Often referred to as a ‘miracle drug’, PrEP has been shown in clinical trials to dramatically reduce HIV infection rates amongst gay men. Despite widespread evidence pointing towards its effectiveness, PrEP isn’t currently available on the NHS – although many activists hope this won’t always be the case.
In order to obtain PrEP (which is commonly known by its brand name Truvada), some gay men are ‘gaming’ the system. One way to get your hand on the antiretroviral is to 'clinic hop' – visiting multiple sexual health clinics claiming that you’ve been having sex in risky settings. By telling a doctor you've had unprotected sex, you can be prescribed PEP (which is used to prevent people from contracting HIV after they’ve been exposed to someone with the virus). As PEP involves two Raltegravir tablets and one Truvada tablet, gay men are able to get their hands on the Truvada tablet – and in so doing, have access to PrEP.
Although clinic-hopping may seem like a time-consuming and controversial way to get your hands on the medication, for many gay men it’s their only choice. A monthly supply of PrEP can cost up to £350 a month, making it out of reach for all but the most wealthy. And although many PrEP activists purchase the drug online, from countries such as China, this isn’t without its attendant risks – ultimately, you can never be sure of what you’re getting. However, it's worth pointing out that taking PrEP won't prevent you from contracting other STIs, and the official medical guidance remains that condoms are the most effective way to stay safe.
Whether you agree with it or not, clinic-hopping has become part of the daily routine of life for some gay men. To find out more, Dazed spoke to three gay men who admit to ‘cheating the system’ to find out why they clinic-hop and what needs to be done to keep men safe in 2016.
Miles Alexander, 22, London
I discovered hopping myself. My first sexual experience took place without protection and this stood as a precedent for any subsequent sexual encounters. I was essentially practising unsafe sex for a long time and toying with fate. I then discovered PEP was being administered as emergency reactive treatment to people who may have been 'exposed' to HIV, and realised that the drugs they gave you during this course of treatment overlapped with PrEP. So, I could essentialy put myself on PrEP by repeating this behaviour across different clinics.
I would do a couple of cycles of PEP treatment until it was questioned by my doctor. Some didn't mind and found solace knowing that I was taking the medication because I was going to continue my behaviour anyway. Truvada makes me feel empowered about making my own choices. It also puts your mind at ease. It allowed me to continue to be sexually active without the niggling unsettling feeling in the back of my head. It also put other partners at ease when we discussed barebacking.
Some people accused me of being selfish because I wanted to act like a slut when I could just wear a condom. But if we are all 100% honest with ourselves, there is nothing pleasurable about sticking shrink-wrap over your dick. There’s nothing more sexual and pleasurable than skin-on-skin action.
I haven't had a sexual partner turn me down upon finding out that I use PrEP to bareback. If anything, I’ve turned other people down when they 'play safe and clean' only. I think it's absolutely disgraceful and such a shame that having natural, unprotected sex is seen as unclean because of societal pressures.
Emotionally it has enabled me to have deeper emotional connections to the partners I have sex with. Nothing beats the closeness of bareback! Also it enabled me to own my choices and reassure others that I wasn't necessarily being reckless, rather I was empowering myself to enjoy sex the way I want to without compromising others.
Anonymous, 33, London
I’m not proud of it but felt it was a necessity. I kept it to myself which was a mistake because being more open I've learnt more, especially ways to get generic PrEP.
I was dating a guy I really liked and we had vers sex during during a hedonistic night, but I knew he had a reputation for being quite liberal with the guys so I went to get PEP just as a precaution. I went every month, but being mostly top (which is a lower-risk activity than being the receiving partner), I had to come up with stories of how I was barebacking on meth with five guys.
I found a huge guilt and stress relief being on Truvada. HIV is the silent elephant in the room for most guys when it comes to promiscuous sex and I think it was a main reason why I used to limit myself. Now my sex life is exactly how I've always wanted.
I've mainly had trouble from guys on Grindr who are ill educated and usually quite young. Older guys are more clued up and responsible. Ironically it's the younger guys who are at most risk so I find myself 'teaching' a lot of guys about sexual health.
I think the NHS still has draconian methods when it comes to STI and HIV prevention, working on stigma and shame to 'put you off' being promiscuous and adhere to prophylaxis for safety, hoping this will curtail infections and any stress on the system for medications. But from my experience at 56 Dean Street and other trailblazing clinics, it's knowledge and frank talk that is keeping people safe.
Stephan Bee, 31, London
Explain to the clinic you’ve been exposed and they’ll give you 30 days supply of PEP in some cases. Sometimes you have to go back after 14 days to collect the remaining pills. By visiting several clinics in and around the UK in one month, I would have 3-4 months supply of PrEP.
After getting PEP, I would disregard the Raltergravir and only use Truvada.
Knowing the price of medication on the NHS, this feeling of guilt would come over me. ‘Some people can use condoms in every sexual encounter, why can’t I?’, I’d ask myself.
But realising that this little blue pill was protecting me from contracting HIV and in the long term, saving the NHS years and years of treating me for HIV.
Organisations have labelled the pill as a ‘party drug’ and that people taking the pill would run the risk of burdening the NHS more as they’ll catch more STIs. But studies have been done and have proved that STIs were on the rise even before the advent of PrEP.
Some have said that when I did clinic hop, I was using and abusing an already strained NHS. But after I’d extensively researched HIV and the other STIs I empowered myself and felt like I had never been taught some very basic things about sex. I had no sex education at school, and when I came out as gay the dark cloud of HIV billowed above me. For the first time in my life - I could have sex free of the fear of HIV.
Follow Dean Eastmond on Twitter here @deanvictorr