Intermittent or Event-Driven Truvada for HIV Prevention

Hi Dr. Olson,

I’ve been on Truvada for about three years. Occasionally, I stop taking it when I’m not sexually active. I’ve stopped for as long as three months and then started back up again. My doctor says this is fine but I’ve heard from sex partners this approach lowers the efficacy. Your thoughts?

First, I must tell you I am not an expert in the prescribing of Truvada, so I consulted with some doctors who are.

Intermittent use of Truvada is called event-driven pre-exposure prophylaxis (ED-PrEP), and it has proven highly effective in reducing HIV men who have sex with men (MSM) who engage in anal intercourse (receptive or insertive sex). It is an alternative to daily PrEP dosing for some men. At this time, the data are only available for Truvada; data are not yet in for Descovy. But you need to know more.

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I Think My Husband Might Be Gay

Dr. Olson:

My best friend recently told me that she thinks my husband might be gay. My initial reaction was to tell her she’s crazy and to mind her own business. But now that I’ve had some time to think about it, I wonder if she could be right. I’ve seen the signs for some time but always made excuses for Daniel since he’s a good husband and great father to our kids. What’s the best way to bring up the subject with him? Should I be blunt and just ask him if he’s gay?

If you ask your husband directly if he’s gay, he might automatically deny it, just as you initially denied the possibility when your friend suggested it. Then you’d be left wondering if he’s being truthful—either with you or with himself. 

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Why Am I Attracted Only to Older Men?

Hello, Dr. Olson!

I am in my early thirties, and I came out about a year ago after years of casually dating women while having discreet sexual encounters with men much, much older than me. Since coming out, I have tried to date guys closer to my own age but have found that the sexual attraction just isn’t there for me.

I am grappling with the fact that my desires are what they are and trying to reconcile them with expectations for where I want to be in my own life, how I present myself to others, and my fear of judgment from friends and family.

Why don’t I feel the same attraction to guys closer to my own age than I do to guys 20–30+ years older than me? How could a 65-year-old man and I possibly live every day together? I feel that I should be seeking a more “practical” lifelong partner. We are so vastly different in terms of schedule and lifestyle. These are the questions I ask myself.

This is an important question and one I am asked about frequently. First, loving another person is never practical. Our attraction to another is not a rational process but happens due to forces outside of our consciousness and control.

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My Husband Is Gay for Pay

I recently discovered that my husband is having sex with men for money so he can buy marijuana. I don’t allow him to use our money to buy it. He likes anal sex, but I never had it with him because it’s against my beliefs. He does not know that I know that he is having sex with men. My friends know him and the men he is having sex with and their children. Is he homosexual? Should I ask for a divorce? What should I do? I am confused, very disappointed, and upset.

Your brief message contains a lot of different questions to address, so I’ll tackle the questions that may be the most difficult for you but are the easiest ones for me to respond to. First, just a word about terminology. Gay is the preferred word to use for people who have an enduring physical, romantic, and emotional attraction to people of the same gender. The word homosexual is considered an outdated term, and many gay people find it offensive.

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The Shame and Guilt of Same-Sex Attraction

Hi, Dr. Olson,

I am a middle-aged divorced man, and since my divorce I have been struggling with my sexual identity. Perhaps I have always been in denial or confusion with my sexuality. Growing up I had female friends but felt intimidated by them sexually. My first sexual experience was with a childhood friend, but I felt sick, ashamed, and guilty. This increased my need to always have a girlfriend to suppress this shame. Following my divorce, I felt incredibly lonely and started flirting with guys online. For the first time, I felt attractive. Who am I?

Your story is very familiar to me and not much different from my own. Some find it hard to believe that a man could reach middle age before questioning his sexual identity, but in my research, I have even interviewed a man in his nineties who, having lost his wife of over fifty years, began to explore his same-sex attractions. Seeking an answer to the question of who I am led me to write Finally Out: Letting Go of Living Straight. 

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Alcoholics Anonymous and Honesty about Same-Sex Desires

I’m very conflicted now. I am in my midsixties and have been married since I was in my early twenties. I’ve struggled with depression, alcoholism, and drugs most of my life. The first twenty-five years of my marriage were a complete nightmare for my wife—infidelity, alcohol and drugs, and all the lies and false promises I made. For several years, I have been clean and sober with the help of AA.

My wife and I haven’t had a sexual relationship in several years. I have always had a high sex drive, and one day while surfing Craigslist I decided to try having sex with a man. I did, and I liked it. Honesty is a big part of AA and for staying sober. I am hiding this, and now all I feel is shame and guilt and it has ruined my sex life. Any advice?

Thanks for contacting me. First, congratulations on your sobriety. I know how difficult that struggle is. Substance use disorders are chronic conditions, much like diabetes, that can never be cured but must be managed on a day-to-day basis.

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Making the Decision to Come Out

I’m a fifty-year-old man with two sons, ages 23 and 25.  I have struggled with my sexual desires for men for as long as I can remember, and as I get older, it seems harder and harder to resist this, but I have had only very limited experience with men.  How did you decide you are gay and what made you decide to leave your family and come out?

Leaving my wife and two young daughters was one of the most difficult things I have ever done.  I struggled with the decision for many years.  The question of leaving my family and coming out or staying married and trying to repress my desires seemed to have no good answer.

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My Children’s Response to My Coming Out

Having children has always been very important to me, and I have been blessed to have a son and two daughters.  I worry how coming out might impact my relationship with them. How did your coming out affect your relationship with your kids? If you had come out as a younger man, would you have still wanted to be a father?

Being a father was one of my highest priorities.  I lost my father when I was three years old and I had promised myself to be the best father I could possibly be.  A large part of what delayed my coming out was a fear that I was abandoning my relationship with my children and breaking a vow I’d made to my wife.

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