Unprepared: The Difficulty of Getting a Prescription for a Drug That Effectively Prevents HIV Infection

Spenser Mestel | Longreads | December 2016 | 23 minutes (5,642 words)
I’m sitting on the examining table at Student Health in Iowa City, digging a nail into the cuticle of my right thumb, waiting for Robin, the physician’s assistant. Over the course of my grad school career, she’s walked me through a half dozen of these STI checks—swabbed my throat and rectum, handled my urine, drawn liters of blood, and sat patiently to answer my many questions.
She opens the door and sighs. “I’ve got good news and bad news.”
I hold my breath. My ex-boyfriend, Zac, has been my only partner since the last test a few months back, at the beginning of summer, while I was still in New York City. We both tested negative and always used condoms, but I’m remembering a conversation we had while eating in bed about a guy he’d gone on a couple of dates with a few months earlier. Zac was staring at the TV and fumbling with his hands.
“We were starting to hook up, and he told me that he’s HIV-positive.”
I’d dropped my samosa. “What?”
“No, no, no. He told me before anything happened. He said that him and his boyfriend had a threesome once, and the condom broke.”
A threesome and the condom broke.
I look down at my hand. At this point, I’m digging my nail into my knuckle.
“The good news is the tests came back negative.”
I exhale.
“The bad news is I can’t prescribe you Truvada.”
There is no rational reason for me to think I have HIV. I would have avoided this stress altogether if I weren’t interested in Truvada, a pill approved in 2012 to help prevent the contraction of HIV, also known as Pre-Exposure Prophylaxis, or PrEP. I’d heard about the drug at a party in New York and immediately looked it up on my phone. Of the 657 San Francisco residents the study followed for 32 months, zero tested positive for HIV.
“I want to prescribe it,” Robin says, pulling out a prescription pad, “believe me, but the doctor I work under won’t allow it, not until we have the right protocols.” She writes down a name and hands me the paper: “Try Dr. Nisly at River Landing. She runs an LGBT clinic on Tuesday nights.” In the past three years, she’s never referred me to the LGBT clinic, never even mentioned that there was one. As I fold the paper, I remember the first time I met Robin, right after I’d moved to this Midwestern college town from New York. I’d been on guard when she asked if I had sex with men or women or both. “Men,” I said, scanning her face for twitches, her voice for stutters. I waited for a loaded question or curt tone. They never came. Read more…
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