44-year-old Tristan Schukraft recently made gay news when he purchased legendary West Hollywood bar The Abbey, where a portrait of violet-eyed Elizabeth Taylor still hangs memorializing her Sunday tea dance visits as the AIDS epidemic raged across the U.S.
Schukraft has been doing his own work raising awareness and addressing the scourge of HIV. He founded Mistr, a telemedicine platform that provides free online PrEP for anyone with or without insurance, as well as STI testing in all 50 states, DC, and Puerto Rico.
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Schukraft thinks zero HIV infections are within our grasp, and says we owe it “to those that lost their lives at the peak of the epidemic” to get there.
I spoke with the self-described “serial entrepreneur and aviation enthusiast” (he’s visited 109 countries) in Puerto Vallarta, where he was enjoying the “perfect time of year.” He was dressed casually in an open shirt. I was wrapped in a hoodie under a ski cap.
TRISTAM SCHUKRAFT: You look cold.
LGBTQ NATION: (laughing) I am cold. Tell me the origin story of Mistr.
I was hearing from friends that there were all these challenges getting on PrEP, and I didn’t understand. It was easy for me, but I was part of a clinical trial.
And then around this time, the Commission on HIV and AIDS was looking for more participants, and so I went to a meeting there and it was shocking to hear that they have this five-year plan and their goals were off by like 80%.
So I started looking at what the challenges getting on PrEP were, and among the issues were repeated doctor visits, the cost of the doctor visit, the cost of labs, finding a provider that’s willing to prescribe you PrEP. A lot of people go, “Oh, yeah, it must be really hard in middle America,” and I’m like, “You can go to the Valley in LA and there’s doctors that won’t prescribe you PrEP, or on Long Island in New York.”
So after I hear all this, I’m like, I gotta turn this into a viable business. Otherwise, it’s not gonna work.
But what really motivated me is, we have the chance to actually eliminate HIV, right? If everybody who’s negative is on PrEP, and everybody who’s positive is virally suppressed, we could do it. Given all the people that lost their lives at the peak of the epidemic, we kind of owe it to them to utilize the tools that we have in place now. Otherwise, it’s a huge disservice because they didn’t have that opportunity.
You use one statistic on your site that really surprised me: Only 10% of the gay population in LA County is on PrEP. Why is that?
I don’t know. Everybody who’s sexually active ultimately should be on PrEP, right?
In Miami Dade County, they have mobile testing units, and people would come in and get their HIV test and they get it and walk out and nobody was talking about PrEP. That’s like a lot of government initiatives. They’re focused on HIV testing, which is great, or they’re getting people on anti-viral drugs, but they’re not supporting the others that are not HIV positive.
So now when people go to this mobile testing, we get them a Mistr card, right? Because if you’re worried about being positive for HIV, you’re a prime candidate for PrEP.
It’s kind of like birth control. I mean, women should be on birth control consistently, right? They’re not having sex every day, but you’re on birth control for when that moment happens.
You say gay men concerned about HIV are prime candidates for PrEP, but since HIV isn’t the lethal disease it once was, are most gay men really that concerned with HIV and AIDS?
Yeah, I hear this all the time, and it’s disheartening. You know, for them, ignorance is bliss. “It can’t really happen to me,” right? It can happen to anybody. HIV doesn’t discriminate.
But I agree with you. I think a lot of service organizations have the same challenge where, you know, the cause doesn’t seem to be as important anymore, because there aren’t these headlines of lots of people dying. But there’s still 30,000-plus people getting HIV infections every year.
To go back to the comment about those interested, really, when somebody comes into a doctor or a mobile unit or comes into a clinic, they should be offered PrEP and asked, “Hey, have you thought about PrEP?” Because there’s an education gap, right? People don’t know to ask for it.
You mentioned the number of infections. It was 32,000 new HIV infections in 2021, and 70% of them were gay men. The number of annual infections has been reduced by two-thirds since the height of the AIDS epidemic in the late 80s/early 90s, but it’s shocking to think with all these tools at our disposal the number is still that high. What’s preventing us from getting to zero infections?
Access, right? I think that’s what Mistr really does, is it eliminates the barrier to entry. Our service is completely free. You can go to your doctor, and now that the drug is covered by insurance, there’s no out-of-pocket, right? But you still gotta go to the doctor.
First of all, you might not have insurance, but let’s assume that you do have insurance, right? You know, there’s scheduling time to go to the doctor’s office. Then you go, you get your prescription and you go to the pharmacy, and there’s this large out-of-pocket co-pay. You’re gonna abandon the scrip, right?
Maybe you have insurance, but you can’t afford to take time off work. So increasing access, eliminating the costs altogether. If somebody has insurance and there’s a co-pay, we eliminate that co-pay.
A lot of insurance companies will request prior authorization, a letter from your doctor saying that you need this medication, which I think is the most ludicrous thing in the world. It’s one additional extra step, and lot of people hit that wall and give up. Not to be pointing fingers here, but that’s really its intended consequence.
So we eliminate all that. We do a lot of that behind-the-scenes work with insurance companies, and then those who aren’t insured, we get them covered through various patient assistance programs. So access is the number one thing.
And then in some communities, it’s stigma, right? You have insurance, you have the money for the co-pay, you go to your doctor, but you just don’t feel comfortable talking to that individual about your sexual activity, so you don’t bring it up. I mean, I’ve heard stories where people go to the doctor, and the doctor says you don’t need that because you’re not having unprotected sex, even though the person is having unprotected sex and they don’t want to admit to it. So they leave the doctor’s office without a scrip.
So what we’ve tried to do is make it easy. Eliminate the cost. It’s stigma-free. Our doctors work within the gay community all the time, so they can talk about anything. And you do everything at home, right? These are the keys to increase access.
I was in college when the AIDS epidemic exploded. I had a few worry-free years before HIV, but then that barrier to real intimacy was thrown up, including condoms, and it made the whole experience — whether you had few partners or whether you had many — something to fear. So PrEP has kind of dialed the clock back to a time before. There are still STIs to worry about, but nothing as psychically and physically devastating as AIDS was then.For my generation, I think that’s reason enough to take PrEP. What are some of the others?
It’s liberating. You can have sex without worrying about getting HIV. That’s huge. I mean, yes, there are still STIs. Those can be treated, but HIV — there’s no cure for HIV. And while you can live a long, healthy life, we need to avoid getting HIV and spreading HIV.
Do you worry PrEP makes people less vigilant about sexually transmitted diseases?
No. I think the reality is people are going to do what they’re going to do. Our STI positivity rate is around 9% to 10%. So it’s not that high. And since everybody coming through our platform is getting tested, we are helping eliminate the spread of STIs. Let’s get them tested every three months. Let’s get them on PrEP.
What STIs do you test for when you onboard a new client?
Hepatitis C on the initial intake and three-site gonorrhea and chlamydia, HIV, and then we have the ability to do syphilis testing, as well.
When you say you have the ability to do syphilis testing, is that a regular part of the regime?
It’s not.
I know that syphilis is on the rise in the U.S., up 80% since 2018. Why wouldn’t you include it in your regular testing?
You know, we do in some markets. It really just comes down to funding. We’re subsidized by various government programs and grants. But I agree with you. It should be included in every test kit. That is ultimately our goal.
You may have seen an episode of a little-watched Netflix show called Glamorous, where the 20-something lead snaps back at a hater, “I’m a twink on PrEP. I can do anything!” Has PrEP made a generation of young gay men feel invincible?
Yes, that and they’re just being youthful (laughing). I saw a meme that was like, “Oh my God, I left the microwave on! It’s okay — I’m on PrEP.”
(laughing) That’s a good one.
It goes back to that liberation that we were talking about earlier. I mean, it is true. They don’t have anything to worry about if they’re on PrEP, right? So yes, definitely. They feel invincible, for sure. That can be a good thing. I mean, as long as you’re regularly taking your PrEP, then you can have that confidence that you’re protecting yourself and you’re not gonna get HIV.
The problem comes in if you’re not gonna take your PrEP all the time, or you’re on PrEP for six months and you stop, and then you’re still feeling invincible. That, to me, is the risk.
What do statistics say about PrEP in different age groups? Is one more likely than another to be on it?
A majority of our users are 18 to 35, but we have people into their 50s on PrEP.
In terms of demographics, we focus a lot on young people, which is important. But also, the Centers of Disease Control says nationally 11% of Blacks and 21% of Latinos are utilizing PrEP. For us, we have 15% of the Black community and 25% of the Latino community, and we’re actually serving more Latinos in California and Texas than any other demographic. But we want to be doing better because you look at the stats, it’s the Black and Brown community that’s most impacted by new HIV infections.
How do your clients find you?
We like to say Mistr is everywhere. We are online, we sponsor a lot of events, we partner with a lot of promoters and venues. We like to partner with influencers. Because you could hear it from us, right? But maybe when you hear it from an influencer that you know and respect, that’s going to be the tipping point for you. We did 55 cities last year, 16 activations per city. Whether it’s Folsom Street in San Francisco, or it’s Market Days in Chicago, or Miami Beach Pride, we’re there with our Mistr models to engage with the community and support the community and get people onto the platform.
(laughing) There might have been some inspiration.
Tell me about how subsidies work for people without insurance.
For those who are uninsured, we have the Gilead Advancing Access program, which is fairly simple to enroll in. Five years ago, you had to print it out, complete it and fax it. Who uses a fax machine besides lawyers and doctors? Not by accident. But Mistr makes it all seamless. If you have no insurance, we ask a couple of additional questions, we complete those forms and send them on your behalf.
What percentage of your clients are subsidized?
70% of our users are insured and 30% are not.
There’s a misconception that Mistr is only for the uninsured. We really need the insured users’ revenue to make it free for the uninsured. So you can go to your doctor and if that’s where you feel more comfortable, by all means. But with Mistr, it’s convenient, it’s free, it’s easy, and you’re helping those that are uninsured get access to PrEP.
A big part of your outreach is hookup apps like Grindr and Scruff, where Mistr is ubiquitous, but you also just bought the iconic West Hollywood bar The Abbey, where I spent a lot of my youth.
(laughing) I spent a lot of my money over the years at the Abbey, and I’m finally getting some of it back!
Is buying the bar a vote of confidence for socializing and hooking up in person?
Sometimes it’s nice to order in, or order UberEATS, but going out is a different experience, right? I’ve always wanted to have my own bar/nightclub. It’s been a dream of mine, but never in a million years was The Abbey on my radar, and then I found out David Cooley was selling it. It’s important to preserve it as a cultural institution. I mean, it’s a cornerstone of the gay community in West Hollywood. It’s world-famous. We just had JLo there this weekend. Vogue Mexico, the Daily Mail in the UK, everyone’s talking about JLo at The Abbey.
So it’s an iconic institution. It’s a safe place for the gay community, and it’s an anchor. It’s like a mall. If you lose a couple of the anchors, the mall starts to fall apart. So it’s really important to ensure that Boystown in West Hollywood stays Boystown. And it’s really complementary to Mistr. It gets 1 million visitors a year, right? So, for sure, when you go to the bathrooms at The Abbey, you might see ads for Mistr.
