Still, AHF's uncompromising reluctance to consider endorsing PrEP is puzzling. AHF leaders repeatedly list reasons that the drug will not work, despite mounting scientific evidence stating the contrary. There is no doubt that PrEP should not be taken lightly or with a blasé attitude, but why eschew it with such fervor?
"We are not refuting the science," Kenslea said. "We are disagreeing on the understanding of human nature."
A DAILY ROUTINE
When Damon Jacobs re-entered the dating game in 2011, it was a completely different playing field from what he remembered. At first, he wasn't sure what to expect after coming out of a seven-year relationship with his boyfriend, but he quickly realized there were some significant differences since he had last played the field.
"For me, getting back into the dating world and the cruising world, I was realizing that people were not using condoms as they were a decade earlier," Jacobs said. "And I wasn't using them like I was in 1990's San Francisco either."
But even scarier than Jacobs' risky behavior was the reasoning behind it.
"I noticed that my thinking had changed," he admitted. "I started thinking of HIV as a 'when,' not an 'if.'"
It was during that time when the PrEP studies were just beginning to be published. After attending a forum about using an HIV treatment drug to prevent HIV, Jacobs gathered all of the information he could on this unconventional approach and ran back to his doctor. He knew he wasn't being as diligent to prevent HIV as he once had, and PrEP seemed like an effective way to stay negative.
His physician had never heard of giving Truvada to a patient without HIV, but Jacobs showed him the research and promising results. He began taking PrEP in July 2011, exactly one year before its FDA approval for HIV-negative individuals.
"Those of us using PrEP now, we were the first ones asking for this, so we've had to be the educators and the advocates," Jacobs said. "We even educate the doctors. Some doctors take that and say, 'yes, I want to work with you.' Others give tacit dismissal, and then some tell outright lies about it."
In the past three years, Jacobs has never missed one of his daily pills. He has built it into his everyday routine: eat breakfast, brush teeth, take PrEP. If you can remember to brush your teeth, he postulates, you can remember to take your pills.
Unfortunately, Jacobs has dealt with the stigma that surrounds PrEP as well.
"If I'm on a date with someone who is negative and he finds out, he'll ask me, 'Oh, so you're a whore? Do you have sex with everybody?'" Jacobs lamented. "It's not a common reaction, but it stems from a misunderstanding of what PrEP is."
Instead of being offended, embarrassed, or angry, he takes the time to educate, often resorting to the same analogy: that it's very similar to women taking birth control; it reduces the unwanted consequences of condom-less sex.
Even though Jacobs disagrees with today's critics of PrEP, he seems to understand where they are coming from. He volunteered with the Stop AIDS Project in San Francisco in 1992, while HIV was crippling the gay community and condoms were considered the only safeguard from a then-fatal virus.
"Michael Weinstein's message has been that people should use condoms," said Jacobs. "When I started volunteering at Stop AIDS [Project], we had a marketing campaign where we gave out pins and T-shirts at local bars and clubs that said, '100%' because we knew that if everybody used condoms 100 percent of the time, we could eradicate AIDS by 2000. "Well I ask you, how did that pan out?"