Three years ago, Nicolas Gourdine had the scare of his life.
"I had put myself at risk by having unprotected sex," he said. "Someone I deemed a friend didn't disclose their HIV status, and I learned they were positive. And I learned it sometime after."
Gourdine ended up testing negative for HIV, but the experience left him shaken and with an awareness of what engaging in risky behavior could mean. "I was quite alarmed, quite concerned … devastated," he said.
Now he takes Truvada daily, which he says protects him from ever feeling that fear again.
The pill is a part of a program of pre-exposure prophylaxis (PrEP). The Centers for Disease Control and Prevention says PrEP, if properly followed, reduces the risk of HIV infection by 92 percent. PrEP includes taking Truvada every day and checking in with a doctor every three months.
"Where pre-exposure prophylactic is so helpful is that it prevents that initial infection," explains Dr. Richard Elion, clinical research director at Whitman Walker Health in Washington, D.C. "HIV doesn't get into cells. It's met on the surface of the cells by the drug."
A year of Truvada can cost about $13,000, but most health insurers cover it. An estimated 4,000 people who are HIV negative regularly take the drug.
Elion says PrEP's adoption, especially in a high-risk population like Washington, could be the answer to the city's HIV epidemic.
"Washington, D.C., has the highest prevalence of any … city of HIV in the United States," he said. HIV-positive residents are "a bit shy of about 3 percent, overall, of the [city's] population — which is higher than some rates of countries in Africa."
"If you're an African-American man who has sex with men and you're between the ages of 20 and 40, your chances of having HIV is 1 in 5," he added.
For decades, gay health advocates have centered efforts on pushing condom use and awareness about HIV status. In the 1980s, when contracting the virus was essentially a death sentence, that message largely worked. Now, 30 years later, some medical professionals are skeptical about promoting PrEP.
"PrEP, in fact, may quiet our conversations with each other around sex because why bother if everyone is just either HIV positive and taking their medications as they should or negative and taking their PrEP?" said Dr. Dan O'Neil, a second-year resident at George Washington University Hospital. "In a way, it could be seen as an excuse to not take responsibility for our actions."
A lot of that worry stems from what many in the gay community attribute to a generation gap, with today's young people simply having no idea what it was like to go through the early days of the HIV crisis.
“We have a major crisis going on in the United States, specifically in youth," said Dr. Gary Blick, a co-founder of World Health Clinicians. "In youth, we have about 18 percent of people who are HIV positive and they don’t know their status."
Earlier this month, the Washington LGBT community tried to bridge this gap by offering a free photo shoot to anyone who got tested for HIV, because many young people in the capital don't know their HIV status or have protected sex. Every year there are an estimated 50,000 new cases of HIV in the U.S.
"You know, youth think a whole lot differently than we did in my generation," said Blick, who co-founded the event. "If you were 10 years old in 1996, well now as a 28- or 29-year-old, you’ve never seen that death and dying. We changed our behavior [by using condoms] because of a fear of dying."