Michael Rubio is a front-office coordinator at San Francisco’s Positive Resource Center (a community organization for people living with or at risk of HIV/AIDS). He’s HIV negative and currently taking a daily dose of Truvada PreP, as a means of preventing infection.
Why did you decide to start taking Truvada?
Rubio: Part of my rationale was that at the time I decided to start taking Truvada I was not in a monogamous relationship. I was having casual sex with multiple partners. It seemed like the right choice for me at the time because I saw it as another layer of protection that I would be able to use. It really got to a point where sex was almost scary, and I don’t think it should be something that should be stigmatized. It should be enjoyable. I didn’t want to always be worried and getting tested every three months and nervous about what the results would be. If I could take a daily pill that had such a high rate of success of keeping people HIV negative, why not try it?
I had a little bit of a struggle with, should I do this, should I not do this—deciding what was best for me and weighing the pros and cons, because I’ve always been very adamant about using condoms. Maybe I’m not at a high risk, but I have had scares where condoms broke. They are not 100 percent effective. It seemed like the best decision for me, just having that extra layer of protection.
Were there any other factors that affected your decision?
Rubio: In the year leading up to when I decided to start taking Truvada, four of my close friends became [HIV] positive. I had already been researching PrEP and the pros and cons, and after so many of my friends had been infected, it really hit close to home. I felt that I needed to do something more to alleviate some of the anxiety for myself. I know a few people taking it. I did a lot of research. I read a lot about it.
I work at an organization where we assist a lot of people who are HIV positive. We receive a magazine called Positively Aware. They did a whole issue on Truvada and people’s different experiences using Truvada. That was one of the other publications that really helped me make my decision to start PrEP.
Were you concerned about how much the drug would cost?
Rubio: Cost wasn’t a concern. I’m fortunate—it was really easy for me to access. I have Kaiser. I contacted my doctor via email and told her I was interested and wanted to know what steps I needed to take, and she basically sent my information to another department within Kaiser, and they contacted me and set up an appointment to screen me to see if I was an appropriate candidate for PrEP.
I had to do extensive testing to make sure I was not positive and to make sure my kidneys and liver were functioning properly, because of the damaging effects if they are not already healthy. Most insurance companies will cover it, and even if you don’t have insurance, there are other avenues you can take. I was really fortunate: I just had to email my doctor and wait a few weeks for an appointment. I do have to pay copay for labs and the medicine.
Truvada must be taken on a daily basis. Is it difficult to be compliant?
Rubio: Not for me, no. It’s just like brushing my teeth. I wake up in the morning and take a pill. I haven’t had any side effects. It’s more peace of mind for me.
Do you think that your generation is less frightened about becoming HIV positive than the generation that grew up at the height of the AIDS epidemic?
Rubio: The thing about my age group is we really didn’t grow up with the epidemic. I don’t really have a recollection of how it was in the 1980s and early 1990s because I was so young. It wasn’t really part of my community. There’s just a level of fatigue that went along with the community with using condoms, and you put in the addition of the medications that are out now, and people are living long, healthy lives with HIV. I can’t speak for everybody, but I think there’s a large feeling it doesn’t seem as catastrophic.
There have been reports that the gay community has been slow to embrace Truvada. What do you attribute this to? Do you think enough people know about Truvada, or is more education about the drug needed?
Rubio: There never can be enough [education], right? I think the problem is it’s often left on individuals to seek out the information. The problem with Truvada is a lot of people don’t know about it. There’s not enough information out there. I don’t understand why even in places like San Francisco, which is supposed to be a gay mecca, a lot of people really don’t know much about Truvada and PrEP, and there’s also a lot of stigma that goes along with it. That was part of the reason I decided to be open and vocal and honest about starting Truvada myself. I think a lot of people in the community that did know about PrEP, about taking Truvada for prevention, associated it with that “You are a slut,” “You are having too much sex,” “Why do you need that?” “Why can’t you just use condoms?”
There was a lot of shaming going on with it instead of looking at it as a positive thing… a new way we can combat the epidemic and a new way we can protect ourselves. There were a lot of negative connotations thrown on it at first. I don’t know if that’s part of the reason a lot of people aren’t talking about it or are afraid to talk about it. We have this great new way to prevent a horrible disease. That’s why I wanted to be vocal about it. It wasn’t that I feel that everyone who is gay who is not in a monagamous relationship should be taking it. I don’t think that’s the case. I think everyone should be educated about their options and be able to make an informed decision for themselves. This drug is also for heterosexual women who are in a relationship with someone who is positive. There are so many groups that could be educated.
Some people may be afraid to speak to their doctors about taking Truvada. Were you afraid to approach your physician?
Rubio: In San Francisco, I think the doctors are better informed than a lot of other places in the country. I’m definitely fortunate about that, but even a lot of doctors don’t know about it, which is scary because if you want to find out more information, that’s where you should be able to go, to your doctor. There's not enough information out there. At Kaiser in San Francisco, I check in every month with a pharmacist in the HIV department. I met with a pharmacist and we talked about my situation and why I wanted to take Truvada. He is the one I check in with once a month via emails.
Can you discuss your opinion on the issue of the potential adverse effects of the drug?
Rubio: A lot of people feel taking the drug is going to be really harmful to your body. But if you do test positive, you are going to be taking a lot of medication. So if you feel you need to protect yourself, is it worth it to be on a medication that will help protect you and save you from having to take heavier medications for the rest of your life?
What it comes down to is, the reason rates are skyrocketing right now is...there is a fatigue of using condoms, and a lot of people aren’t using condoms every single time. People go out drinking, and they forget. Or sometimes certain people don’t want to bring it up, or they don’t have a condom. If you are weighing the pros and cons of Truvada, you can take it as prevention, or if you do become HIV positive, you are going to be taking it for the rest of your life. They have to take multiple drugs, not just one pill.
People are usually reserved when it comes to their medical history. What prompted you to speak openly about your use of Truvada?
Rubio: I definitely felt that because there wasn’t much being vocalized in the community around it that it was better to talk about it and be open about it. One of my family members saw I was taking Truvada because I posted on Facebook, and she was really concerned at first. A lot of people fear that it’s going to prompt people to make riskier decisions. From all of the studies I’ve read that they’ve done there hasn’t been any proof of that. Most of the people in my inner circle have been very open. I talk to them about Truvada and the reason I take it.