it. What's your feedback? What's your emotions? All that kind of stuff that happens in a support group," he said.
To research PrEP, visit www.CDC.gov/hiv/risk/prep