From PrEP to Hepatitis, One Gay HIV-Positive Senior Offers New Advice on #WorldHepatitisDay

Let’s get the basics covered out of the gate: I’m 63. I’ve had HIV since the early 1980s or late ’70s. I’m healthy, active, considered stable, intelligent, and attractive. I’m in a 20-plus-year open relationship with another man.

Having accomplished all of that, I see a new landscape of language and potentialities emerging before me more rapidly than a cold sore after a quick encounter.

 Grindr, SCRUFF, GROWLr, Manhunt, Adam4Adam, BBRTS, ad infinitum. And add one more acronymistically neutral sounding event in the dating arena: PrEP.

Pre-exposure prophylaxis, or PrEP, is the daily administration of a magic-bullet pill that prevents those engaging in what people my age call “risky behaviors” from the trauma and life sentence of HIV.

Like a lot of gay men my age, I was against PrEP before I was for it, much like the political posturing that came before the actual votes were taken for the “wars” of the new generation in Iraq and Afghanistan.

My initial thought was, This is a license for bad behavior. After all, I come from the condom culture way back in another century when that latex liner was really all we had to even begin to ensure our continued longevity and still allow us to be sexual beings—if not the fully realized ones we thought we were becoming before the plague.

What’s to stop the rapid resurgence of barebacking now that people assume that they are safe from HIV, even though all the literature and health care workers continue to remind us that PrEP does not prevent other sexually transmitted diseases? I used to ask.

As I came to know more and more people who began taking PrEP, sponsored largely by their insurance carriers making the calculated assumption that a little spent on prevention would save a lot more on treatment over the long haul, I only had more questions.

But I did pause in my Negative Nancy, knee-jerk responses to think about it. Aha, I thought, if I were a mid-hormonal 20-something, trying to find my sexual self amid the onslaught of online porn and gay perfectionism, I would so totally take that pill, gladly.

I realized that at the very least, PrEP is another instrument in the toolbox for HIV prevention. And so I switched my allegiance to the pro-PrEP camp. Go for it, guys. I’ve already got HIV—and I’m managing it quite well, thank you—but I do hope you can avoid all the anguish, errors, and expense that I have had to endure over three decades. (Just as an informational note, the medicine cabinet is a large enough hurdle when you have HIV; the annual tally of what those meds cost you is another. In my case, it’s upward of $85,000 per year and climbing.) HIV is part of me, a companion on my journey.

Still, here is where the narrative can easily take an ugly twist. There comes a point in all people’s lives when they begin to look in the mirror at the self-perceived ravages that aging entails. I presume we gay men are slightly more apt to be self-critical, as we have been taught by our peers, from our earliest inklings and urges, that looks are currency and the body must be beautiful.

The new instant, selfie-stick, handheld, jerk-off technologies only ramp up the pressure to perfect and classify and reclassify us all into tighter and tighter boxes. Just look at those profiles: DDF (drug and disease-free), clean, no one over 35, VGL (very good-looking) only, NEG UB2. These acronyms make it clear: HIV and the men with it are unwanted commodities.

Who but a fresh-faced farm fella from the wilds of Kansas, right out of high school, can possibly meet these criteria? And so we lie.

To ourselves, to each other, to the greater world in which we crave to be accepted but fear that we will never be. We lie to get laid. Period. We’re men, after all, and our relationship to our orgasms is preordained in many respects, and the axiom of which head we think with is never more true than in today’s world of split-second decision-making apparati.

Disclosure was a bitch back in the days of face-to-face, in a bar or a club or, if we were lucky, someone’s home or bedroom. When and to whom do I disclose my HIV status? If I use a condom, do I need to tell that anonymous trick? Or just someone with “potential” (i.e. relationship material)? The price to be paid was often too great to overcome the need to remain a morally coded adult.

Now today, with most effectively treated HIV virtually undetectable and therefore almost impossible to pass on to others, we are back in a new era: to disclose or not. And I see more and more reasonable humans posting their PrEP status on hookup sites, and I think kudos to them. It shows they are thoughtful, engaged humans who, whether through dislike of condoms or simple casual laissez faire-ism, know they will encounter men who have HIV—and they are no longer frightened of them. Of us.

Men will lie, especially in the heat of the moment. These guys who take PrEP are no longer requiring men to lie to them. Still, the ugly truth comes back to that disclaimer that all the prevention people, drug companies, condom manufacturers, astute parents and teachers, and anyone who knows better espouses: PrEP does not prevent a host of other, often serious, sometimes deadlier, diseases.

Back in the day, many of us spent more than a little time at the free clinic in our fair cities getting a jab in the butt to cure a dose of something. A shot, a few days of self-imposed abstinence, and we were good to go. In fact, some of the better dating pool candidates were the other guys in the clinic waiting room because you at least knew that they too, in three days, would be fresh meat on the market shelves—at least until the next slip-up.

But I digress. I really let my standards lag along the way as the years passed. Having assumed early on that I would die an ugly and early death, alone, I am continually amazed at the life I have been graced with. Still, I was lazy, casual, self-critical, and yes, horny. Who wouldn’t, with the all-access pass to people I never imagined I’d come across? “There’s someone for everyone,” the old adage goes. Nowadays there’s an unlimited pool of playmates.

Unfortunately, the pool has bacteria floating in it, and no amount of chlorine or PrEP can protect you from the host of ill-gotten gains left swimming around from body to body. Think about the math here. Back in my heyday, one person hooked up with one person in a bar (that was the major way to find a “date”), and it took them at least a night to recover before they wandered out again in search of more tail. Today, thanks to apps, we can line up our potential tricks like cards in a stacked deck, whisking them off as easily as a Vegas croupier. And our behaviors with each of these encounters slip incrementally as their youth, looks, and availability multiply.

And so we arrive at yesterday. The call from my doctor just said, “Repeat your labs and come in; your liver enzymes are wonky.” I had long assumed that my HIV meds might take a toll on my liver or some other vital organ, but I have been so steady, so healthy for so long that I was lulled into a very false sense of security.

When I was told years ago that I had HIV, I honestly was not surprised. I had no life crisis, no fretful nights. I had expected it. All my friends were poz, either dead or dying. I assumed my fate was sealed. Decades of struggle and activism had forged in me a steely core that has served me well in all of life’s challenges. But I’ve lived and I was healthy until this call from the doctor. Had my HIV meds done me in?

Nope. When my doctor turned to me and said, “You have acute Hepatitis C,” I finally had my moment. I was too shocked to even respond. My mind literally went blank. This is no joke. Hep C, or HCV as it’s called, comes with a whopping price tag for treatment and a host of other don’ts. For the next six months, maybe longer, I could have no alcohol, no Tylenol, no cholesterol medications, only a minimal amount of marijuana (medical or otherwise). The list of “nos” was long.
Contracting HCV came from an invincibility factor that I thought only belonged to the young. The arrogance of youthful noblesse oblige. A haughty thought that I was past all of this. I had done my worrying. I had persevered. I had survived. I was healthy.

And now I’m back to the beginning. To rethinking how I live my life, choose my partners, which behavior patterns I like and which I should finally ditch. I have disclosure issues like never before. I am an old guy having to have awkward, painful, intensely personal conversations with [past] casual encounters, informing them of their risks, hoping they will seek immediate attention yet knowing that, because this is largely a symptomless starter, many will not. And then knowing too that it could mushroom from there, everyone passing it on unknowingly.

So I look at PrEP with yet another twist of the kaleidoscopic lens that is life. What shapes will the shiny, colorfully tantalizing pieces fall into before they settle? That too-hot-to-say-no-to guy who hit me up yesterday on Grindr, flattering my flagging youth with urgent longings and tempting pics?

Do I write, “No, sorry, I have HCV and couldn’t possibly have sex with you for the next few months?” As the Tempos sang back in the 1960s, “See You in September”?

I think not. I can’t say how this will change me in the long run—these tectonic shifts take time to settle, and the aftershocks are absorbed with a shifting of the soul and a morphing of mood. I can say this: Yes to PrEP, but guys, PrEP with precautions may be the more prudent path. ✜