The View From Your Obamacare: Gay Men’s Health

Several more readers share their stories:

I have a “Dish Double” for you! First, thanks for your recent series on Truvada. Somehow I hadn’t been aware of the Truvada PrEP. I’m a 47-year-old gay man who is HIV negative but I had recently found President Obama Visits Boston To Talk About Health Caremyself engaging in riskier behavior. After all these years, condom-fatigue had set in and with AIDS becoming a manageable disease, the fear that once kept me from indulging in barrier-free sex has passed.

Don’t get me wrong; I was and am not seeking to become positive. I just was finding myself in a position where the idea of using condoms forever was no longer an option for me. In other words, I’m a perfect candidate for a Truvada PrEP regimen.

Which brings me to the view from my Obamacare.

I’m one of the people who was not able to keep my old insurance policy and is now paying more than double each month for my policy. I should mention a few things about my old policy. When I first purchased it back in 2002, I was 35 and had never had any major health issues, so it seemed like a great policy. The premiums were low. Sure, it had a $3500 deductible and no prescription coverage, but so what. I was young and healthy.

Until I wasn’t.

Just before I turned 40, I experienced some medical issues that resulted in hospitalization and ongoing care. Everything is fine now, but for about six months I was seeing doctors once a week. While my insurance did cover most of it, I still faced some large bills due to the deductible and prescription costs. The experience revealed the severe limitations of the policy. It was basically a catastrophic coverage plan. Of course now that I was the proud new owner of a “pre-existing condition”, it was the plan I was stuck with up until this year.

The view from my Obamacare is that my new policy has a premium that is a bit more than twice what my old insurance cost. My new policy also has prescription coverage and a very low deductible. I added things up and with my new policy, I am expecting to save thousands of dollars each year. My Obamacare may cost me more in premiums but it will offer significant savings elsewhere.

Which brings me to my “Dish Double”. After your articles about Truvada, I made an appointment with my doctor to see about starting a PrEP regimen. My doctor was immediately open to it. I had the required blood tests and my doctor called in the prescription. When I went to pick it up, I was expecting the worst. I wasn’t sure if my new Obamacre would cover it but If I had to pay the full $1,700 monthly cost I would. It was just too important to me. When I got to the counter, I discovered that my monthly cost for Truvada is …

$15

Right now the view from my Obamacare is fantastic, and as of last week I’m on the pill.

Another is paying even less:

I’m just writing to say that thanks to the recent thread on the Dish, I just took my first dose of Truvada for PrEP. There are a lot of reasons I’d been skeptical of it in the past, and my HIV risk these days is not nearly what it was when I was, say, 23. But I’m still single and gay and sexually active. I use condoms, but on those occasions where it doesn’t happen for whatever reason, I can quit torturing myself for the next two weeks worrying. I do not expect it to change my behavior (although time will tell), but it will liberate me from these cycles of excruciating worry.

So thank you. Bonus: It is costing me precisely $0.

Update from a reader:

Thank you for your post on gay men’s health. I feel compelled to say that I definitely relate to the 47-year-old man who wrote to you. As a 47-year-old man myself, I am also considering going on Truvada. I think we need to have an adult conversation in the gay community about widespread use of this drug as a HIV-prevention strategy, rather than just relying on someone just using the same, tired 30-year-old safer sex campaign, and wagging his finger at younger gay men saying “use a condom every time”. Even if I go on Truvada, I still plan to use condoms for there are other STIs out there that I don’t want any more than HIV.

That said, “condom fatigue” is a REAL issue in HIV prevention campaigns in the gay community. When many of us were working on safe sex campaigns in the 1980s, most of us never imagined we’d STILL be telling people to simply “use a condom” three decades later. I know gay men of my age who had been practicing “safer sex” for twenty to thirty years and eventually just got sloppy with safer sex, a handful of whom then seroconverted even after two straight decades of having safe sex. Truvada might have been of help to them.

Also, with crystal meth use being a tragic problem in the gay community, if Truvada can help spread the stop of HIV in these cases, where the crystal overwhelms any safe sex message, and most people I meet nowadays who have seroconverted admitted to drug use as a contributing factor, how can we not spread this drug as widely as possible?

For those who say that Truvada will only encourage unsafe sex, I laugh at them as much as those who preach abstinence-only birth control; both are people who have no connection with real life or the real world.

Another dissents:

So we’ve heard over and over again in the press coverage concerning Truvada PreP that it doesn’t lead to riskier behavior. This evidence comes from a single study (though it was conducted on a variety of gay male populations around the world). Your two emailers in the Obamacare post, and my own experience so far in the gay community, give the lie to this claim (at least for gay men in the US). I’m not saying I disagree with PreP – but it is simply dangerous to be anything less than honest about what PreP means to many gay men like your reader with “condom fatigue” who will now engage in riskier behavior because of the protection of Truvada. There is danger down this road …

All of your Views From Your Obamacare are here.

(Photo by Yoon S. Byun/The Boston Globe via Getty Images)