Truvada trance

Truvada (otherwise known as emtricitabine/tenofovir disoproxil fumarate 200-300mg) is a combination of antiretroviral drugs that can be taken to prevent exposure to HIV. Most queer people are aware of this; most cis/het folks I know have never heard of the medication or even knew that there was something available beyond condoms to reduce the chances of transmission. Every night when I pop the now familiar blue pill right before bed I am reminded of the politics of HIV/AIDs, the distinct hardship and stigma placed specifically on MSM in respect to their sexual practices, and the severe issues in access to life saving medication like Truvada - thoughts that may just be mere glimpses, but are still ever present. Though those are all worthy topics in their own right (that I encourage you to research for yourself), that's not what I actually want to talk about in this post. 

One of the lesser emphasized potential side effects of Truvada, one that they don't mention when making sure you understand that you'll need to come in every three months for invasive swabbing and bloodwork, is that of "strange" or "abnormal" dreams. As someone who hardly ever dreams, I doubt I would have even remembered if it had been emphasized. Especially after my first day on the medication, which was extremely unpleasant - it felt like I had swallowed an entire brick that my body was thanklessly trying to digest while also having the worst tension headache of my life. Getting through that day felt like an accomplishment, and it seemed like the only major side effect I was destined to suffer from.

This would not come to be. Within the first week, I began to dream more frequently and far more vividly than I ever had before. Now, this isn't saying much if I'm being honest. I've had issues sleeping for as long as I can remember, a struggle that has only recently been improved in the two years I've returned to sleeping alone (go figure) and with a better mattress in particular (thanks Tuft & Needle). But still, Truvada came into my life and so did the dreams. 

Speaking only from my own experience, Truvada dreams are unlike any other. It is hard to put quite into words what makes them so unique, and so disconcerting, but the best way I know how is to call them hyper-real. Everything, every detail feels true to life - there are no fuzzy monsters, or celebrity encounters, just everyday situations with people I know or have known. And yet, there's always just one thing off, one characteristic or one facet of dream reality that's not quite real. This makes them particularly disorienting to wake up from, as you try to overlay the experience it just feels like you had with the knowledge that it wasn't a part of the particular timeline we live in. Sometimes they are nightmarish, like the one where my father and I were hiking near their house in Connecticut only to be attacked by a bear - the kind that lives nowhere near Connecticut. In the dream, I froze - and when I awoke I remained paralyzed for a moment, sweating, and making sure flesh was still intact. 

Other times it's less explicit torture, like the time I dreamt of getting back together with my ex - the dream was not about the desire, per say, but literally took me through weeks of what that progression would look like and ultimately where things would end (again). I've had many dreams since breaking up, but only since I've started Truvada had they been focused on a future unseen rather than reliving the past. 

And so I am left taking the gamble, weighing the risks. Will tonight be a night of tenofovir tinged terror? How many casual encounters a week, or a month, or a year makes it "worth it"? How cruel it seems to have to make such a decision, and to make it over and over again on a daily basis - much like I make the decision every single day to "come out" by living openly and freely, come hell or incessant stares on the subway for my hair/piercings/tattoos/gait/etc etc etc. Maybe that's why I take the pill time after time - because I know at the end of the day that these are choices I will always have to face because of my queerness, and because I know which option I'll always choose. 


Matthew Kastellec