The (anonymous) man who became the first known to contract HIV in spite of using PrEP has opened up about his experience on the drug—and says he regrets nothing except his bad luck with the person who infected him.

He says:

The more we know, the better we’re prepared. PrEP’s a calculated risk. It’s important for people to know that there is the possibility as opposed to the fantasy that there have been no recorded infections on PrEP. At least now there is one, so it makes it more real. And I tell people, ‘It didn’t work for me, but I still think it’s great.’ If I had to do it all over again, I would still go on PrEP. I just wouldn’t have sex with that specific person.

The man admits that being on PrEP created such a sense of protection due to the low odds of HIV infection that he stopped using condoms, becoming so accustomed to sex without them that if someone on a hook-up app requested condoms, he would call off the encounter.

Needless to say, this is not how PrEP is intended to be used. Previously, however, many staunch PrEP advocates had argued, with a straight face, that people on PrEP were not likely to use condoms any less than people on PrEP. That seemed to be suggested from early surveys, but I think any gay man who's perused Grindr or Craigslist knows that not to be the case anymore.

I'm pro-PrEP, but have long been bothered by that falsehood, that users would still use condoms. I applaud this guy for being honest about his experience, even as I marvel at his statement that he'd still recommend the drug that gave him false confidence (or that he allowed to give him false confidence), which led to HIV infection.

He thinks he was just unlucky to encounter a rare, PrEP-resistant strain of HIV, but I wonder how rare it is or will be in the very near future? I would think if people are having sex without condoms more frequently due to PrEP (and condom fatigue, the culture, porn, their friends), the PrEP-resistant strain won't be rare or uncommon for long.

PrEP is a valuable tool, but it's not a magic bullet. I think it provides wonderful protection, but users need to think carefully about pushing the boundaries of that protection as this guy did in adamantly avoiding condoms even in hook-up situations. It shouldn't be about (God, I hate this phrase) “slut-shaming,” but it should be about pointing out unnecessary risk-taking.