Help With Question Doctor Asked During Prep Appointment

[bwinter00]

I am HIV negative, and I'm inconsistent in using condoms during hookups. Therefore, I want PrEP.

 

I had an appointment with my primary care physician yesterday in which I asked about going on PrEP. He was familiar with PrEP and began asking me questions about my sexual habits. I lied and told him that I was in a relationship with an HIV+ guy. He asked me what my fake-bf's viral load is. I told him that I don't know. Essentially, he said that by this point in my relationship (having sex with a poz guy), I should know what my bf's viral load is if I'm taking my health seriously. He said that if my bf's viral load is elevated, it's an indicator that he either has a particularly virulent strain of HIV or that he is irresponsible in taking his HIV meds, and I really should know if either of these is the case. He told me that PrEP consultation/prescription is handled by my HMO's infections disease specialists, and that I should receive a call from one by the end of the week.

 

My question is, when I talk to the infectious disease specialist, what should I say my bf's viral load is? I'm concerned that if I say "undetectable", they may be hesitant to prescribe PrEP (since PrEP is costly and HMOs have a reputation for being stingy). On the other hand, I don't want them to think that my bf has a virulent strain of HIV or is irresponsible with his meds. I was thinking... maybe I could give a fairly low viral load, and just say that he recently seroconverted and has not yet reached undetectable? What's a reasonable viral load for this situation? Also, how long does it take the typical poz guy to reach undetectable after starting HIV meds?

 

Thanks for reading this far. I feel like maybe I shouldn't have lied in the first place, but now I'm kind of stuck with maintaining this story.

[subbytch]

Good question.

 

First thing to remember is that the ID doc works for you, not the other way around. You don't have to please the doc. A doc doesn't have to write you an Rx -- that's their out -- but you shouldn't feel like you are in front of a teacher, having to justify your work.

 

Second thing. Since HIV in undetectable people periodically "spikes"  or "blips"-- for a variety of reasons, some understood, some not -- even if really had a positive boyfriend, you'd still be well within your comfort level to ask for PrEP. Since these blips can be unexpected, PrEP would be an added layer of defense in case something like this happened.

 

Third, there are a lot of HIV+ tops who are paranoid about infecting their partner. The fear of accidentally passing HIV prevents them from being fully intimate. PrEP has helped these couples get closer. It's insanely unlikely that a viral spike would infect a partner taking PrEP 6 or 7 days a week.

 

So, tell the doc that a recent viral load spike / blip with your BF freaked him out about infecting you. You are worried, too. You want to the PrEP to ease both of your worries. 

 

FYI, depending on the test used, my understanding is that less that 400 copies per ml is considered "suppressed." Just tell the doc that you can't always keep it straight, and that with PrEP, you don't have to.

More about HIV "blips" here:

 

http://www.hivviralload.com/blog/2008/11/5/what-sudden-spikes-in-hiv-viral-load-really-mean.html

Edited January 28, 2015 by subbytch

[baggerr]

Tell the truth. The doctor cant help you correctly without the correct information. He is going to prescribe a certain treatment based in part by what you tell him so he needs to know. If he asks if you party there could be drug interactions with something and if you dont tell him things could go bad (I'm talking about anything not just HIV & Prep stuff)You arent the first gay man he's seen and you're not the first person in general that has unsafe sex that he's ever seen either. Since its not his first rodeo he can probably tell if you're bullshitting anyway He can better serve you with the correct facts.

[Poz1956]

I am HIV negative, and I'm inconsistent in using condoms during hookups. Therefore, I want PrEP.

I think I'm with Baggerr on this one.  The first sentence of your post says it all.  Use it when you see the ID doc.  That situation is one of the indications for which the CDC says PrEP is appropriate.

Over the course of the time you're on PrEP you'd need to be consistent with you lie at every 3 month appointment.  It will be a lot easier to just tell the truth.

 

From the sounds of it the ID doc probably has a some experience with PrEP.  He's also probably had lots of conversations with both Poz guys and people wanting to go on PrEP that include the exact same words as your first sentence.  He may give you the condom lecture, but you can take it.  It's not like you haven't heard all that before.

But don't take any BS from him.  Dr. Demetre Daskalakis, the Assistant Health Commissioner, heading New York  city's Bureau of HIV/AIDS Prevention and Control said it was time to start identifying a practitioner's refusal to prescribe PrEP when medically indicated as "malpractice."  If you need to whip out that line, do it.

If he tries to slut shame you, call him on that too.  Ask if he'd rather be treating you as a Poz patient for the rest of your life, of if he'd rather help you prevent that situation.  There are lots of stories from guys who let a doctor delay their access to PrEP, and became Poz within the next year.

 

If he tries the "Test now and we'll repeat it in three weeks" before he'd write the prescription, tell him to order a viral load test to rule out an acute infection.

But you might be pleasantly surprised.  He may just say "let's get these blood tests done" then write you the script.

[not_sure_bb]

never lie to your doctors or your lawyers.