On a Quest for Pleasure, He Discovered Empowerment

One of the earliest users of Truvada as pre-exposure prophylaxis (or PrEP), Damon Jacobs now wants to reframe people’s thinking about PrEP.  Jacobs adopted the daily HIV-prevention pill, in July 2011.

“I wanted to use PrEP so I could have sex without condoms and not get HIV,” he admits. But he says, in the long-run he discovered taking PrEP has become “a lot more than just about sex and pleasure.”

For many of those who are already taking the HIV-prevention protocol, Jacobs says, “PrEP has come to mean something more than just protecting our bodies from HIV. It has come to mean that we are being Proactive, Responsible, and Empowered about our Pleasure.”

“It’s proactive because it’s done ahead of time,” the activist-therapist says, explaining the alternative definition of the PrEP acronym he came up with in 2014. “It’s done at moments when we are likely to be sober, rational, and mindful about our decisions. Sometimes, when you are in the middle of sex you are anything but mindful and sober and rational.”

Taking PrEP is responsible, he adds because, “I’m not only protecting my own body, but I’m also protecting my HIV-negative partners.” It’s empowering, he says, because, it has given him “control over my sexual health and my physical well-being.”

“And then pleasure. I always want to mention pleasure,” Jacobs says. “The ability to connect, and have pleasurable, intimate, body-fluid swapping sex without condoms and without fear of HIV is a very, very meaningful, pleasurable thing. It’s not just trivial, it’s not just sexual. It’s also, for me, a very emotional and spiritual experience that makes my life a lot more meaningful and fun and purpose-filled.”

Today, Jacobs is a licensed marriage and family therapist in New York City with nearly two decades of experience counseling couples and families. The author of two books, Rational Relating and Absolutely Should-less, Jacobs is also an HIV-prevention activist, who has been speaking publicly about taking PrEP — to The New York Times, MSNBC, HuffPo, and NPR, among others — since 2013.

The activist came out in the mid-1980s and says his sexual development was “inextricably tied to trauma, AIDS, and death. I became aware of my feelings for other men exactly at the same time that the media was exploiting Rock Hudson and his experience of struggling and dying from AIDS. And throughout my young adulthood… that [thought] was just always, always there: That if I were to enjoy sexual pleasure… I would inevitably die an excruciatingly painful death.”

In 1990, Jacobs moved to San Francisco, where he says, “I had friends, I had partners, I had roommates, I had colleagues who were ill and dying with AIDS [complications].”

But even in the worst of times, Jacobs says he believed that if he used condoms religiously and stayed alive long enough there would eventually be a vaccine or a cure for HIV.

“Then the millennium came and went and we were no closer to a cure; we were no closer to a vaccine. My own sexual practices were becoming more lenient and less inclusive of condoms…but [a] part of my brain [is] like ‘Oh my God, condomless sex is like a suicide mission. How could you be doing this after so many years of staying safe?’”

That’s one of the reasons Jacobs says he was so excited when he began hearing about the initial results from the iPrEx study, the first clinical trial using Truvada to prevent HIV transmission. The study found that taking the antiretroviral medication daily kept HIV-negative people from contracting HIV. At a Gay Men’s Health Crisis training in 2011, with some of the researchers involved in the study in the room, Jacobs recalls learning that daily PrEP was 92 percent effective or more in preventing HIV (that number is now understood to be closer to 99 percent).

“By 2011, I was 40, we were no closer to a vaccine or a cure and I really thought, Will I ever, ever in my life get to have the kind of sex that I want to have? And part of my brain said, Well yeah, there is a way to do it: the only way you’re ever going to do it is to become HIV-positive and then you don’t have to worry about [becoming] HIV-positive anymore.”

Jacobs admits that becoming HIV-positive had started to feel inevitable. “It felt a lot more like a when, not an if,” he recalls. And he imagined he might end up on daily antiretroviral medication anyway. So why not start it now, in the form of PrEP, and potentially avoid the damage to his health that HIV would do?

Looking back on the past seven years that he has diligently adhered to his PrEP regimen, Jacobs says, “Quite to my surprise, taking PrEP has given to me a sense of control that I’ve never had before, because as the bottom partner in most of my interactions, my HIV status was always contingent on somebody else’s actions. It always depended on the top wearing a condom, and making sure it didn’t fall off or fall in or sort of disappear in the romance of the moment. It was always contingent on someone else’s decision.”

Jacobs says that taking control of his own sexual health, has “given me a sense of agency and purpose in my life that has now translated into other areas as well. It’s given me this sense of empowerment that has guided me towards being more active in my education around HIV prevention. And it has really given me confidence. I never really had that confidence as a teacher before, until PrEP came around.”

Out of that newfound confidence came the Facebook group Jacobs founded, PrEP Facts: Rethinking HIV Prevention and Sex, which now boasts over 20,000 members. Many of those members in the PrEP Facts community are first-time users who post a photo of the blue Truvada pill in their hand on their first day of taking it. Others check in to ask about side-effects, insurance problems, and advice for friends who don’t have access where they live.

“It’s emboldened me to speak more frankly and explicitly about sexuality,” Jacobs says. “Which is something I was afraid to do, before I was on PrEP.”

Of course, taking PrEP is an on-going commitment, but Jacobs says taking a daily pill isn’t the struggle some might think it is, because “I associate, psychologically, that blue pill with something very empowering and freeing — and it’s a privilege to be able to take it instead of a burden.”

With injectables and other long-acting medications on the horizon, Jacobs says, “There will be other things that we’re going to be referring to as PrEP. I really hope to be part of people learning about those methods as well, as they become readily available. … The future is an open canvas and I’m pretty okay with that.”