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.

Are you familiar with the term demisexual?

Demisexuality refers to a sexual orientation where people experience sexual attraction only to others with whom they have close emotional connections. In other words, demisexual people experience sexual attraction only after an emotional bond has formed.

Love and sex are knotty; sometimes, they go together, but they also can occur independently. Unfortunately, in English, we use one word, love, for all of those complexities, and many times we associate it only with erotic or romantic love. Many people predict that erotic love will die after about a year into a relationship.

You have mentioned that what you want is an “enduring, romantic, and monogamous relationship.” You experience sexual attraction only in the presence of someone with whom you are connected. In other words, an emotional attraction precedes erotic attraction; without that attraction, you will not experience the sexual attraction without it.

Gay people may be better at negotiating these things upfront than heterosexual people. 

Whether in person or on dating apps, the question “What are you into?” often comes up early in the conversation. Usually, this question is interpreted to mean “Are you a top or a bottom,” but a declaration of “I’m relationship-oriented” will often sort the wheat from the chaff pretty quickly. It might frighten many potential suitors, but they are time-wasters for you anyway.

You are not alone in what you are wanting. In urban areas, men with similar interests have formed groups to explore these issues on a deeper level, and online groups exist as well.

Men who have sex with men (gay, straight, or bisexual) have higher risks for HIV and STDs, so your concern about those is justified. Unfortunately, your first experience sensitized you to the dangers, and thoughts about the risks create anxiety. Anxiety interferes with sexual pleasure. You can reduce that anxiety by understanding what the actual chances for infection are and vetting a potential partner about his sexual experience.

Condoms and pre-exposure prophylaxis (PrEP) can significantly reduce risk. If you meet someone with whom you want to have a relationship that might lead to sex, ask him to go with you to get tested.

Delayed ejaculation is frequent in older men. It simply takes longer to get there. It is important to remember that sex is about more than orgasms. Particularly physical touch, cuddling, and pillow talk may be much more critical than cumming. Men seem to believe that ejaculation is the only way men can express their appreciation for their partners.

A masseuse (with or without the “happy ending”) or a male escort might help relieve your anxiety about sex. In contrast to a dating relationship, your partner works for you; you’re paying for the services. Tantric massage also could help you experience your sensual potential in the safety of a trained and skillful teacher. 

These activities focusing on your response would allow you to separate your wish for a committed relationship and just focus on what gives you pleasure. This would make you more confident. You could then take this new knowledge with you as you explore the world of dating to find that special someone.


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