ACT UP Dublin member Noah Halpin speaks about his decision to begin PrEP and the process of gaining all the necessary information.

For some time, it had been my intention to begin PrEP as part of my own personal HIV prevention strategy, but like many people in Ireland, I wasn’t 100 percent sure of the process or where to source it affordably. Add my transgender identity to that and I really wasn’t sure where I could attend to obtain a prescription and get accurate, reliable information.

All of this led me to an insightful year of research and learning. I knew that PrEP was safe and extremely effective, and having to remember to take a pill every day seemed well worth it for the peace of mind of knowing I’d be protected from HIV. But most of the discussion about PrEP in Ireland has focused on cis gay and bisexual men. I still had questions, like - how would PrEP interact with my testosterone hormone replacement therapy?

After talking to friends who are on PrEP, joining ACT UP Dublin and gaining information from extremely knowledgeable HIV activists, conversing with the GMHS, and reading a lot of literature, I decided that PrEP was right for me.

The first port of call was the Thursday morning PrEP clinic at the GMHS on Baggot Street. Although the name - Gay Men’s Health Service - doesn’t make it clear, the clinic is extremely trans friendly (to all trans identities) and wholly knowledgeable.

I knew that with demand for PrEP increasing, the chances of getting a walk-in appointment at the over-subscribed PrEP clinic was low. With only five walk-in slots available that morning, I turned up before nine o’clock to give myself the best chance of getting a spot when the clinic started handing out numbers at ten. Luckily, I got my number.

After a 45-minute wait, I was called in to have a rapid HIV test. Quick, painless and non-invasive, as always.

From there, I was sent down the corridor to meet with the doctor.

I was put at ease immediately by the doctor’s calm and friendly demeanour. With no judgment, she asked a few questions about my sex life, my use of condoms during sex, my medical history and about any medications I may be on. It was all very straightforward, and I wasn’t made to feel uncomfortable at any point.

“ We now have a method to protect ourselves and to curb the spread of HIV, so let’s use it.

After this, she explained the pre-PrEP baseline testing process, which was what I was in for that morning. Following the rapid HIV test and the consultation, I would see a nurse for blood work to check my renal function, and my HIV, syphilis and hepatitis status. After that I’d do swabs and a urine sample for a full STI screening.

She also informed me that I would be offered free vaccinations against hepatitis A and B as well as HPV. The ongoing monitoring process was also explained: I would return to the clinic by appointment every three months to have these tests done again, and to collect a repeat prescription for PrEP.

She explained the different dosing regimens to me. If a person were to only engage in anal sex, it is suitable for them to ‘daily dose’ - take one pill per day. And it is also suitable for them to use the ‘event-based dosing’ method - taking one pill at least two hours before sex, another 24 hours after sex and another 24 hours after that.

However, if a person is engaging in vaginal/frontal sex, or is a trans woman on HRT, daily dosing is the only recommended regimen. This is because it takes longer for PrEP to build up in vaginal tissue than in anal tissue. And in terms of trans women, feminising HRT can have an effect on the concentration of PrEP.

Following these recommendations correctly will ensure that however you are having sex, you’ll be well protected against HIV whilst taking PrEP.

I was then given the opportunity to ask any questions. Which I did. Mostly about interactions between PrEP and the testosterone I take as part of my medical transition, which she confirmed is wholly safe and no interactions are to be expected.

Onwards to the nurse’s office! If there was anything at all that I was apprehensive about, it was this. And I’m not talking about the needles. Like many trans people, talking about our genitals or the fine details of our sex lives can be awkward if the person you are speaking with isn’t sensitive to the language used.

Well, I needn’t have worried. After we realised that we followed one another on Twitter, the nurse and I got down to business.

Although I’ve had screenings many times before, he took great care in explaining the swabbing process and how I should do it.

Now, you must remember that some trans men have vaginas, some trans men have penises, some have sex vaginally/frontally, some have sex anally, and some are versatile in that sense. So I was a little concerned about having to explain this, but I didn’t have to be.

After he explained what swabs need to be done in different circumstances such as throat, rectal, penile and vaginal, he simply asked me how many I need and what he should write on the vial, which I thought was a wonderful method.

It’s also worth mentioning, that when talking about anything related to vaginas, he would use the term “the front”, which is very encouraging and can spare a lot of trans men anxiety, should they be worried about terminology.

So off I went to the privacy of the bathroom with a tray containing swabs and a container for a urine sample, where I could easily, comfortably and quickly do it all myself before heading back to his office, tray in hand.

My bloods were then taken quickly and painlessly and I was offered the HPV and hepatitis A and B vaccines, which I jumped at the chance to have.

Following that, I was all done and given an appointment to return in a month to have the second part of the vaccines done, an appointment in three months’ time for the regular PrEP monitoring, as well as my prescription, which I could fill in one of a number of Irish pharmacies stocking PrEP or more affordably through recommended online pharmacies which I found information on by visiting www.getPrEP.online.

I left the clinic feeling relieved that I had finally begun the process of taking PrEP, knowing now that I am effectively protecting myself against HIV. And it was all done with relative ease and at no financial cost (Excluding the actual purchasing of PrEP).

If you are concerned about HIV and considering taking PrEP, I would highly recommend exploring the website above and/or dropping into the GMHS.

We now have a method to protect ourselves and to curb the spread of HIV, so let’s use it. Let’s talk about it more and let’s keep pressure on the Government to roll out the promised 2019 PrEP program, making PrEP truly accessible for all who wish to make it part of their own personal HIV prevention strategy.

We must continue to demand and to educate.

This conversation is no longer taboo. It is essential.