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#IfYouAreBehind —Youth is Wasted on the Young/Does PrEP Equal Risky Behavior?/ChemSex Classes in the UK

Edward Melcarth: “Last Supper”

Art — Youth is Wasted on the Young.

“Youth is wasted on the Young” — George Bernard Shaw

Edward Melcarth (1914–1973), a Kentucky-born artist, is now the subject of two outstanding exhibitions, Points of View and Rough Trade, at the University of Kentucky Art Museum and Institute 193, respectively. His youth obsession, like most of us, played deep into his artistry, sparking his works: Blond Youth in Turquoise, Last Supper, and The Hanging. But who was Edward Melcarth? And what was his take on The Last Supper, of which many called his masterpiece and I, “every gay man’s dream”.

Edward Melcarth was an openly homosexual artist and supported communistic principles (I never knew you could be both). But clearly, these minority associations seemed to be the limitation of his significance in modern art history. He was active on New York’s post-World War II art scene with his work being shown at the Museum of Modern art, as well as several well-known galleries. He was indeed a true socialite, knowing many of the “who’s who”, like Peggy Guggenheim, Tennessee Williams, Gore Vidal, and the multimillionaire art collector and Forbes magazine publisher, Malcolm Forbes (who of note was a closeted homosexual himself). His circle also included “many other artists as well as countless, now nameless hustlers, sailors, beach bums, and representatives of working-class “trade” who posed for his pictures and with whom he had sex”. Wow! My type of guy! And to think there are still plenty like him in this post-modernism world, using social media platforms as their canvases — digitalism at its finest. Yippie!! Some of my personal favorites include our very own photographer, Maxwell Poth, and the very talented Stuart Sandford.

One needs to take into context his continued defiance of the normative, specifically at a time of abstractionism; staying true to him being a figurative painter. He focused on “depicting the male face and body, subjects he often eroticized in compositions whose structures can appear as sophisticated and dynamic as their emotional-psychological atmospheres can feel strangely ambiguous”. The human body was his central theme with homo-eroticism being constant, even at a time of closeted homosexuality.

The two shows lie in some element of juxtaposition with the “faces of several of the hustlers, blue-collar workers, and other acquaintances who posed for Melcarth and presumably also kept his bed warm” as the subjects on view at Institute 193 and compromise small-format, oil-on-canvas paintings. All the while the larger “complex compositions” are on view at the university. Which leads us to his supposed masterwork known as his Last Supper, in which the “old Christian story is set at the counter of a diner. In this long, horizontal composition, the arms of handsome men reach out in a tussle to grab doughnuts or touch a muscled server — who just might be the figure of Jesus Christ with his face turned away”.

I won’t discuss his work entitled The Hanging, but you should take a peek, as his depiction is self explanatory and in my ideal fucked up concoction of humanity, should never be repeated.

I see art daily in my world and no it’s not the beautiful depiction of the perfect pucker 🍑. But maybe it should be 🤔. Every now and then you come across an artist that through his work, we, as a society, become better. And by better I mean more understanding of disobedience or rebellion or just plain ol’ different. Yet to disobey in a world who’s principles lie within the context of order? Hmm. As a father, it’s a constant reminder to forgo any stifling or limit any deviation. I guess within reason, right? But without these innovators standing true to their own form, we would not, to simply put it, be. I knew nothing of him and his craft and it is through wonderful curators that the history of our kind continues on. And through the youth of his paintings, we now see history. Youth, homosexuality, eroticism, and now antiquity. Fuck yeah!

Science — Does PrEP Equal Risky Behavior?

A few weeks ago, The NY Times broke a story on denial of medical and liability coverage for gay males taking PrEP for prophylaxis. And just this week, the New York courts decided it will hear some of these cases for discriminatory claims. It is an interesting discussion to take on for this week’s science section of A.S.S., so let’s dive in.

With nearly 800 life insurers in this country, many of them have denied coverage to men because they take PrEP. H.I.V. specialists say the denials “endanger men’s lives by encouraging them to drop PrEP if they need life, disability or long-term-care insurance”. Though on the flip side, most insurance companies usually cover PrEP for “anyone at substantial risk of H.I.V., which includes any gay or bisexual man who might have sex without a condom with anyone of unknown H.I.V. status”.

This raises such an interesting point to ponder — “men who do not protect themselves can get policies, while men who do cannot.”

Clearly, advocates point out that this singles out gay men for discriminatory reasons and use comparable situations, like the fact that women are not denied coverage if they use birth control pills or get the vaccine against human papillomavirus (HPV), which can cause cervical cancer.

So the real dilemma lies with the assumption that Truvada use suggests an active sex life, with inherent accompanying risks. So let me ask you, are they wrong? We hear all the time slut shaming as it is related to the use of PrEP. But if you were in charge of a for profit insurance brokerage and knew nothing of the individual other than usual parameters of insuring and saw the individual to be on PrEP, would it raise red flags for your overall balance sheet as being a liability? When I see injustices like the above, the best is to role reverse and truly think of the other side.

My intent is not to offend anyway here. There is no doubt I believe this is bullshit and no one should be denied purely because they use PrEP, but I do think further investigations into one’s sexual practice and full risk assessment is warranted, as long as it is uniform across all applicants, regardless of sexuality. For sure, we see those on PrEP who use this blue pill as a free ride to be completely uninhibited in their sexual exploration and with that comes inherent risks, as well as associations with drug use and abuse. So the interesting dilemma lies with what other prognostic indicators can be used to truly anticipate risk and overall liability. And even further, how comfortable and willing are those on PrEP to be honest about such intimate details?

So what can we do? Kudos to The NY Times and others who have exposed this conundrum and shed light on all of its discussions. Education on PrEP’s use and efficacy is imperative on the matter, especially in the Midwest and suburban regions where lack of overall knowledge on the subject and/or its sensitivities is rampant.

And although insurers routinely cover applicants with actual diseases controlled by medications, including diabetes, epilepsy, high blood pressure, and bipolar disorder, they definitely do further analytics on proper assessment to make sure their clients take proper medication when warranted and have full blood or medical assessments to monitor its overall control. So, no, I don’t think it’s out of the question to raise questions about PrEP. And by raising them, I’m not advocating the denial of coverage, specifically for someone who is using it properly with complete, serial evaluations every 3 months. What I’m advocating is further assessment of any proposed risk, which is imperative with adjustment of premiums to properly reflect that risk.

Then the question becomes: what are those further risk assessment questions and by asking them, are we just opening up more ways to discriminate? I’ll leave this with you to ponder 🤔.

Sex — ChemSex Class: Any takers?

Don’t you feel as if London always takes seemingly difficult topics head on, spearheading some kind of call for action? Their responses are usually light years ahead of the rest of the globe. In this case, it’s a sexual health service hosting a first aid class designed to help people who use drugs for sex — a practice known as “chemsex”. 56 Dean Street and the British Red Cross will host a ‘Chemsex First Aid’ class this week and it seems to be beyond popular and much needed — it already sold out. The talking points will highlight and teach people what to do when you are faced with an overdose, if you make mistakes when injecting, and when to call an ambulance. It also will include ‘conversations about the importance of shared care while we’re playing’, the ramifications of consent and setting discussed boundaries, as well as exploring how to look out for yourselves and others in chemsex environments.

All of this stems from the GSN Global Chemsex Survey that found that not only nearly a quarter of people who take part in chemsex overdosed themselves, but also nearly a quarter also know someone who has died after chemsex. Also of note: the number of chemsex-linked sexual assaults is on the rise in London, doubling in three years, with the survey revealing that the sex offenders are deliberately targeting vulnerable gay men at chillouts.

Just as an aside — people who take part in chemsex do it with the so-called ‘holy trinity’ of drugs that are made up of a mixture of GHB, mephedrone and crystal meth, and are preferably injected.

Some experts have commented on its use stemming from an escape from alienation, easier accessibility via the role of the app culture, and also economic reasons (more the downturn). Regardless of this rise, the UK has taken on “reflecting how some people use drugs for sex” and instead of denying its role in the gay culture, they are providing support services above and beyond the call of the duty. Another important point is the shift from services geared towards heroin users to now “reflecting the way drug use has changed”.

Again, we at Bespoke Surgical are all about positive actions for change. We can preach all we want about its use and misuse, shouting “don’t do drugs!”. But the fact of the matter is that this rhetoric only hits a small subset of the larger audience. What’s key is full and constant evaluation and re-evaluation of people’s overall sexual habits, with a focus on risk reduction. How do we play safely, feel supported, and, if desired, engage in mind altering experiences in a positive way? One way is to provide comprehensive education and support, which the UK has already built a platform for. I hope that by constantly talking about all these issues, it translates to positive change across the Atlantic and beyond.

Stay in touch on Instagram: me and Bespoke Surgical.



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Dr. Evan Goldstein

Dr. Evan Goldstein

NYC Gay Surgeon discussing ASS: A\rt, S\cience, and S\ex