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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Children of Gay and Bi Fathers

Dear Dr. Olson,
I was married to a “bi” man for over twenty years. We never told our son until we separated and were divorcing. He wanted to know why we were divorcing, so his dad told him. Our son was a teenager when my ex-husband disclosed this. How does keeping the sexual orientation of a parent secret from a child affect a child/teen/man psychologically? My ex had sex with only men besides me before and during our marriage and identified as openly gay after our divorce. 

You have asked a good question that does not have an easy answer. First of all, it depends upon the child’s level of maturity and experience in the world. 

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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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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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