I started my work as a Peer Educator in February 2015 at M Clinic, Perth’s sexual health clinic for men who have sex with men. It is just over 3 years on, and I have three months left of work before I move to Sydney to start my Ph.D., where I will research in this area, specifically on PrEP (Pre-Exposure Prophylaxis) and UVL/U=U (Undetectable Viral Load/Undetectable=Untransmissible). As a philosophy graduate and a new volunteer at the clinic, I was offered a job to work in the clinic, given in-depth training on all of the facets of sexual health, and shortly after starting, phlebotomy training so that I could collect blood and other samples. I had taken up volunteering at the clinic because I was wanting to temper my theoretical interest in understanding sexualities with some practical experience, and because I was starting to become more comfortable with the idea of participating in this thing we call ‘gay community’, and wanted to give back to it – even though I wasn’t really sure what it was or if I felt like I fit in with it (I still don’t really know if I feel like I fit in with it).
I have had unforgettable experiences working in a sexual health clinic. Enthusiastic discussions with guys who are embarking on new and promising relationships, gratitude from guys who lamented that “they wish they had learnt this in high school” (to which I say, “me too!”), serious conversations about the impact that alcohol or crystal meth is having on someone’s life and sex, upsetting tales of the negative experiences that people have had in accessing healthcare or social services elsewhere, witnessing gradual transformations in attitudes and beliefs about HIV, seeing the difference that a referral to counselling, or a referral to accessing gender affirming services (such as hormone replacement therapy) has made for someone. I have provided a diagnosis to a handful of people with HIV, and sat with them and answered their questions and helped to guide them through the next few days; their next appointments, the available services, the implications. I have seen some of them return for STI testing some time later, on treatment and living well. Others I haven’t had the privilege of seeing since I diagnosed them – I hope they are doing well and I occasionally think about them and wonder how they are faring. Perhaps the most relieving is seeing someone who has walked in with terror and fear on their face, and left my room half an hour to an hour later calm and collected, with a pragmatic resolve (I haven’t always relieved fears, but more often than not calmed down the imagination and corrected some misinformation about the likelihood of HIV transmission).
But most of the time people fare remarkably well on their own. They make the changes they want to make to suit them and the life they want to live. Most of the time I am a just a necessary step to receiving the tests that a person wants to have, with maybe a question or two answered about accessing PrEP. I often wonder if people accessing the service are going to be worried that I might judge them for not using a condom, or for injecting a drug, or for having 21-50 sexual partners since their last test. Do I judge? No – honestly, I am always thankful that people are upfront about these things – so that we can talk about them (if they want to talk about them). People in the broader community often speak about worrying over things like declining rates of condom usage, and the use of crystal methamphetamine. I have concern about these things to the extent that they impact the person sitting in front of me – but I don’t usually go home worrying about them.
What I do go home worrying about more often are the ways we do and don’t support one another. What are the ways that we talk about HIV, and about people with HIV? What are the implications we make about members of our community who smoke and/or inject meth, or who use other drugs? How do the things we write on our Grindr/Scruff/etc app make other people feel? What unhelpful racist, sexist, ableist, and other discriminatory ideas do we replicate in our microcosmic queer community? Do we talk enough about the things that allow us to have meaningful and fulfilling relationships – sexual as well as platonic? Even though I am HIV negative, the proximity of my work with HIV means that I internally shudder every time I hear someone say “he’s clean” or see the words “drug and disease free” (I am comparably a lot happier that people on Grindr seem to be against ‘taps’ moreso than anything else at the moment – but I still see ‘no Asians’ far too frequently).
The biggest change I have seen in the field of sexual health over my three years of work has been around PrEP and Undetectable Viral Load. When I started, it was communicated to me that a person living with HIV taking medication every day and achieving an undetectable viral load (as a result of their treatment) is pretty much incapable of transmitting HIV to their sexual partners. But we lacked enough data at that point to absolutely confirm it for anal sex (we had good data on vaginal sex). Simultaneously, PrEP was a sputtering of murmurs, at least in Western Australia in 2015. At best, many people were sceptical of it, but usually concluded that it was a probable option for those guys who were at ‘really high risk’ and ‘were never going to use condoms’. Then we had options for personal importation, and then discussions about study trials. Almost overnight it seemed like we were pro-actively educating everyone in the clinic who reported any bareback about PrEP. The findings of the PARTNER study came out and we had powerful data to point out the efficacy of an undetectable viral load. Early 2016 I decided to go on PrEP, and was able to draw on my experiences to inform our clinic and our community. Every few months I would email some of the guys at PrEP Access Now (now just called ‘PAN’) in Melbourne and they would mail us a couple of hundred business cards with their website information about personal importation. We would then collect these with other brochures and print out slips with information about PrEP prescribing GPs and sexual health services and put them together in an envelope that we called a ‘PrEP Pack’. We gave out hundreds of these packs to educate our community about PrEP. Another wave of vital research on the efficacy of an undetectable viral load arrived with the Opposites Attract study, giving even more authority to the global campaign of U=U. Present day we provide a PrEP trial, and as of April the 1st, 2018, PrEP is on the Pharmaceutical Benefits Scheme. A lot has changed – although I am reminded by my historical readings of the early-mid HIV/AIDS epidemics and the dramatic changes that occurred when people living with AIDS stopped dying en masse with the advent of antiretroviral treatments. As a young inheritor of this history, I still have trouble comprehending the enormity of that shift. These stories still move me beyond words.
Three years on working in sexual health – I’ve learnt that people in our community are complex, but also share a lot in common. The situations people find themselves in, the resources (knowledge, finances, cultural understanding), and people’s priorities are all very diverse and complex. But the things we all want – to be loved, to love others, to enjoy fulfilling and pleasurable sex, to be free of STIs, to be free of fear, to know that we are going to be OK and that people will still be around for us – they are all roughly the same. These are the kinds of things we want to help people achieve at M Clinic and at the WA AIDS Council. And as such, I cannot understate how much love I have for my colleagues at M Clinic, and what an important service it is. As I leave WA, I ask OUTInPerth readers to please support M Clinic as much as you can. Our success has always been dependent on the input and support of our community.
Anthony K J Smith
