If you weren’t aware that Gilead recently started running Truvada for PrEP ads, I wouldn’t blame you: they’re exactly the sort of vanilla, stock-photo-and-fine-print yawners that you might expect from a pharmaceutical company. For a prevention strategy meant for men who enjoy dicks in butts au-natural, most outreach efforts have been about as sexy as burnt toast. As a gay filmmaker, I’ve been watching from the sidelines as a parade of ham fisted attempts have tried to move the needle. Frustratingly, less than a quarter of the men who meet the CDC risk criteria are on PrEP, despite four years of public availability.
I thought that we needed something bolder, something sexier, and something that reflected the realities of gay sex, so I raised a modest sum on Kickstarter (thanks Mom!), called in every favor I could possibly think of, and created my own video series. There’s naked guys (and actors of at least six different nationalities), sex toys, bondage, exploding glitter-filled condoms, lip sync, un-bleeped four letter words, a drag queen serving lemon jello in urinalysis cups… it’s deliberately as explicit as YouTube allows, and the furthest from high school sex-ed as I could get. I’m not a department of public health or a pharma company, so I don’t have to shy away from controversy. I went straight for the target market that would most benefit from PrEP: guys who don’t like condoms. To get their attention and signal that we get it, the first scene has activist Eric Paul Leue doing something that’s never been done in a HIV prevention video before: listing the reasons he doesn’t like condoms.
I know that it’s still taboo to admit that barebacking is a thing, but I think it solves the paradox of PrEP outreach thus far: PrEP is the best strategy for people who don’t like condoms, yet the organizations typically tasked with educating about PrEP can’t appear to endorse condomless sex. The subtext is still that barebacking is bad, and no one will start the conversation with their doctor if we layer it with so much shame. PrEP is about harm reduction, not harm elimination.
If a condoms-only strategy were working to stop HIV, we wouldn't need PrEP. The shocking statistic that got me started down this path was the CDC’s report in 2013 that only 16.9% of gay men use condoms consistently, and that number had been riding the down escalator for years, even before PrEP became available. If we’re going to beat HIV, we have to start talking to the other 83.1%, and we have to stop assuming that yet another clever billboard will suddenly make them religious latex adherents. Whether it's forgetting the condom at home, bodily incompatibility, decreased sensation, etc…, I believe prevention should address these concerns instead of dismissing them.
There's a lot of hand wringing about “the end of safe sex,” but the thing is, the definition of the term has evolved, and gay culture must evolve with it. Even the CDC has stopped using the term “unprotected” and now uses “condomless,” because condoms are no longer the only form of protection. Value judgements shouldn’t get in the way of enabling guys to make the best possible choices about their health, whether they have one partner or one hundred.
To be clear, The PrEP Project is not anti-condom. If you use one every time, I think that's great, and you should keep doing it; I’d never to presume to tell you that one is better than the other. Condoms are still the best way to prevent STIs, but in the big picture of gay health, HIV is still the biggest concern. I don’t think we should let the suggestion that PrEP may reduce condom use rates deter us, because all the reliable research thus far shows that the guys getting on PrEP weren't using them in the first place.
I’ve also heard the theory that the condom use rate is so low because millennials haven’t seen their friends die of AIDS. Among my HIV+ friends, none are dying of AIDS-related diseases. With all due respect to those who gave their lives to bring us to this moment in HIV treatment, the reality of the virus in 2017 is that with access to good healthcare (up in the air under the current administration, but that's a discussion for another day) they’ll live out the rest of their normal lives without much complication.
This doesn’t mean HIV is a cakewalk, or isn’t a problem worth solving, but I think we need to recognize that fear isn’t the way to end HIV—it doesn’t feel relevant to the lives of young gay men, and it isn’t fair to HIV positive men who have suffered enough stigma and shame. That's why it was important for me for the videos to emphasize knowledge over fear, and to explain undetectable status and TasP (Treatment as Prevention). Only 9% know that undetectable means uninfectious, so we have our work cut out for us.
I’m proud to be part of a new wave of sex-positive, shame free HIV prevention efforts that educate without judgement. There's a lot more to subtlety The PrEP Project than I can discuss here; you can take a moment to watch all four episodes played in binge-watch format at the top of the page (under 18 min), or watch and share episodes one at a time. I hope that bringing barebacking out of the closet provides a model for future efforts, where honest and open discussions about sex in the real world empower a new generation to end HIV transmission.