PrEP. Preventing the Last Disease. Inviting the Next One.
Head to Grindr or Scruff or Jack’d or Growlr or A4A or Manhunt or Squrt or any app/site where gay men meet other gay men and 2 words dominate: masculine (I don’t have time to get into that one) and PrEP, which is 2 words, one hyphenated: Pre-exposure prophylaxis. Truvada (the brand name) contains 2 antiretroviral drugs, tenofovir and emtricitabine. It is a proven way to prevent HIV infection in high-risk individuals. Ok fine. Great. I’m glad it does that and I’m fine with the idea that access to it is widespread among sexually-active gay men.
What makes my head spin is the idea that it somehow allows individuals to stop using condoms completely. PrEP does one thing and one thing only: it prevents HIV infection. But I might add it isn’t 100% successful at doing that. And it requires the individual to be 100% vigilant in remembering to take it.
Here’s what PrEP doesn’t prevent: syphilis, gonorrhea (which is becoming untreatable), chlamydia, anal warts, herpes, etc etc. Anecdotally, I know at least 10 men who have had repeated bouts with syphilis in the past year. In one case, 4 exposures. Statistically, syphilis rates among men who have sex with men are growing year-by-year in the U.S. at double digit rates (15% from 2015–2016, 19% from 2014–2015).
Now I’m not here to attach any stupid moralizing to this problem. Prudishness and religious fervor have no place in this debate. Sexual activity is a fact of life among gay men. Monogamy is not always the relationship mode of choice for gay couples. And celibacy is, well, quite rare if non-existent. Also I understand: condoms suck. I’ve been out of the closet for 35 years (I came out in 1981. The same year AIDS came out). I managed to avoid HIV infection (probably because I’m generally a “top” and because I came out in St Louis which was one of the last big cities to see a case of AIDS). Throughout my sexual journey I’ve had a difficult time matching safety (condom use) with satisfaction. I use them (most of the time) or I avoid the need to use them (by making the sex more about touching etc).
But I remember. Anonymous sex equaling sexual freedom. Then a horror show that lasted more than a decade. A frightening lack of knowledge followed by a horrific surplus of knowledge. Getting tested every year hoping against hope that the one slip (condomless sex) would not result in a death sentence. And watching the death sentence take lovers and friends and friends of friends and sickly strangers on the street. Death masks everywhere. A plague that took the young, the aged, the rich, the poor, everyone.
I also remember this: HIV was just a virus waiting to find a community in which it could live and spread. It took decades, but it finally found it in the urban gay community of the late 70's. Men finally finding kinship and acceptance in urban neighborhoods. Men finally allowed to express their sexuality with less fear of arrest and derision and things like loss of employment. But it was also a community that was playing with some potent bodily fluids: blood and semen.
Believe me I understand the desire to turn a page and forget the horror and sadness and fear of the 80's and 90's. I do. But I think in this case forgetting may mean inviting a new problem into our community. Can I say for sure? Absolutely not. As Republicans like to say, “I’m not a scientist.” But I can say that when I raise this topic, I get a pretty strong pushback from my peers. And I can say that blood and semen are still pretty good carriers of virus and disease. That hasn’t changed.
But here’s one thing that has changed. The world today is way more connected than it was in 1981. Take Los Angeles International Airport for example. In 1981 there were probably 20 or so international flights. Mostly to European capitals, plus Tokyo, Australia and Mexico. A few a week to Seoul and Brazil. Today there are dozens of daily flights to every continent. From Addis Ababa to Moscow to Santiago to Changsha to Doha and Cebu, LAX (and JFK, SFO, O’Hare, Miami etc) welcome the entire world to this country. It is a wonderful thing that brings trade and cultural understanding. It also can bring sickness.
Am I a Scrooge-like curmudgeon about this? I’ll say yes, guilty as charged. But here’s the thing. I’m not saying be 100% perfect about your condom use. I assume few if any of us of us have been able to do that ever. But I am saying don’t abandon condoms when you agree to have sex with someone about whom the only thing you know is his name and what he likes to do in bed.
Please don’t forget what gay men went through and could go through again. Safety first guys. Safety first.