Pride, passport stamps, and PrEP’d with options: One man’s journey with HIV prevention

Funded and developed by ViiV Healthcare.

“Sex wasn’t something that was talked about in my family,” Dino says. “I had a cousin who died at the start of the AIDS epidemic, so I was always very cautious and wanted to protect myself against HIV in the best ways that I could. My mother was concerned for me, but her idea of protection was to sprinkle holy water on me as I was walking out the door for a date!”

Dino has traveled a long road from the West Virginia steel mill town of his youth, where he was raised in a traditional Catholic household. Growing up, homosexuality was a taboo topic, and sexual health was a source of silence and stress.

His lifelong wanderlust was sparked during childhood when his parents took him to visit Disney’s Magic Kingdom just after the original theme park opened in Florida. Now 55 years old, Dino's life story unfolds like a map of adventures, from his days as a competitive bodybuilder and tennis player to his current quest to visit every Disney theme park worldwide. Amidst these travels, he found love in the most unexpected of places – Maui – where he met his husband of eight years, Craig.

“I knew from the start that this was the man that I was going to marry someday,” Dino says. “He disclosed that he was living with HIV to me, so we always used protection. His diagnosis was never a concern because I loved him. Being in a polyamorous relationship, I knew about HIV prevention options including PrEP, and talked to my doctor about it.”

Pre-exposure prophylaxis, commonly known as PrEP, is a medication taken by individuals who do not have HIV but may have reasons for wanting to help prevent HIV. When adherently taken as prescribed, PrEP can significantly reduce the chance of HIV transmission as part of a comprehensive risk management strategy used in conjunction with other safe-sex practices. PrEP can be taken as a daily oral pill or a long-acting injectable.¹ For many years, PrEP was only available in pill form, and Dino started out by taking it as a daily tablet to help him stay HIV negative.

But, as an avid traveler, Dino admits he always had apprehension about taking his PrEP pills with him when on the go. Between lost luggage, negative social stigmas associated with PrEP and sex, and distractions that occur when he is away from his regular routine at home, the daily pill regimen could be a source of stress when traveling.

“I worried about having a bottle that someone might accidentally see during my travels, and I may get questioned about it,” he says. “You never know where that stigma might come from, especially when traveling to new places that may have different societal attitudes.”

Then in 2021, the U.S. Food and Drug Administration approved APRETUDE (cabotegravir), a prescription medicine used for HIV-1 PrEP to reduce the risk of getting HIV-1 infection in adults and adolescents who weigh at least 77 pounds (at least 35 kg).²

It is important for people who receive APRETUDE for PrEP to help reduce their risk of getting human immunodeficiency virus-1 (HIV-1) infection to know that you must be HIV-1 negative to start APRETUDE.² Do not receive APRETUDE unless you are tested and confirmed to be HIV-1 negative. APRETUDE does not prevent other sexually transmitted infections (STIs). Practice safer sex by using a latex or polyurethane condom to reduce the risk of getting STIs. You must stay HIV-1 negative to keep receiving APRETUDE for HIV-1 PrEP.

You must stay HIV-1 negative to keep receiving APRETUDE for HIV-1 PrEP.² Know your HIV-1 status and the HIV-1 status of your partners. If you think you were exposed to HIV-1, tell your healthcare provider right away. Your risk of getting HIV-1 is lower if your partners with HIV-1 are taking effective treatment. Get tested for HIV-1 with each APRETUDE injection or when your healthcare provider tells you. You should not miss any HIV-1 tests. If you become HIV-1 infected and continue receiving APRETUDE because you do not know you are HIV-1 infected, the HIV-1 infection may become harder to treat. Get tested for other STIs. These infections make it easier for HIV-1 to infect you. Talk to your healthcare provider about ways to reduce your HIV-1 risk. Do not miss any injections of APRETUDE. Missing injections increases your risk of getting HIV-1 infection.

Do not take APRETUDE if you already have HIV-1 or do not know your HIV-1 status, are allergic to cabotegravir, or are taking certain medicines containing carbamazepine, oxcarbazepine, phenobarbital, phenytoin, rifampin, or rifapentine.² If you are HIV-1 positive, you need to take other medicines to treat HIV-1. APRETUDE can only help reduce your risk of getting HIV-infection before you are infected. If you have HIV-1 and receive only APRETUDE, over time, your HIV-1 may become harder to treat. Please see the Important Safety Information below, and visit www.apretude.com to learn more about APRETUDE.

After learning about the different treatment options, Dino approached his doctor about a PrEP option that didn’t require a daily oral pill. They discussed the pros and cons and agreed to change his prescription to APRETUDE.

“As a gay man in a polyamorous relationship, I try to stay in the know about HIV, PrEP, and sexually transmitted infections,” Dino says. “I have a good rapport with my doctor and asked him what he thought about APRETUDE. After talking with him about how I would have to be tested before every injection, I liked knowing that I was taking an extra step in helping to protect myself against HIV. I decided to give it a try and have been taking it ever since. I feel like I’m on the right form of PrEP for me.”

“I refuse to let anything hinder my exploration of incredible destinations in the U.S. to cities like Atlanta and Orlando, and to cities in other countries, like Dubai and Hong Kong. It is nice to fully immerse myself in every experience, embracing each moment with gusto! It is also nice to not think about someone discovering my pill bottle when I'm traveling,” he says.

Dino says his next big trip with his husband, Craig, will be to Japan. He says after long days of food and adventure, he’ll appreciate knowing he doesn’t have to remember to pack or take a daily PrEP pill. “I encourage everyone with reasons for HIV prevention to speak to their provider about different PrEP options available.”

Considering the unique experiences of individuals like Dino, it's important to understand and explore the different PrEP options that best fit an individual’s needs and preferences. Have you experienced any of these challenges when taking a daily oral PrEP:

• Do you struggle to fit a PrEP pill into your daily routine?
• Do you occasionally forget to take your daily PrEP pill?
• Are you concerned that people may see your PrEP pill and ask you about it?

If you experience any of these challenges – you are not alone! Talk to your doctor about whether APRETUDE may be right for you.

IMPORTANT SAFETY INFORMATION

What is the most important thing I should know about APRETUDE?

Important information for people who receive APRETUDE for pre-exposure prophylaxis (PrEP) to help reduce their risk of getting human immunodeficiency virus-1 (HIV-1) infection:

Before receiving APRETUDE to reduce your risk of getting HIV-1, you must be HIV-1 negative to start APRETUDE. Do not receive APRETUDE unless you are tested and confirmed to be HIV-1 negative.

• Some HIV-1 tests can miss HIV-1 infection in a person who has recently become infected. Tell your healthcare provider if you had a flu-like illness within the last month before starting or at any time while receiving APRETUDE. Symptoms of new HIV-1 infection include: tiredness; joint or muscle aches; sore throat; rash; enlarged lymph nodes in the neck or groin; fever; headache; vomiting or diarrhea; or night sweats

While you are receiving APRETUDE for HIV-1 PrEP:

• APRETUDE does not prevent other sexually transmitted infections (STIs). Practice safer sex by using a latex or polyurethane condom to reduce the risk of getting STIs
• You must stay HIV-1 negative to keep receiving APRETUDE for HIV-1 PrEP
  • Know your HIV-1 status and the HIV-1 status of your partners. If you think you were exposed to HIV-1, tell your healthcare provider right away
  • Your risk of getting HIV-1 is lower if your partners with HIV-1 are taking effective treatment
  • Get tested for HIV-1 with each APRETUDE injection or when your healthcare provider tells you. You should not miss any HIV-1 tests. If you become HIV-1 infected and continue receiving APRETUDE because you do not know you are HIV-1 infected, the HIV-1 infection may become harder to treat
  • Get tested for other STIs. These infections make it easier for HIV-1 to infect you
  • Talk to your healthcare provider about ways to reduce your HIV-1 risk
• Do not miss any injections of APRETUDE. Missing injections increases your risk of getting HIV-1 infection

Who should not receive APRETUDE?

Do not receive APRETUDE if you:

• already have HIV-1 or do not know your HIV-1 status. If you are HIV-1 positive, you need to take other medicines to treat HIV-1. APRETUDE can only help reduce your risk of getting HIV-1 infection before you are infected. If you have HIV-1 and receive only APRETUDE, over time, your HIV-1 may become harder to treat
• are allergic to cabotegravir
• are taking certain medicines: carbamazepine; oxcarbazepine; phenobarbital; phenytoin; rifampin; or rifapentine

What are the possible side effects of APRETUDE?

APRETUDE may cause serious side effects:

• Allergic reactions. Call your healthcare provider right away if you develop a rash with APRETUDE. Stop receiving APRETUDE and get medical help right away if you develop a rash with any of the following signs or symptoms: fever; generally ill feeling; tiredness; muscle or joint aches; trouble breathing; blisters or sores in mouth; blisters; redness or swelling of the eyes; swelling of the mouth, face, lips, or tongue
• Liver problems. Liver problems have happened in people with or without a history of liver problems or other risk factors. Call your healthcare provider right away if you have any of the following symptoms: your skin or the white part of your eyes turns yellow; dark or “tea-colored” urine; light-colored stools; nausea or vomiting; loss of appetite; pain, aching, or tenderness on the right side of your stomach area; or itching
• Depression or mood changes. Call your healthcare provider or get emergency medical help right away if you develop any of the following symptoms: feeling sad or hopeless; feeling anxious or restless; have thoughts of hurting yourself (suicide) or have tried to hurt yourself

The most common side effects of APRETUDE include:

• Pain, tenderness, hardened mass or lump, swelling, bruising, redness, itching, warmth, loss of sensation at the injection site, abscess, and discoloration; diarrhea; headache; fever; tiredness; sleep problems; nausea; dizziness; passing gas; stomach pain; vomiting; muscle pain; rash; loss of appetite; drowsiness; back pain; or upper respiratory infection
• These are not all the possible side effects of APRETUDE. Call your healthcare provider for medical advice about side effects

Before receiving APRETUDE, tell your healthcare provider about all your medical conditions, including if you:

• have ever had a skin rash or an allergic reaction to medicines that contain cabotegravir
• have or have had liver problems
• have ever had mental health problems
• have or ever had kidney problems
• are pregnant or plan to become pregnant. It is not known if APRETUDE will harm your unborn baby. APRETUDE can remain in your body for up to 12 months or longer after the last injection. Tell your healthcare provider if you become pregnant while or after receiving APRETUDE
• are breastfeeding or plan to breastfeed. APRETUDE may pass into your breast milk. Talk with your healthcare provider about the best way to feed your baby while or after receiving APRETUDE

Tell your healthcare provider about all the medicines you take, including prescription and over-the-counter medicines, vitamins, and herbal supplements.

• Some medicines may interact with APRETUDE. Keep a list of your medicines and show it to your healthcare provider and pharmacist. Do not start a new medicine without telling your healthcare provider

How will I receive APRETUDE?

• APRETUDE will be given to you as an injection by your healthcare provider
• APRETUDE is initially given as an injection into the muscle of your buttock 1 time every month for the first 2 months, then as an injection 1 time every 2 months
• Before receiving your first APRETUDE injection, your healthcare provider may have you take 1 oral cabotegravir tablet 1 time a day for 1 month (at least 28 days) to assess how well you tolerate cabotegravir
• APRETUDE is a long-acting medicine and may stay in your body for 12 months or longer after your last injection
• Stay under the care of a healthcare provider while receiving APRETUDE. It is important that you receive APRETUDE as scheduled
• If you miss or plan to miss a scheduled injection of APRETUDE by more than 7 days, call your healthcare provider right away to discuss your PrEP options
• If you stop receiving APRETUDE, talk to your healthcare provider about other options to reduce the risk of getting HIV-1 infection

What is APRETUDE?
APRETUDE is a prescription medicine used for HIV-1 PrEP to reduce the risk of getting HIV-1 infection in adults and adolescents who weigh at least 77 pounds (at least 35 kg).

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088.

Please read the Patient Information, including an Important Warning, for APRETUDE and discuss it with your healthcare provider.

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References

1. Pre-Exposure Prophylaxis. HIV.gov. Updated March 22, 2024. Accessed April 22, 2024. https://www.hiv.gov/hiv-basics/hiv-prevention/using-hiv-medication-to-reduce-risk/pre-exposure-prophylaxis

2. APRETUDE [package insert]. Durham, NC: ViiV Healthcare; December 2023.