For many gay men, having safe sex isn't so much a choice as it is a requirement. After the AIDS crisis and the loss of hundreds of thousands of lives, the fear of contracting HIV was enough to scare you away from ever having sex without a condom or ever going more than six months without getting tested. The decades have gone by and medicine has made advancements towards providing people living with HIV long and healthy lives. There is no cure available, but a remarkable new drug has appeared on the scene, as of late, that prevents people who do not have HIV from contracting it. That drug is Pre-Exposure Prophylaxis, more commonly known as PrEP.
According to the CDC's website, Truvada (it's brand name) is taken in pill form once a day and is intended for people that are at high risk of contracting HIV. If someone is exposed to the virus through sexual contact or through the use of injection drugs, the drug prevents the virus from establishing a permanent infection. When taken consistently, the drug has a 92 percent success rate in preventing the contraction of HIV. The prescribed treatment also encourages the use of PrEP with the continued use of condoms.
Among gay men, this drug has, no doubt, changed the way people view HIV and living with it. For those people who do not have HIV and are in a relationship with someone that does, there is no longer a high risk of infecting your partner. The drug allows couples to engage in a more stress-free sexual life. The drug has also affected those sexually active single men with HIV that are now able to have a more regular dating life without the fear of scaring off a potential partner when the news of their status hits the table.
One demographic that has been greatly affected by the arrival of PrEP are young and promiscuous gay men living without HIV. Some have said that they feel like young gay men have a misconception that PrEP can replace a condom. "If there's no way I can get HIV, then why should I wear a condom? Everything else I could get can be cured..." The drug has been referred to by some as "the slut drug" that allows men to live in a world of sexual freedom again with many different partners as we did in the back rooms of the 1970's and 80's. Anonymous social media apps like Secret and Grindr now feature a large number of men boasting of their involvement with PrEP and their ability to have sex without a condom... All of these men are living without HIV, but more importantly, living without a fear of HIV.
HIV and AIDS had to kill off almost an entire generation of gay men in the United States to earn it's place at the top of the list of big, bad, scary things that can come from having unprotected sex. The fear of contracting HIV was real amongst the generations that came before us because they had to watch their friends and lovers die in their arms in vast numbers. The current generation of young gay men may have to watch as their friend gets a shot in their ass because it burns when they pee, and that's about as bad as it gets. Removing the fear from our generation has made us vulnerable -- comfortable. In some circles, PrEP has provided gay men with the illusion of complete safety and invincibility.
If gay men remove their condoms, will we see an increase in other sexually transmitted diseases like gonorrhea, syphilis, and chlamydia? If you read the fine print on the CDC's website about Truvada, the word "condom" is quite prominent and their use is highly encouraged, but do people listen? According to many gay men and what little exposure they have had to PrEP, the answer is no.
Perhaps the answer is to get the word out. A majority of people don't know enough about it to make a decision and those that know about it are split right down the middle. When I spoke to several HIV positive individuals, who requested to stay anonymous, they seemed a little skeptical that such a drug would actually work. One man mentioned that he still wouldn't want to assume that kind of responsibility because if the drug didn't work and his partner ended up contracting HIV, where is the finger going to point? According to one HIV positive young man I spoke with who is in a relationship with someone who is negative, the risks aren't worth it. "PrEP consists of the same drugs I put through my body, and sometimes, those drugs can be more aggressive than the virus. They have the potential to destroy a healthy body and what's the point in both of you hurting?" It should be noted that this individual is undetectable and he went on to tell me that they prefer to trust in the research and the facts that are relevant to them and their risk factors. They encouraged everyone else to do the same. In the end, this is a decision between one individual and their doctor.
Another question that has arisen is the question of cost. One HIV positive individual I spoke with shared that the cost of his HIV medication (which is different for everyone based on their individual insurance coverage) is $80 a day. For a medicine that is taken every day, that's $29,200 a year. Now, all of this is covered by one of many state run acts that assist HIV positive individuals, but how would it work for a completely healthy, HIV negative individual, seeing as the medications are basically the same thing?
This drug needs quite a bit more exposure and experience to win over the doubtful and the skeptical. Maybe our community needs time with this new-kid-on-the-block to see it in real time. Many clinics specializing in HIV testing are already embracing the drug and getting the word out as best they can, but is the information getting to the people that need it the most? Perhaps this is a case of "only time will tell," but one thing is sure -- that a majority of us, both positive and negative, still have questions.
To single gay men living with HIV, this drug is a glimmer of hope that increases their chances of a substantial relationship. To some couples living with one positive partner and one negative partner, this drug is a breath of fresh air that allows a stress-free sex life. To those single men living without HIV that view this as permission to begin our next sexual revolution, this drug has the potential to be a very dangerous gateway. Increasing the risk of many other sexually transmitted diseases and infections is a very true possibility that affects all of us, regardless of our status. In addition to the wonderful things PrEP provides, it also increases people's comfort and allows many to let their guard down to the other incredibly real health threats that could strike.
The arrival of HIV was an attack on a completely unsuspecting, unprotected and unarmed population of gay men. The result of that attack and the attacks that would continue for several decades is an estimated 636,000 people dead due to complications with AIDS since the 1970's. While medicine is changing every day, it should be noted that disease is as well. Gonorrhea, a living bacterial infection, is on it's way to building up an immunity and outsmarting our antibiotics. What will happen when we can no longer treat it? Who's to say our own bodies won't build up allergies or immunities to the drugs used to treat what gay men refer to as "common STDs?" Who's to say another major virus like HIV, or another strain of HIV like the incredibly dangerous African strain, won't make landfall here in the United States? And if it does, what will it find? An unsuspecting, unprotected, and unarmed population of gay men?
Scare tactics? Yes. But the scare tactics used to spread awareness of HIV worked. Modern medicine along with a true awareness of the virus has allowed HIV to no longer threaten many of us, including people living with HIV at this moment. It is no longer the death sentence it once was. But let's not forget what we had to go through to achieve this calm and serenity. Let's try and enjoy this freedom without tearing down every safety net we have in place...
PrEP has magnificent potential to prevent infection. It has the potential to provide many with a chance at a more comfortable life. PrEP most certainly deserves to be celebrated, but I would encourage the young gay population to be responsible and remember that none of us are invincible, no matter what powers we think we possess.