* Any views expressed in this opinion piece are those of the author and not of Thomson Reuters Foundation.PrEP for me means far more than a means to combat the transmission of HIV - it will ease the burden of trauma for the next generation
For the past few years, every six months or so I have woken with a small red mark in the crock of my arm and a stinking hangover. For many gay and bisexual men this is not the result of a heavy weekend, but what we call housekeeping: the regular HIV test.
And whilst I am armoured with the knowledge that being HIV+ nowadays is no worse than living with diabetes, it still terrifies - hence the hangover.
On Sunday, we mark World AIDS Day.
More than 35m people worldwide have died from complications related to AIDS, according to the World Health Organisation. An estimated 37 million people were living with HIV at the end of 2017.
When I was growing up in the 1980s, I presumed that I would be one of them. Death hung heavy over men who had sex with men, as the medical jargon has it, in the two decades spanning the eighties and nineties.
My generation - I’m 46 - wondered whose would be the first funeral we would attend. But it didn’t happen.
The introduction of anti-retroviral drugs in 1996 to treat HIV/AIDS, saw the diagnosis of being HIV+ move from being a death sentence to a treatable condition.
We were the lucky ones. But only just.
Of my closest 10 gay male friends today, five are HIV+. Whilst so many of the previous generation died - and to this day I am still horrified by how many lost their lives - today we are propped up by pills.
Stigma, not death, is the battle we in the global west face today.
For many parts of the so-called developing world, however, including Africa and eastern Europe, transmission rates of HIV continue to rocket.
In eastern Europe, for example, almost 130,000 were diagnosed HIV+ in 2017 - the highest ever level for the region.
But despite the medical advances, the psychological scars run deep.
When the doctor handed me the first batch of PrEP - or pre-exposure prophylaxis, a daily pill that prevents the transmission of HIV - I almost burst into tears.
Sex had been so long equated with death that the realisation that I wouldn’t die of Aids was overwhelming.
And PrEP works. PrEP, added to the impact of effective treatment preventing transmission and led to startling drops in HIV incidence, particularly among gay and bisexual men. Rates of HIV transmission in Australia have fallen by 23% over five years. HIV infection rates in San Francisco halved between 2012 and 2016 following the roll-out of PrEP, also known by its drug brand name Truvada.
Medical experts and HIV/Aids charities suggest it is at least 99% effective at removing the possibility of HIV transmission with only a handful of reported cases of people becoming infected whilst on PrEP.
But my god, it’s strong.
My first two weeks of taking it were marked by extreme nausea. One day was spent at home dry retching whilst having to explain to work that I wasn’t coming in, not because I was sick but because I was taking a pill that would prevent me from becoming sick.
The nausea passed - and I should stress that I am one of one of the unlucky ones; the vast majority of people report no significant side effects.
But the meaning of PrEP, what it means to have sex without the attendant fear of what could happen, is still sinking in.
Some warn that sex without condoms could lead to a rise in sexually transmitted infections - and the recent dramatic increase in rates of gonorrhea and syphilis among men who have sex with men would seem to bear this out.
But PrEP for me means far more than a means to combat the transmission of HIV.
I’ve often thought that lesbians, gays, bisexuals and trans people of my generation all suffer from a form of post-traumatic stress disorder; our mental health collectively ruined by decades of bullying, abuse and inequality.
PrEP won’t eradicate that, of course. But it distinctly lessens the burden for the next generation.
Whilst Britain’s national health service dithers over a national roll-out of PrEP, people are becoming HIV+.
No one needs to go through that any more; no one - ever again - needs to spend decades worrying whether sex will kill them.
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