Photo by NIAID (CC BY 2.0)
The HIV prevention drug PrEP is slowly and belatedly reaching Berlin, but health insurance companies won’t cover it. So is it really an option?
After we were done, Brian rolled over and turned his inquisitive eyes on me as I sparked my cigarette. “How come you didn’t use a condom?” That wasn’t strictly true. As the libidinous ballet got underway, we barebacked for a brief five seconds before we both stopped and opted to cover it up. Still, I blinked and exhaled. I didn’t really have a proper answer.
“ Well, it’s okay, I’m on PrEP anyway,” he answered for me.
Which meant... what, exactly? For over a year, I’d heard about this supposed wonder drug that stops you from getting HIV. But despite the virus’ presence on the gay scene, with 12,900 HIV-positive gay men in Berlin as of 2015 according to the Robert-Koch Institute, Brian was the first guy I’d known (at least, in the Biblical sense) who actually used it. I resolved to find out more.
PrEP stands for Pre-Exposure Prophylaxis, and for the past five years has been used for exactly what it sounds like – preventing the HIV virus from being able to attach itself to a host’s DNA, with a 90 percent efficacy rate against transmission. The pill, which goes by the patented name Truvada, has actually been around since 2004 as an HIV treatment drug. The WHO first recommended it as prophylaxis in 2012, followed by the CDC in 2014.
It was only in August 2016 that Truvada was approved as PrEP in the EU, which may explain why it’s only recently become big in the news and social media here. I visited Dr. Martin Viehweger of STI and HIV specialist clinic Praxis Dr. Cordes in Friedrichshain, the affable co-founder of Berlin’s “Let’s Talk About Sex and Drugs” discussion series. “Before last fall, we weren’t even allowed to talk about it,” he explained. “Awareness is rising now, though – we get one to two people a day coming in and asking about it.”
The Krankenkasse doesn’t want to pay for a drug that might encourage gay men to have unprotected sex.
But it’s not just late acceptance in the EU that’s held back PrEP from becoming commonplace – it’s a hefty €820 a month price tag, not covered by insurance. “I wonder if straight people can liken it to the Krankenkasse not paying for birth control?” Viehweger ponders. Both are viewed as “lifestyle” drugs. But one prevents a life-threatening disease, the other does not. And birth control’s side effects seem to be more serious than PrEP's, which according to Viehweger can include headaches and dizziness upon initial dosage, but are relatively negligible.
One of the Krankenkasse’s concerns, Viehweger says, is that they don’t want to pay for a drug that might encourage gay men to have unprotected sex. After all, HIV isn’t the only STI in town, and PrEP does nothing against the likes of syphilis, gonorrhea and chlamydia. So are PrEP takers indulging in riskier behaviour? There aren’t any official Berlin numbers, but a study by Kaiser Permanente in San Francisco does confirm a rise in STIs among men using PrEP, though nowhere near the level of it being a crisis. “Of course, for those flirting with sexual ideas that they may not have considered before, PrEP allows them to open up. But a great occurrence of STIs is due to behaviour, not the PrEP,” says Viehweger.
What do Berlin users say? I asked my friend Wolfgang (not his real name), a handsome 34-year-old urologist who first bought the drug in November 2016. “Yeah, I may be more prone to do something I wouldn’t otherwise do,” he admitted. “Particularly in the moment, in that state of sex intoxication. Knowledge doesn’t always translate to good decisions. But for me, it’s a safety net.” One of the other benefits of PrEP is that unlike birth control, you can be relatively spontaneous with it: while some users take one pill a day, it’s just as effective if you take two pills the day before possible exposure, one the day of and one the day after. Wolfgang’s in an open relationship that allows him to mess around when his boyfriend’s away, so irregular use is the best and most economical option for him – he’s still on the €820 pack he bought in November.
Although he’s satisfied, he admits honesty is not always an option. “I haven’t told my boyfriend I’m on it. There’s the whole ‘Truvada whore’ thing...” Yes, like with birth control back in the 1960s, there’s an ongoing myth that PrEP leads to promiscuity. Taking a pill won’t guarantee you’ll be having astronomical amounts of sex. And even if you did, what’s with all the slut-shaming in 2017?
For those who can’t spare €820 a month, Viehweger says that bringing cheaper, Indian-manufactured generics from the UK, the US or France isn’t uncommon. And, though you won’t hear this from any doctor, those who really want the stuff can order those generics online. If that still sounds dodgy, services like Berliner AIDS-Hilfe, ManCheck, Schwulenberatung or regular old doctors can help field any questions you might have. “Everyone should have an STI doctor anyway,” Viehweger says.
And me? From the start, I never liked the idea of having to be on a pill every day, but Wolfgang laughed that off when I told him. “I have to take a pill a day for hypertension – why should this be any different?” Fair enough. In the end, whether or not we choose to PrEP, more gay men feeling comfortable and secure with their sex lives can only be a good thing. But at the moment, that’s not a simple option for us.