Interview with Dr. Steven Hutto

Dr. Steven Hutto, known to most as Dr. Steve, is a general care practitioner who has become an incredible asset to the Austin queer community.  Considering that he stands at six foot six with a foot long beard you’ve probably seen him somewhere because it’s hard to not to see him at all.  He is a warm, gregarious person who has helped people get access to PrEP, HRT, and HIV care. Recently, he has expanded his career to become a DJ and has instantly connected with dance floors throughout the city.  In his interview with ASHwell’s new blog, Questionnaire, we touch on the many aspects of his work.  

Q: Where did you grow up?

SH: In South Alabama, a small little town called Grove Hill.  It's probably about an hour and a half from the nearest big city, Mobile.

Q: What was your experience of being queer and tall and good looking?  (laughter)

SH: I would say there wasn't a lot of queer experience there.  I was totally in the closet the entire time in high school. It probably wasn't until during medical school that I started getting comfortable with that part of myself.

Q: Is that what maybe drew you to Austin?  

SH: It was a number of things.  That was a strong force- being able to live my life and more realized it was just really hard to do that there.

Q: Then you moved to Austin, and you were able to be yourself.  Did you have a vision for yourself that this is the life you want to lead, or did you show up and see what would happen?

SH: It was kind of a process.  College is the first time I got on the Internet and I discovered that I can look up pictures of whatever I want! (laughter) Okay, here's that stuff I knew I liked I was never able to dig into.  Looking at dudes online it’s like I started struggling with it, and I started meeting more gay people and there was this huge dread of becoming myself.  That lead to some wrecked relationships in college that were of course all hidden from my main group of friends anyway.  I started really getting tired of that drama that I was creating for myself. Little by little I started going out in gay bars in other towns and making up white lies to hide what I was doing from my friends. While you’re in residency you go into this hole, you don't have a social life anyways.  You can avoid dealing with it.

Q: Being a closeted med student is actually pretty advantageous.  

SH: I mean, yeah! You don't have a sex life, you're like reading all the time.

Q: You show up in Austin and did you just fly out of the closet?

SH: Actually I had a year where I graduated residency and I was doing urgent care, so I was working like a schedule where I would work ten or twelve hour days then I would have half of the month off.  I was able to travel more, I went through this process of auditioning big cities to figure where I wanted to live.  I had been in New Orleans a lot. I met a guy on vacation and we started long distance keeping in touch, and he lived in Austin and that was another string that tied me here. And I loved Austin. There was a lot that was good and made sense.

Q: What were those things?

SH: It has a hippy dippy atmosphere, everyone’s a little more laid back, weird, cool, and that appealed to me.  That also is why I like San Francisco. It was like a southern San Francisco.  

Q: I can see that... maybe not now but- (laughter)

SH: To my young Alabama eyes!  

Q: As someone who is a very out, queer man but also a doctor, what's your take on gay sexuality in Austin?  What do you see is happening that's good or bad?

SH: I see there's a duality. It's like a process that I had to go through as well. Everybody is ignorant at some point, about PrEP and HIV and safety and what puts you at risk. As a physician in training I was going through this process in my personal life, I was having sex with guys for a time and not really understanding what risk I was adopting with my behavior.  It kind hit me on vacation one time where I was having sex with this guy and saw an HIV pill bottle on his nightstand and I was like (gasp) "You didn't tell me!" and this was after the fact. He's like "you never asked..." and I was like- oh wait, I can't be mad. That's on me.  I need to take more responsibility for this.  That's where I started to learn more about behavior and risks.  I learned about PrEP when I was a physician at Austin Regional Clinic.  I was talking to a grad student, he became my patient and he asked if I knew about this medicine I could take once a day that can help you prevent HIV, and I was like, no, but as a gay doctor I should definitely know more about this! It was a process...

Q: Cos there was a huge lag.  A lot of doctors particularly in somewhere like Texas weren't finding out about PrEP. A lot of times patients were explaining it doctors.  Why is that?

SH: There was only a couple of studies in 2013, and it just didn't get a lot of publicity in the mainstream medical structure.  We weren't reading about it in journals.  I think only within the last year have there even been television and print ads about it, so it’s almost like there’s an amount of social progress surrounding gays that has taken place along with PrEP.

Q: Is that part of the taboo that it might promote condomless sex?  

SH: Maybe, I think that was the concern around it.  Some concerns I had personally were:  do I really need to take an HIV medication just so I can have certain behaviors with lower risk?  What's the cost benefit there?  How much is this gonna harm my body?  Is this gonna cause fat redistribution, or kidney damage, is it worth it?  

Q: Well... is it worth it?

SH: Totally! (laughter) Even as a physician, I had to come to my own personal conclusion about PrEP.  It wasn’t until I had a scare that I decided to do it to make sure I was doing everything I could to prevent getting HIV.  It happened when I hooked with with a guy once.  I mean, all we did was oral, but afterwards, he told me he had HIV and didn’t really believe in taking medications for it, that drugs are more harmful, that he’s been living with it for years and hasn’t had any problems, doesn’t see a doctor regularly.  In my mind, I immediately started going through the risks of what we had done, and was like, ok, no big deal, just oral.  Well, about a day or so later, I developed a sore throat and a fever, and was like, oh shit, really? This is how this happens to me?  I freaked out, and went to see one of my partners, and a strep swab was positive - I just had strep throat!  So it’s one thing to tell people about risks / behaviors etc, but when it’s happening to you, it’s different!  I decided I didn’t want to go through that again for any reason, and just thought about how I’d feel especially being a doctor and contracting HIV, when I knew there was a pill I could have been taking every day to keep from getting it.  And those types of side effects you hear about in ads and lawyer commercials for PrEP are not as big of an issue with Truvada as they had been with older HIV medications.  I remember seeing patients on Truvada in medical school, so it’s even been around for a while as part of HIV treatment.  I feel like with the trend of ongoing studies around HIV medication, we’ll soon get to take newer even safer medications for HIV prevention as well as treatment.  I’m in a study right now as a patient to clear a newer / safer version of Truvada for use as PrEP, so who knows what it’ll be like 10 years from now?

Q: Do you think PrEP has changed the way men are having sex?

SH: Completely. Myself included. I saw it go two ways-  you would have these people who were like "Yes! Finally I have this key to have all the sex I want and not be afraid anymore." And then there were some people who were taking it and it kind of went the other way, "I can now have sex with anyone I want but do I really want to at this point?" It's a quality over quantity thing at some point.  

Q: You can maybe put more thought into what you want... interesting.

SH: If I'm taking this pill everyday I'm automatically thinking more about my sex life [more,] so [now that I know I can have sex with people without getting HIV, I can start thinking about relationships in other ways.  It kind of frees up some emotional bandwidth.

Q: Do you feel like the medical community has caught up to the possibilities of this or is it still controversial?

SH: I think it's still controversial with some people, you still have conservative physicians that look at it in the same way that physicians initially looked at birth control.  They're making judgements about people's behavior that is really up to the person and not the physician.  You initially had all this shaming on the women's revolution back in the 60’s placed on these women who were now sexually liberated when birth control came out.  Sex didn't automatically mean getting pregnant and completely changing your life. It's the same for us, the shame in the physician community- well if I do this you'll be able to engage in behaviors I don't personally don't believe in.  Which is bullshit.  

Q: Is a lot of partners bad?  

SH: I think everybody has to figure that out for their own.  It has now unlocked that possibility.  Now you have a lot of guys who are navigating that for themselves personally. It's like girls that watch The Bachelor hate that kind of behavior but then they want to be on the show.  [People need to learn how to not judge themselves

Q: Some people are more interested in making it really good, rather than this high volume.  

SH: The bottom line is that PrEP takes HIV off the table.  It's this new bag of questions for a lot of people.  I have some older clients that are really intelligent men that have gone on PrEP and lived through the HIV era, they’re in their early 60s, and even though they're taking PrEP they still can't overcome that fear.  You talk to them, "you're not gonna get HIV at this point".  And the way they talk about it, it’s just this thing that's ingrained in them, you just don't have sex, or you get AIDS and die.  So you have to work hard to break down those walls so they can fully realize themselves and their sex lives.  It's been cool to see some of those guys do that. Like, not only by taking PrEP, but also by just having very frank conversations with them about specific behaviors, like telling them, “you're not gonna get HIV from oral sex, pretty much,” and seeing a light go off in their heads.  PrEP not withstanding, go ahead!

Q: Suck that dick!

SH: Scream it from the mountain top. You help them understand this is why you're taking this medicine. That fear is over for you.  It's awesome to see those breakthroughs happen.

Q: Do you feel younger guys adapt quicker? Or do they have a different set of issues to work through?  

SH: Younger guys are more proactive. They come in and they want it.  They seem to be a little more informed about it.  This is probably a generalization about my patient population, which tends to be insured.  The flip side of that is that in certain settings, I’ve come across young people who rarely got screened, and then turn up positive, and just really seem aloof about it.  It’s usually when they don’t have insurance, or have had other social issues or poor support system, etc…. It’s like, some of them don’t even know this entire history of how HIV/AIDS wiped out so many people, or they just are too busy running around being crazy to understand how big a deal it can be if you don’t do something about it.

Q: Do you think PrEP is actually going to decrease the transmission rates of HIV?

SH: Definitely. That's why these bigger cities are making these goals of 'no new transmissions' by this date.  They are seeing the new cases go down.  I think the biggest way we're gonna get PrEP out there is that- that community clinics are great, but we need more providers on the private sector.  

Q: I’m interested in you talking about single payer and the overall direction of healthcare in our country.  

SH: Right now the whole reason that people are able to get on PrEP is because Gilead offers this copay card, they are making the price to begin with and then they're offering the huge discount to people.  Why are we not just lowering the whole thing and making it available?  That's one of the barriers.  I understand they have to recoup their research costs and pay people but navigating that whole thing is a challenge.  

Q: When I was first trying to get on PrEP I was making okay money but my deductible was too high, this way before they only paid copay fees not deductibles, and I thought "do I want to spend thousands of dollars to be more of a slut?"  And the answer was no (laughter).

SH: I think what needs to happen now is we need to work harder on making providers aware so more of them are giving access to PrEP.  We see a lot of insured patients using community resources right now.  They should be getting PrEP from doctors like me so there are more room for people in that gap that don't have that insurance to be able to use the resources that are there for free.  I think right now there is such a demand because people can't talk about it with their own provider that you have insured patients using the community resources making the wait for appointment dates two months out, so it makes it harder for people who have zero access to care.  We need more providers that are equipped to do it, and it takes having very frank conversations about sex with your patients, which for me is fun and easy! These appointments are my favorite appointments.  Do you have an STD? Have you taken your pill? Do you have any side effects? Are you ready to do your labs? Ok, bye!

Q: Hmm. (Long pause) A more important question is- how did you become a DJ?

SH: (screams) Oh my god!

Q: Time to switch gears I suppose (laughter)

SH: It's weird, I was at a local Burning Man event, called Burning/Flipside, and they have these huge parties and our camp leader said we haven't seen much of the queers at the main tent, so you're having a party for us whether you like it or not, so figure it out who's DJing and figure out who's bartending, who’s pole dancing, etc... It was actually Daddy Dearest, who was like, I always DJ, somebody else needs to do it, we need some fresh blood around here!. I was laying low, being nervous, and didn't want to do it and he said, "I guess you're gonna do it".  I think that was the first time that gave me that high of people getting down to [the songs] I was picking. From then on I was on fire and wanted to learn how to actually DJ.  I was like 'this is awesome' being the shaman laying down the groove down for everybody.  

Q: Is it totally separate or do you see overlap in these different parts of your life?

SH: It is cool when it overlaps. I've had house parties that are fundraisers and that's where I can really make it overlap is DJing in queer places and you know give space for the other people and organizations like ASHwell to come in and do a table or have some conversations or put a donation up. If we can get some people to start asking "what's PrEP?”, that's cool. If we can do that on the dance floor even cooler.  

Q: What are your hopes for the queer community of Austin?  

SH: I really hope that the rates of new HIV fall here as they are in other cities.  I really hope young people don't get complacent with it and that they realize that HIV can happen to them, and though nowadays it’s easier to deal with, it’s still not something you want in your life.  I think focusing on all queer health is rewarding for me, especially trans health that has been super rewarding.  To not only help protect people from disease with PrEP, but to help people be who they are is like, maybe a little more rewarding. Kinda.

Q: It doesn't have to be kinda.

SH: Yeah- it definitely is more rewarding.  I had a conversation with a client today, it was the first time I saw her since she had her surgery, and she was just a different person. She had been living as a woman, after surgery there's nothing else.  Done.  She's doing great.  I can just see it in her eyes and in her voice and she was so happy. She's taking less meds. Her mental health is better.  I think trans people have so many issues with anxiety and depression and other related issues with just not being themselves, that are suffocating. That's an even bigger reward than sexual health for me.  The pinnacle is when I can talk about PrEP with a trans person, because it’s like, yes, be yourself, get your love, do it right!!!

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