PrEP will protect you from HIV. Understood as a "miracle drug" by many, the pill holds a powerful potential to reverse trends around new infections. Currently unavailable in Ireland, as long as its introduction is delayed, HIV infections will continue to increase. As groups such as Act-Up continue in their stellar campaigning efforts for the mainstreaming of PrEP, the only means of procurement is with minimal or no state assistance around information and costs. The result is an inherently inequitable system for at-risk groups, drawn along the lines of socio-economic status. Here, Adam Houlihan offers insights from his own journey of circumventing current government inaction in order to get on PrEP.
When did PrEP first arrive on your radar? I had heard about it first in the more general discourse, chatting with people in bars or whatever.
When was it something you decided to go on? Only in the last three or four months. It occurred to me, in my role as Integration Office in the LGBT society in UCD, that maybe I should know about this for members who want to come to me about it. We also get a lot of talks from people who are in that sector and HIV Ireland give us condoms so you always hear it being discussed. I thought maybe it was the thing for me.
How did you decide to go on PrEP? I hummed and hawed. Should I? Shouldn’t I? Is this for me? Is it a waste of money? Is it a waste of time? Is it too much effort? I use condoms every time I have sex with someone but, equally speaking, there are so many times where you have a mad session and you’re out of it. And that is the reality of it versus the theory of, ‘well, surely if you use condoms it’s not a thing’. You might be right, but life isn’t always quite so perfect that way.
You wake up and you don’t remember the previous night. Did you [use a condom]? Didn’t you? And maybe you did – you probably did – but what if you didn’t? Somebody could take advantage of you. Then there’s the threat of sexual assault. And, if you meet someone who is HIV positive, you don’t have to do the thing where you sit down and have ‘the conversation’. It’s reassurance, it’s peace of mind, it’s duty of care.
Was there much of a decision-making process? There was. There absolutely was. The big thing that drew me away from it – and it’s quite a sad situation – was that I really thought people would judge me for it so much.
I was vacillating on that and then I read a report and, fuck me, a lot of people don’t get checked. I remember one time – he was probably the second or third guy I ever slept with – and I hadn’t even thought of a condom, I was so new to [sex]. The next morning, it very quickly emerged that he likes to enjoy his sex life – go him – but it occurred to me that I had just gotten with him and he hadn’t even bothered to stop for a condom. I thought, clearly, he doesn’t use one regularly and I just had a massive panic that I put myself at such a risk.
Are many of your friends on PrEP? I know virtually nobody who is outside of one or two people on Twitter who I was chatting to.
Did you involve your friends in the decision-making process? I didn’t. Again, it’s a sad state of affairs that I didn’t feel totally comfortable talking to them about it. And, while I absolutely expect certain people to take a certain view of it, if [being public about being on PrEP] helps someone to decide that it’s also for them, and it helps them, then why not?
You go to the GMHS on Baggot Street. Tell me about its role in the process. They were quite supportive of it and told me that it’s a totally personal thing. They said that if I did decide to go on PrEP [and obviously they can’t supply it or anything like that], to come back to them and they can check my levels and make sure everything is okay to ensure the efficacy of it is genuine. They were to happy to accommodate me coming back to speak about it more to help my decision-making process. I was glad of that.
But I was amazed by the lack of information. I could not get all the information I needed from a HSE-funded organisation. For all the talk about PrEP currently, when it comes to logistics, there is so little. I wish there was a place in Ireland I could go to, sit down and have a full session where it wouldn’t be this ordeal whereby I’m on forums, speaking to a mate, etc. I’m connected enough that that’s fine but, for the person on the fringes, that’s not okay.
Did you get any sense from the healthcare professionals you were dealing with of them wanting to have PrEP introduced over here? I certainly got a sense from them of hoping things would move along quickly, that we get [PrEP] eventually. But their hands are tied, particularly the HSE-funded ones. And I would imagine there is a fear amongst them whereby you go out, order something online and you don’t come back and check the efficacy of it and something happens to you – suddenly they’re responsible. It must be a burden on them as well.
Describe the process you went through to get PrEP. I went to I Want PrEP Now. Run by incredibly nice people, it has all the information, there’s no jargon. They recommend five or six different websites with different prices, different timing structures [some would be every month, some would every three months]; some don’t take card payments, some only deliver to the U.K.
I found the one that was cheapest – naturally – and it wasn’t clear whether or not they delivered to Ireland. I mailed them to find out that they do. So, I was going through the process on their website and suddenly it said my order would be sent the next day and I hadn’t even gone through the payment process. I thought, because I hadn’t made payment, that the product won’t arrive. And then a week-and-a-half later three month’s worth of PrEP had arrived from Thailand. How? Because it’s such a dodgy system, the company uses bank transfer. So, presumably, they assume I would pay immediately, and I presumed they wouldn’t dispatch it until I paid. There was something quite good will about that.
What is the cost? It’s €120 for three months. It’s another €30 or €40 for delivery. You could pool with others but I didn’t know any other people on it. Or the people who I do know I wouldn’t know well enough to approach.
There’s also the risk, and this is where the grey area appears again, if you did link in with someone else, if you have a big enough stock coming across the border, then you’ll get taxed which wouldn’t be ideal. It’s like sneaking the condoms across the border in the 1970s – what the fuck is this, genuinely? I’m trying to look after my health and save the state money.
What is the dosage? For Ricovir-Em, it’s 300Mgs in a little blue pill and I take one every day – I keep it sellotaped to my toothbrush. Check the batch number. 56 Dean Street do therapeutic drug monitoring every month so you can see if its effective.
Have you encountered any side-effects? They’re listed on the leaflet but I haven’t experienced any of them myself. Flatulence is one of the main ones and its funny how people latch on to that. I haven’t noticed it myself but on every discussion board you visit you will see, “I’d like to go on PrEP but … ”, as though that's the last taboo!
Do you still use condoms? Why? Yes. Because STIs.
Do you anticipate a complacency towards condoms as PrEP becomes more mainstream? I would love to say I don’t. But I do. I have been on it for close to a month now and I do fear some complacency. That is the biggest risk associated with it. One thing [and it’s not its saving grace] but with the rise of super gonorrhoea – the one that can’t be treated with antibiotics – I do think that might pull people back from not using condoms but that also would require information around it to prevail in the community which currently isn’t there.
Your PrEP status is on your Grindr. Tell me about that. Grindr is the beautiful coalface of the gay community. You get raw, uninhibited opinions. I put being on PrEP on my profile [during my 175th re-download of the app] and mainly got questions around where to get it as well as some confusion around PrEP versus PEP.
Have you had any negative responses? Not yet. But that was the initial thing when I was deciding whether to go on it or not – the judgment of others. At a house party recently, someone said, "he loves his PrEP, that’s our Adam" [implying that I sleep around loads]. It was grand, he’s one of my mates. While that’s fine for me, for someone comfortable in myself, I have no problem. But what about someone who might not be? Even though I only know three people in the entire gay community in Dublin who are on it, I feel a slight stigma is starting to pervade.
What’s the legal status of PrEP? I still don’t know. For personal dosage, I’m pretty sure its fine according to European law. Equally speaking, I’m not 100% sure and that speaks volumes – I’m on it, I’ve researched it fairly comprehensively, I’ve spoken to sexual health professionals, I’ve been on I Want PrEP Now and I’ve looked online.
To [Minister for Health] Simon Harris, what say you? Legalise that shit. Or offer clarity of information at the very least – make it concise and available. It only does the government, the people of Ireland and queer men good. After that, I would love to see it on the medical card and freely available to any at-risk group, regardless of socio-economic status and to see it out there in the community.
Any last words? When your making your consideration, disregard any inhibitions you may have based on other people’s opinions – that’s cliche and I hate saying it as if it’s that easy – but that's what you have to do. See it as insurance – nobody wants it until they need it.