 
April 2, 2010
Broke: Thoughts on Post-Exposure Prophylaxis
by Louis Jordan
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In his quest to not become HIV positive after his condom breaks during sex, Louis Jordan unfortunately can't prevent the hurdles in his search for post-exposure prophylaxis, or PEP.
I don’t know anyone with an 817 area code. I looked it up, and its somewhere in Texas. I don’t know anyone in Texas. So when I see 817 on my phone, I don’t pick it up. I don’t want to hear a disapproving, matronly Texan voice telling me that I owe money to Beth Israel Hospital in New York City. She says it as though I’m stealing, I’m cheating, I’ve done wrong and now I’ve been caught red handed. That isn’t what I want to hear every day at 10 a.m. So I don’t answer. I don’t think I’m the one who’s wrong.
It happened in June of 2009. My boyfriend and I had broken up in March after nine months together, because he couldn’t stop drinking himself into a stupor several times a week. We weren’t speaking anymore. I’d tried to save him, and it didn’t work. After he checked himself into rehab, I left Bay Ridge and the dreaded R train and moved to Williamsburg in downtown Brooklyn. I was working at a catering company where I served hors d’oeuvres at bat mitzvahs. I spent most of my free time watching old movies and going to the gym.
One day, I decided I’d had enough. I’d been mourning the death of my relationship for too long; it was time for me to go on a date. I called up a boy I’d been chatting with online, and we met up at a neighborhood bar. He had the softest brown eyes and sandy blond hair, buzzed at the sides. He wore an oversized tank top, tapered black jeans—a true Williamsburg boy. After a few drinks, I invited him over to watch a movie. This is, of course, code for having sex on the couch while a movie flickers unnoticed in the background.
Ten minutes into the movie all our clothes had come off, and he asked me if I had any condoms. I pulled out a Kimono Microthin Large condom (my favorites) and rolled it on. He wrapped his legs around me, urging me to go faster, harder. Sweat dripped off my forehead. His face flushed pink and he began to make little gasping sounds. Finally, I exploded in a warm flash, and we collapsed on the couch. After kissing lazily for a while, he asked me to pull out. As soon as I did, I noticed that there was no white liquid at the tip of the condom. It took me a second to realize that the white liquid was inside of him. The condom broke. The condom broke and I’d come inside of him. Everything seemed very far away. Finally, I spoke.
“Um. The, uh. I think the condom, uh. The condom broke.”
“Are you sure?”
“Yeah. I’m sure.”
We both sat for a moment, paralyzed. Then he got up to clean off as best he could. I sat on my cheap black futon and listened to the water run in the bathroom, trembling. I stared at the torn condom on the floor like it was dead rat. It was okay, I said to myself. It was okay. I’d just been tested two weeks ago. I was negative. He’d be fine. Finally, he came out. He looked beautiful.
“Are you okay?” I asked tentatively. We stayed four or five feet apart. He didn’t move closer. “I was tested two weeks ago,” I said, my voice stronger, “and I’m clear. I haven’t had sex with anyone since then until you.”
He didn’t say anything for a few seconds. Then he started to speak very rapidly.
“I should tell you. I haven’t been tested in a while. And, um, I’ve recently been having unprotected sex with someone. I don’t know his status. I mean he’s a friend. I don’t think he sleeps around. But you should probably get tested in a few months. I’m not worried. I think you should probably be more worried than me. But I’m sure everything’s fine.”
He began looking for his underwear.
My brain froze. I stammered something about “morning after” HIV pills. He pulled on his tapered jeans and repeated he was sure everything was fine. He asked for a glass of water and was out the door within two minutes.
Was I at risk? What was the risk for a top who’d had unprotected sex? I sat down at my computer and Googled “HIV risk insertive.” I couldn’t find two sites that had the same numbers. I kept hearing that there was “a lower risk, but definitely still a risk.” Was it 1 out of 31? 1 out of 1,300? I grew up in Indiana, where there is no such thing as reliable sex education. I was always taught that HIV was easily transferable, and a guaranteed death sentence. AIDS was something that happened to promiscuous gay men in New York. But I was a gay man in New York now, and what I just did could definitely be considered promiscuous. Was I willing to take the risk? I imagined the look on my mother’s face as I told her I was positive. No. I wasn’t. I searched for “HIV morning after pill.” I found out it was called post-exposure prophylaxis, or PEP, and was available at very few places, even in New York. One of them was Beth Israel Hospital. The sooner I took it, the more effective it would be. I grabbed my iPod, my wallet and my keys and practically ran to the L train.
I was in the waiting room for nearly an hour. I listened to Annie Lennox, because she reminded me of my mother. Finally, a nurse came and had me fill out a form. I told him what happened and that I didn’t have health insurance. “It’s okay,” he said. “We can take care of you.”
Twenty minutes later, another nurse came to take me to a room. She asked me some questions about my sex life and warned me that I should always use a condom, especially if I plan on having “high risk” sex. I told her I did use a condom. It just broke. She nodded but didn’t look at me. I don’t think she heard. She handed me a sheet with the names of potential HIV meds and asked me to pick out three. I told her I didn’t know what any of these medicines were and the side effects to all of them looked pretty horrible. She just told me to pick one from each column. I chose the ones that didn’t include “suicidal behavior” as a potential reaction.
The nurse left and returned with a syphilis test and a small pack of walnut-sized pills, the first dose of my PEP meds. We made an appointment at another branch of Beth Israel the next morning for me to get the rest of my pills for the month. She told me that I needed to go there with the other person “at risk,” that he should be tested. I told her that could be a bit of a problem—he didn’t seem overly concerned about the situation. I called him anyway. No answer. I got on the train, went home, set my alarm, climbed into bed and stared at the ceiling until 7 a.m.
After downing two cups of coffee I headed into Manhattan, eager for this nightmare to be over. In the waiting room, two very loud, very large women carried on, yelling to each other about some girl who was a bitch, a skank and a jump off ho. I kept my eyes fixed on “The People’s Court” until I was told the doctor would see me. She was young, blond and stern. She took me to a small room and asked me what happened. I let the whole story spill out. It felt good to tell someone. She didn’t respond for a second. Finally, she said, “I’m very sorry, but we can’t help you here unless you were sexually assaulted. You don’t have insurance and we can only treat you without insurance if you were assaulted.”
“But, the condom broke. It’s not my fault.”
And did it really matter even if it was?
“I’m sorry. I wish I could help.”
I was exhausted. My nerves were worn ragged. My eyes began to tear up.
“Well, what do I do now?”
She let me use the phone to call a clinic in Chelsea that could help me. She apologized again and sent me on my way. The social worker at the clinic was horrified when I told him what happened to me at Beth Israel. So typical of the medical system. They would help me, he said. They weren’t like that awful hospital. But, there was just one thing. If I had come to their after-hours clinic right away, I would have been covered completely and not had to pay for my meds. But since I went somewhere else for my first dose, I had to pay $600 for the month’s supply—the money I had saved for next month’s rent.
“I’m so sorry, but those are the rules,” said the social worker. “I wish I could help you.”
I couldn’t afford it. But if I didn’t, I might be infected and know I hadn’t done everything I could to prevent it. So I paid the money. I didn’t care anymore. I just wanted to take the pills and go to sleep.
I did quite a lot of sleeping that month. I had to take seven pills, three times a day, for 30 days. I barely ate and when I did my stomach would rebel. I was exhausted all the time. Once my friend Lukas took me on a walk to Greenpoint for ice cream. I was so tired by the time we got there I had to take a cab home and slept for five hours. I couldn’t work, but the catering company didn’t have any jobs for me that month anyway. I stopped going to the gym. I tried to have a good attitude. I kept telling myself I was lucky that a treatment like this existed. Lukas came over sometimes and we would watch cartoons and eat microwavable lasagna. Other than that, I stayed inside with the shades drawn. I never heard from the boy again, nor did I expect to.
I’d been counting down the days and, finally, I took my last pill. I was elated. Still too tired to celebrate, but elated. I wanted nothing more than to go back to my life and forget that this nightmare ever happened.
A week later, I received a letter from Beth Israel, asking for payment in the amount of $1,250 for services rendered. I stared at the piece of paper for a few minutes, dumbfounded.
“This has to be a mistake,” I thought. “They must have charged me for a month of meds by accident.” There was a number included in case I had any questions regarding payment. I dialed it. The woman on the other end calmly explained to me that the charge was only for the hospital visit and that the fee for my single dose of PEP would arrive separately. Would I like to set up a payment plan?
I hung up. My brain was surging with panic now. I had borrowed money from my parents and several friends to make rent. I still wasn’t getting jobs. I’d never been in debt before. And for what? A few pills, a Q-Tip up my urethra and some accusing glares. Like I was asking for it. Couldn’t they just treat me like a human being? I sat down heavily on the futon and put my head in my hands. There was no way out. I was trapped. So I did the only thing I could do.
I called up Lukas.
“Lukas,” I said to his voicemail, “the hospital wants $1250. The one who said they couldn’t help me unless I was raped. I don’t have enough to even pay my rent. So I’m gonna buy a bottle of vodka and a bottle of vermouth. I think you should come over and help me finish them.”
He came over, and we drank ourselves into a stupor while watching cartoons.
Even six months later, whenever I have sex I can’t get the image of that broken condom out of my mind. Sometimes I get so nervous, I have to stop and change condoms. I know logically that everything is fine, but my heart starts pounding anyway. I’m trying to get over it, but I can’t stand the thought of going through that ordeal again. I wish I could push the whole experience out of my mind, but I can’t. The collection agency still calls me. And I still haven’t paid. I never will.
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Previous Comments:
comments 1 - 12 (of 12 total)
Louis Jordan, New York, 2010-05-15 19:25:39
Thanks for all the comments. Yes, I realize my reaction may have been neurotic. Like PozAlready said, the issue was ignorance. I didn't know what my risk was. But this article is really about how a scared, uninformed guy needing advice and help obtaining PEP is instead treated abysmally and given the runaround. I'm sure many other people have been treated just the way I was, and that is not okay at all. The way the medical system deals with PEP needs to change right now, for everyone's sake.
Sean Strub, New York, 2010-04-11 15:16:50
Louis Jordan's difficulty in accessing PEP is all too familiar. If you're available to help with a project to create a website with PEP resources, please get in touch with me. SeanS "a" poz.com.
Thanks
Jon, Los Angeles, 2010-04-07 12:21:25
My My. So many critics here. Can anyone say, with certainty and honesty, what you really would have done if this happened to you? Some would panic. Some would not. But what happened happened and yes, I can see how this situation could be frightening to someone. What I don't see is how disparaging someone for their reaction is going to make a difference.
Jose, Miami, 2010-04-06 23:21:19
Nothing is 100% safe but if was top and in the absense of trama to his penis or the presence of blood, stastically we know his changes of transmission is approximately 1 in 500. I think this is a little nuerotic since he wasn't even sure his sex partner was positive. I think I would have tried to have the partner test first using a quick oral method before even considering PEP. There is a 72 hour window for starting PEP although optimal is 12-24 hrs.
Barry, Philly, 2010-04-06 19:43:45
I read the first part of this and it just irritated me. Why didn't you just get tested first is beyond my comprehension. The big question I have...did you use a good lubricant? I see lot's of porn and they are rarely using lube at all. DUH!
Condoms will break w/o lube. The anus can tear and bleed. Been poz since at least 1986 and healthy as a horse. Only one time a condom broke...using spit instead of lube. Not bad for 24 yrs of boinkin'.
PozAlready, Austin, Texas, 2010-04-06 16:28:25
Wow. I think the real issue is ignorance here. Ignorance and fear. Louis Jordan should have gone into the bathroom, washed himself with soap and then gotten tested for STDs. If he came up negative for gonorrhea and clamydia, his chances of contracting HIV would be negligible. HIV is killed dead with soap, and unless he has open sores, or a tear on his penis, he could probably take a piss, wash his privates, and go. It's only with additional STDs that would open up the possibility of getting HIV.
David, Chicago, 2010-04-06 13:53:33
$1250.00 is not extortion, but the $3500.00 I pay for Atripla is. Lucky I have insurance. They are jerks, but I have to wonder why you did not go to a clinic in the gay community. Finally, It figures a doctor would say "pay up" Fitzgibbons... what happened to "first do no harm" so much for the oath. My doctors and clinicians are nothing like you have described they actually referred me to the local clinics before incurring any costs. Unfortunately I am POZ, but I have great doctors so I'll be ok
Jon, Los Angeles, 2010-04-06 12:48:59
Oh, I forgot. SensiblePOZ has a great point. The hospital already HAS been paid. Now it's on the collection agency. And I have an opinion on them...if they're stupid enough to buy the debt from someone, they should expect to go through hell to get it paid.They're buying someone else's problem.So the hospital is already taken care of.The agency might mar your credit a bit if you don't pay, so I would still do a payment plan, but I were in this position? I'd drag it out. You did nothing wrong!
Jon, Los Angeles, 2010-04-06 12:28:46
I'm so terribly sorry you're going through this. You were responsible in your encounter, and then an accident like this happens. For the record, I'm terribly angry that hospital did that to you. It's cruel, and it's wrong. It was inhumane treatment.However, they did provide services. The $1250 is exorbitant, but that's the price of medical care. What about a payment plan? Even $5/month? Trust me they'll survive on that until it's paid off. I'm so sorry for your trouble. You have my support.
Nancy, Denver, 2010-04-06 12:28:30
You are not alone! What is amazing is that Beth Israel Hospital said they would help you at all. It is hard to find PEP providers!! It's cruel that Beth Israel retracted the offer, so I don't blame you for feeling like you don't owe them. Our nation needs to have PEP providers and plans clear and available to the public. Just like a morning after birth control pill, there is a cost, but at least it has a standard of practice. Happy that PEP was successful. You might try counseling now.
SensiblePOZ, Atlanta, 2010-04-06 12:27:58
If a collection agency is calling you it means that they bought the debt. The hopsital has gotten all it will get. If you pay the $1250 plus any expenses the collection agency adds, it all goes to the agency.
S. Fitzgibbons MD, Houston, 2010-04-06 10:27:36
Beth Israel did some expensive lab work and also provided the services of trained personnel, not just pills. That $1250 is not extortion...and it's money that could pay for somebody else's treatment. Pay up.
comments 1 - 12 (of 12 total)
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