It was the 1960s. Both straight and gay people embraced the sexual revolution. The result? An explosion of STDs, and then, 30 years after it began, over 500,000 were dead. The HIV virus had appeared on the scene.
In this era of confusion and horror, gay men embraced whatever solutions were available, including experimental drugs to stop the deaths from AIDS, and for the first time, condom use became a part of gay life.
Today, the AIDS epidemic is over in the US. It has morphed into the HIV epidemic, with a steady 50,000 new infections a year. Individuals are still dying, but in the bigger picture, this is a largely silent epidemic.
Individuals who survived the AIDS epidemic, having lost partners, brothers, sisters and even parents, are still shell-shocked by the carnage it wreaked on their lives.
The younger generation, and those older individuals who came out late, like me, were insulated from the plague. Individuals who could be mentoring us are either dead or in relationships away from the scene.
What is left is a gay health infrastructure set up to fight one epidemic that has failed to transition to a new reality. This is largely due to grant requirements dictated by the federal government.
In the midst of this situation comes a blog post by Mark S. King. Mr. King is a former director of the AIDS alliance in Atlanta and also a contributing columnist for TheBody.com, which provides valuable information about gay health issues to the community.
The blog post's title: "Your Mother Liked It Bareback."
Some of the post is factual: One has a low risk of dying from HIV. Still, there are 18,000 deaths a year. Cigarettes do kill more people than unprotected sex does. HIV-positive men who are medication-compliant and have bareback sex only with those of a similar HIV status are at low risk; there is increasing evidence that men who are HIV-medication-compliant (a pathetic 28 percent in the U.S.) and have an undetectable viral load are basically unable to transmit the virus. And even if HIV-negative men have unprotected sex with HIV-positive men who are medication-compliant, they are likely to remain HIV-negative.
PReP has recently come onto the scene as another option. But is it feasible? Let's look at PReP. For one, the actual effectiveness of PReP is unknown; all the literature says, "Use with a condom." With barely 28-percent medication adherence among HIV-positive individuals, what is the assurance that anyone on PReP will be totally adherent? For HIV-positive guys to be drug-compliant requires 90-percent adherence, whereas PReP requires 100-percent adherence. And for anyone who thinks PReP is a panacea for dispensing with condoms, think about at least a few weeks of your body adapting to some really strong meds. Sure, some guys have no side effects. Others do! Mark mentioned that "some" insurance companies are paying PReP's cost (presently $14,000 a year). What value do you put on your money and your health?
Mark quotes a "survey done on Grindr" that found that the majority of men on that site bareback. This is not the only site where this is occurring. In fact, one prominent site is 100-percent bareback and hosts bareback parties in 19 cities in the U.S.
More and more men who last tested negative are looking for men to have unprotected sex. They are also looking for someone in the know to tell them that condoms are no longer required. Mark provides such an authoritative voice. Note one of the comments on his site regarding his blog post: "As a gay youth, it is SO REFRESHING to read this."
Just because more and more gay men are having unprotected (bareback) sex doesn't make it right! It just shows a lack of education and awareness of risk.
Unfortunately, the gay community is bombarded with ads promoting "one pill a day," which happy-looking gay men saying, "I'm pleased with my HIV regimen." These ads present HIV as an easily treated disease. Nothing could be further from the truth! HIV is not a treatable disease! It remains a manageable disease. The distinction is huge. Accompanying these ads are three pages of side effects, many of which require additional drugs to counteract. These pills are for life, not a one-time dose. Mark is concerned about condom fatigue. What about drug-adherence fatigue?
Mark calls barebacking a romantic, emotional, spiritual act of intercourse without a barrier. I call it an opportunity for a lifetime sentence of managing your HIV and a health-care cost shared by the government and health insurers of $20,000 a year (or more), with individual co-payments ranging from $0 to $7,000 or more a year.
In a way, I share Mark S. King's opinion that gay men are over condoms. Unfortunately, the potential consequences of unprotected sex are not mentioned, and they are huge. I am surprised that he does not direct his energy in a more productive way. Why not press for release of those microbicides that he mentions?
Meanwhile, the gay health organizations remain totally complacent in the midst of this epidemic. There is presently no economic incentive for anyone in the HIV field to reduce HIV infections.
Are 50,000 new inflections per year accepted as the new normal?