PrEP on the way!

About two weeks ago, I went to an appointment to see about getting a prescription for PrEP.  I kept putting it off, thinking that if more time went by, I would become comfortable with the idea of unprotected sex to conceive without PrEP.  But I couldn't get comfortable with it, so to the appointment I went.

I was scared that I'd have another experience of the doctor refusing to prescribe it, and then hurling ignorant judgmental statements at me for even considering having unprotected sex with my husband...PrEP or no PrEP. But if we want to have another baby, then I'd just have to deal with whatever came up at the appointment. So, I called and the woman who answered seemed a bit rushed...I told her I'd like to make an appointment with the Dr. She asked what was the nature of my wanting an appointment. I said, "I'd like to get a prescription for PrEP."

Suddenly I was aware of my pounding heartbeat, and held breath, waiting for her response. She said, "Oh, you can see the Physician's Assistant (PA) for that, we can get you in sooner that way." Oh my goodness. The relief. The acceptance. The lack of judgement.

As the appointment date drew closer, I began to have a fear that I would seem out of place in the waiting room.  You see, this doctor treats many HIV (and non-HIV) patients in the Castro District of San Francisco. I thought I'd be sitting in a room full of burly men with large mustaches, tight leather pants, and studded black boots. And they'd all look at little ole' me and wonder what in the hell I was doing there.

But, the patients in the waiting room all looked "normal." And I realized...how judgmental of me! What is "normal" anyway?

Needless to say, the PA ordered some blood work and then told me if all is normal on the blood work, she will send the prescription electronically to my pharmacy. She made sure I knew to take it every day, get blood work done every 3 months, and to be aware of side effects.

As I walked out of the office, I felt relieved that it went so well, and once again realized that the fight to have a baby with my husband was behind me...

Security of PrEP

Well, when it came down to it...I couldn't do it.  I couldn't have unprotected sex to try to conceive, without PrEP. My husband was always a bit apprehensive about it, but I insisted that I felt comfortable and confident that my risk was practically non-existent. (I still think my risk is practically non-existent, but that's different from entirely non-existent)

For those who don't know what PrEP is, it is a new HIV prevention strategy for HIV negative individuals, who are exposed to HIV, that reduces their risk of becoming infected. It consists of taking an anti-HIV medication called Truvada, once a day before coming into purposeful or accidental contact with HIV.

We had discussed it, and made the decision to try to get pregnant without using PrEP this month.  I began tracking my cycle using an ovulation monitor.  Things were progressing as planned and I began daydreaming about how I'd react to a positive pregnancy test. Thinking about how I'd tell my husband, how we'd tell our family and friends, what a sweet big sister our daughter would be, etc. But the first morning that showed an increase in hormones that trigger ovulation, I was struck with the teeniest amount of fear. Suddenly that almost non-existent risk seemed significant. And for the next two mornings, that fear grew. On the morning the monitor showed I'd be ovulating, I knew in my gut that I couldn't go through with it.

I realized I need to have the security of PrEP as a safeguard in our efforts to conceive.

For me, the smallest, teeniest and most nominal amount of risk was monumental. It felt like stepping over a crack on the sidewalk and jumping over the Grand Canyon at the same time....either way, there was no way I was going to cross over.

I started to pressure myself, knowing that I'd have to make the decision THAT day or else wait another month to try to conceive. I thought about all the data, research, studies, etc. that shows low risk.  In the end, I thought about the moment I'd be looking at a positive pregnancy test again...and I decided that I only want to feel joy and elation.  I don't want even the smallest, teeniest amount of uncertainty because it would cloud over the moment for me. And I've fought too hard and too long to such a moment be anything but joyful elation.

To PrEP or not to PrEP?

Still debating whether we should use PrEP for Baby #2.  Husband says yes, I say maybe not. He has been undetectable for over 10 years (with a slight blip here and there), and I'm not sure I want to expose the baby or myself to the potent medication that is PrEP...

3 years ago I wouldn't even have thought there would be a choice between taking PrEP or not, but the more I research and learn about an undetectable viral load, the more I'm learning that the risks to me are minimal.  But are they minimal enough for me to have condom-less sex in hopes of conceiving?

My parents freaked out when they learned that I used PrEP to get pregnant the first time, they felt the risk I took was careless and the decision wreckless, but they finally came around once they believed I remained negative and the baby was healthy and growing normally with no defects. (Yes, my parents sometimes think that I'm lying about my negative status and that long ago I may have contracted HIV from my husband...my mom demanded to see my HIV negative blood test before she could celebrate having her first grandchild...but hey, I give people room to react remember?)

I have to admit, even though I found a doctor to prescribe me PrEP before, I am a bit nervous about bringing it up with a new doctor--given my first experience.  Read about it here. The last doctor who did prescribe it to me, was an HIV specialist.  This meant I had to go to an HIV clinic every month for a check in and bloodwork....not very fun (but good for me to confront my own stigma around HIV). Its just not an ideal place for an HIV negative female to receive primary care...in fact, the internal paperwork they used to order my monthly blood work didn't have a code to order an HIV test.  Why would it?  Its an HIV clinic...where people who are HIV positve receive specialized care. But still, there I was, month after month, telling the lab professional that, YES, I was there to get an HIV test among other things, NO, you're not reading that wrong. 

If all goes well, I'll be ovulating next week...maybe we'll try without the PrEP...maybe not. 

Is HIV Beautiful?

I first heard my husband talk about his HIV status in passing to a mutual friend. That's how I found out he was positive.  Long before we dated, long before we were even friends...barely just acquaintances, and he was so open with disclosing his status.  I found out last week that prior to telling my parents about his status, he was quite open about it with everyone he came in contact with...and then when my parents found out, he completely shut down.  He stopped telling people, and started living under a blanket of shame from that point on, to this very day today--going on 12 years now.  Amazing how a small moment in time can be so defining for a person.  Equally amazing, how such a tiny cellular thing can cause such a reaction in people.

I want to see this tiny cellular thing. I want to see HIS HIV with my very own two eyes. I want to see what it is that requires him to take these powerful medications, and causes him to feel ashamed sometimes. I want to see what I'm protecting myself against when we use a condom to have sex. I want to know--what does it look like?  How does it move? Does it have a color? Shape? Is it ugly? Is it beautiful?

Its so microscopic and yet so big between us that I feel this sense of wanting to see it, to understand it.

I've done a lot of research about it.  I've talked about it. Cried about it. Worried about it. Written about it. Lived with it...and now I need to see it for myself.

Nanny Fears

We hired a nanny this week to care for our little one while husband and I work...our schedules no longer allow for one of us to be with her every day at home.

As we were prepping for the nanny to start this week, we cleaned the house and put away some personal items such as mail, bills, etc.  As we were cleaning, it occurred to me that maybe we should hide my husband's HIV meds (they are in an area near the kitchen counter), just in case the nanny sees them, googles them, and freaks out!

His "meds area" looks like a small pharmacy.  He takes the HIV meds, but also arthritis meds, psoriasis meds, headache meds, fish oil capsules, vitamins, and general pain meds. There are many more than what is visible in this photo...

I left it up to my husband to decide whether he's comfortable with his meds out in the open like this....he didn't remove them or hide them.  I'm proud of him, but am still struggling myself...fearing that if she googles the names of these meds, she's going to stop being our nanny.  I know that if she does quit on us for this reason, we're better off without her, but its just the realities of our situation. People treat you differently when they know you're HIV+...its unfortunate, but true. 

It took us months to find this nanny. She's great with our little one, she cooks, cleans, and drives! We are comfortable leaving our daughter with her. We've known her for almost 15 years, but she doesn't know his status.  I guess she will now!

All-American Truvada Family

My husband and I are thinking about having another baby.  So,  I will need to find a doctor to prescribe me Truvada. But this has got me thinking....do I want to start PrEP indefinitely regardless of if we're trying to get pregnant?

I don't know. I keep going back and forth between Me on Truvada, and Me Without Truvada.

Me on Truvada: I think I'd feel uneasy about using Truvada alone for HIV prevention purposes. And I'm not sure how my husband would feel about it....probably more uneasy than me. We have both felt very safe and secure using condoms...and we've been very responsible to use condoms since Day One.

Me on Truvada: The thought of not having to use condoms....how amazing that would be! There have been times we weren't able to have sex because we were out of condoms, or couldn't afford condoms. They aren't cheap you know. (I know we can get them for free but I usually don't feel like asking, and I don't get to pick my favorite models and brands--and there's usually someone holding out a basket watching me pick through the pile...its just not ideal) But thinking of the new level of intimacy...without a condom between us is so tantalizing. We could just be "in the moment," have sex with more spontaneity and romance...I know they say you can make applying a condom part of the foreplay but who are we kidding, applying a condom takes away from the moment.

Me on Truvada: What joy to think about a surprise positive pregnancy test, 9 months of preparing for baby (and hoping for a boy this time), labor and delivery...another little baby. So sweet and such another little miracle.  With both of us on Truvada (my husband currently takes it as part of his regimen), and two babies conceived using Truvada...we'd be the All-American Truvada Family!

Me Without Truvada.  Condom use is much safer for me in terms of medical side effects and additional toxins in my system.

Me Without Truvada: We wouldn't have to get his lab work done monthly...not an easy thing to schedule with a full-time job and toddler, and not an easy thing to pay for either.

For now I think I'll just try to find a doctor that will prescribe it for me and go from there....we don't have to decide right now.  Stay tuned!

What's Most Important

After a few posts of processing things that were making me angry and bitter, I decided today will be a day that I come back to what's most important.  My husband and my little girl, and how having a little family was all made possible by many people who are fighting a fight who do not get enough recognition, pats on the back, gratitude, publicity, or understanding.

I am just amazed by all the people who fought and paved the way for me to take Truvada (PrEP) and get pregnant...Shannon Weber, BAPAC's Dr. Cohan, all the doctors that I'll never meet, who made it their life's work to learn about and treat HIV and more importantly, who keep working to find a cure for HIV. The HIV advocates who bring HIV awareness to the forefront when we all start to forget.  The journalists, like Heather Boerner, who found enough interest in this subject that it inspired her to write a book and many articles about HIV and PrEP (Positively Negative...Read it!)

These people were fighting for ME. They had my face and my name on their mind when they felt discouraged and defeated...they kept pushing and challenging the status quo, fighting...so that I could hold my baby in my arms.

And then there's my husband.  For 14 years he let me fervently chase down my dreams, went to the many doctor appointments with me, rejoiced with me when a door opened, and mourned with me when that door shut.

It is his voice in my ear, telling me to keep pushing, encouraging me as I labored, and crying so sweetly when our baby was laid on my chest...it is his voice that was the loudest and for that I am most grateful.  He really is the love of my life.  He is my heart and soul.  He is everything.