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The Hysterical Gay Men in the Attic

Randy Potts

April 10th, 2014

First, this, a black man talking about the first time he saw two black men, and no white men, in an airplane cockpit:

“Do you know, I can’t believe it but the first thought that came to my mind was, ‘Hey, there’s no white men in that cockpit. Are those blacks going to be able to make it?’ And of course, they obviously made it — here I am. But the thing is, I had not known that I was damaged to the extent of thinking that somehow actually what those white people who had kept drumming into us in South Africa about our being inferior, about our being incapable, it had lodged somewhere in me”

This is Desmond Tutu of South Africa, talking about how deeply ingrained are the things he heard about black people growing up that they still, to this day, after decades of fighting for his own equality, influence him.

I sense this same thing in gay people — the same tortured assumption that what we heard when we were growing up is really true, that gay men can’t control themselves sexually, that they will never bond for life, that they will never care about themselves or make good decisions when it comes to sex. This is the message from the people who call Truvada a “party drug” and it’s the same message older men put out there when the Pill came along, that women would use the Pill as an excuse to go wild, that they weren’t responsible enough to take a pill every day, that it would lead to a higher rate of STDs, etcetera, etcetera, etcetera. Yes, condoms are the only thing that prevent many STDs, but is that why many clinics won’t even mention to gay men that Truvada is out there? Imagine if Planned Parenthood refused to tell women about the Pill because they decided it would make women stop using condoms?

from The Saudi Driving Ban & The Five Weirdest Beliefs About Women

This is what’s happening currently with Truvada — we don’t trust gay men enough. We don’t think that if we tell gay men in a clinic that they can get on Truvada, and it will help prevent HIV, but they also need to use condoms to prevent other diseases – we assume that they will simply go wild, just like women were presumed to be wild, illogical people back in the late 60s/early 70s. Women proved those straight men wrong and we gay men can do the same.

Enough of all this religious shaming. I keep hearing that gay men don’t care about themselves, that they are stupid, that they need to just put on a condom already, and it sounds like preaching to me. It doesn’t sound rational. It sounds like a lot of us hate ourselves, or other gay people, like we’ve internalized what we’ve heard our whole lives about those partying, oversexed gay people.

We gay men are capable of making rational decisions as much as the next person. Human beings, in general, have trouble mixing arousal and logic, but this is not anything special to gay men – as Mark S. King always points out, our mothers liked to bareback too, and yet they were (eventually) trusted with the Pill and told to also use condoms to protect themselves fully.

We need to talk about Truvada and PrEP not because it’s a cure all but because it’s asinine that here we have this wonder drug and we can’t bring ourselves to educate sexually active men about it. There’s something wrong with that picture.

Comments

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Hue-Man
April 10th, 2014 | LINK

I don’t have a problem with a conversation but my perception is that there is an intense marketing blitz by the drug’s manufacturer and their paid campaigners to generate sales to those wealthy irresponsible gays. Heavy on the snark.

Maybe growing up in the time of Thalidomide or maybe seeing too many stories like the following have made me cautious in swallowing more pills, particularly when there are zero cost alternatives.

“Review of acne drug related to deaths first of reviews to be released on new website” http://www.theglobeandmail.com/news/national/review-of-ance-drug-related-to-deaths-first-of-reviews-to-be-released-on-new-website/article17882587/

I’m not trying to shame anyone who takes the drug, all I’m asking is to consider the possibility that your decision today may affect your health negatively over the rest of your life. Your life is more valuable to me than the profits the drug company is going to generate by selling the drug to you.

Randy Potts
April 10th, 2014 | LINK

Right, I agree that on an individual level there are many things to consider. I’m speaking strictly at the policy level – PrEP needs to be mentioned when a sexually-active gay man comes into a clinic so that it can be discussed as an option. Nobody likes Big Pharma, but this issue is bigger than any one drug maker. As I have had discussions online the last few weeks, the thing I keep hearing is that gay men are childish, wild, partying, irresponsible sex addicts who aren’t capable of sitting down for a rational discussion about drug possibilities or taking a daily pill. This attitude surprises me, and it seems to be informing public policy as well.

Ray
April 10th, 2014 | LINK

I have spend a good deal of time investigating Truvada and, fortunately, I have a very dear friend who is HIV+ and on the medication who has been helpful. I just don’t see any downside to taking it EXCEPT the outrageous cost.

I found where the first possible generic for Truvada wouldn’t come out until after 2017 – THREE YEARS FROM NOW! I keep seeing the warning that “no generic has been approved for Truvada.” Isn’t the exact same statement that was given for AZT?

It really bugs me that people view this medication as a party drug for the rich. You know what? I really don’t respect anyone who holds that view. While I’m not “rich” by any means, it still resent the idea that the drug gets stigmatize, seemingly, because only rich people can afford it. I guarantee you, if I had the bucks I’d be on this medication and let me take this opportunity tell the nay-sayer that if you don’t want to see this disease end, SHUT YOUR MOUTH! This drug is going already saving lives.

And now that we know that HIV is not being transmitted by people on the cocktail meds, we have a real chance to blow major holes in the AIDS crisis. We will probably have to do that in the face of the anti-vaccination-style morons. I’ve been on this planet for 60 years and I think that has taught me the value of the herd approach to eradicating a disease. I’m stunned to hear that people of my own generation seem to have learned nothing at all for that approach.

Matt
April 10th, 2014 | LINK

What a manipulative, shameless piece. Tee off with an anecdote that suggests your opponents on the issue are racist, check. Then accuse those opponents of being self-hating homosexuals, check. Claim that opponents are doing “religious shaming,” without providing a shred of evidence that anyone’s doing anything of the sort. Where is editorial? Mr. Kincaid and Mr. Burroway, can you please exercise some kind of oversight here?

Truvada is a wonder drug? Really? And the disgusting use of the term “bareback” — how about calling it what it used to be called, unprotected sex, rather than this term beloved of apologists and defenders of the very men who DO NOT use condoms?

We already know that some percentage of gay men choose not to practice safer sex, and we have the epidemiology statistics to prove it. I know, I know–shaming! Hatecrime! Silence him!

Left unexplained in this piece is the mechanism by which men who already don’t care enough about their health or the health of their sexual partners to use condoms or forgo risky sex entirely are going to be convinced to actually stick to a drug regimen, day in and day out, for years, even decades. We already have a problem with getting HIV-positive men to take their drugs regularly, and these are men who will *die* if they don’t take those drugs. Ever hear of pill fatigue? The CDC estimates that less than 1/3 (!) of HIV positive men have their HIV infection under control through regular adherence to a drug regimen.

Seriously–this kind of manipulative junk, this whole “if you disagree, you’re a self-hating gay” kind of thing, is this the direction Box Turtle Bulletin is going? Why is this guy writing here?

Matt
April 10th, 2014 | LINK

The USA Today article you linked to makes it clear that the drug is being used *exactly* in the way you claim it won’t be: by men who don’t use condoms. We get a quote from an “enthusiastic Truvada user” who gives us the delightful oxymoron “responsible condomless sex.”

Another quote from the article that describes exactly what you’re doing in your piece: “Personal responsibility for one’s actions has simply been thrown out the window in a community in which we are too often concerned about stigma and moral judgment,” he wrote. “We dare not speak against the reckless behavior of others because we wring our hands over the omnipresent worry that we will shame one another.”

Tom in Lazybrook
April 10th, 2014 | LINK

I remain deeply troubled by Truvada because I see Gay men REPLACING condoms with Truvada.

Truvada with a condom. Good
Truvada without a condom. Just substitute one problem with another.

We shouldn’t stigmitize people who have a good reason to go on Truvada (serodiscordant couples for example). We shouldn’t stigmitize those who have HIV.

We SHOULD be stigmatizing barebackers and their advocates/apologists. They put themselves, and more importantly, our community at risk.

Truvada is a wonderful tool. But it appears to be used inappropriately IMHO.

I’m sorry, but so long as I see this explosion of barebacking advocacy and the paucity of condom advocacy by the ‘no stigma’ crowd, I remain deeply troubled by the response our community has had to the introduction of Truvada. I’m deeply concerned about MDR and XDR STI’s getting into the community as well as an epidemic of Kidney problems from users of the drug.

Am I glad the drug is there? Yes. Do I think we as a community are losing an opportunity to be healthier as a result of having the drug? Sadly, yes as well.

Matt
April 10th, 2014 | LINK

Truvada is very obviously used by men who do not practice safer sex, and it only protects against one thing — for now. What happens when the next bug comes along? The CDC has been putting out warnings continually that a number of STDs are becoming completely resistant to antibiotics, and don’t forget that, just as gay men of the 1970s didn’t know about HIV, it’s very possible that us gay men of 2014 don’t know about the next thing to hit. Yet a large subset of gay male culture refuses to change, and the sex culture of the 1970s never dies. The bugs adapt, and we don’t.

Randy Potts
April 10th, 2014 | LINK

@Matt, I definitely am not attempting to demonize those who don’t take Truvada, but I’m also trying to accurately reflect the pushback against even discussing it. As far as the cost goes, that’s definitely an issue for many people, and one that could be ameliorated with better policy, if that’s the road we chose.

And to Matt and Tom, I agree that there is potential for or perhaps even documented evidence of riskier behavior. The same, however, was likely true when the Pill was introduced. Just because not everyone is going to use a medication responsibly or in the way we would like doesn’t seem enough of a reason to muzzle its discussion at clinics as a potential method of addressing a big problem.

Matt
April 10th, 2014 | LINK

That other site you linked to is really disgusting. It’s a straight-up argument for and romanticization of unprotected sex. We’re told it’s “the romantic, emotional, spiritual act of intercourse without a barrier” — right, like every craigslist/grindr hookup with some random dude you have no intention of seeing again possesses those qualities. Again, where is editorial? So now Box Turtle Bulletin is just straight-up publishing defenses of unprotected sex? That piece notes that at the height of the AIDS epidemic about the same number of gay men weren’t using condoms as now. Yeah, that’s why we had an AIDS epidemic. You know what’s anti-gay, what really qualifies as self-hating gay stuff? Your piece. This kind of thing causes more hurt, suffering, and death to gay men than conservative Christians could ever do even in their wildest dreams.

Ben
April 10th, 2014 | LINK

Ugg, the shaming from Matt is awful.

Do you really think anyone with the desire and discipline to take Truvada daily is going to skip out on using condoms?

Condoms of course, while being good, are still not as effective at preventing HIV as daily Truvada regiment. Condoms good, condoms + truvada, best.

Plus there are plenty of countries besides the US that do not allow private enterprise to make a profit at the expense of people’s health. Most countries in Europe have socialized healthcare, who provide HIV medication, and Truvada for free, or at extremely low cost, so any indictment of Truvada as a rich gay’s toy, are extremely regionally myopic.

Randy Potts
April 10th, 2014 | LINK

Matt, unfortunately, you prove my point — words like “disgusting” can’t guide public policy. We can preach at gay men all we want and talk about how they “should” behave but that, again, smacks of a religious approach. Public policy is most effective when it engages people where they are. It can steer, it can suggest, it can provide direction, and that’s what I’m asking for via a discussion of PrEP and what it might mean for the HIV epidemic. Mark King is not advocating bareback sex; he is discussing it as an existing behavior that is not going to go anywhere, for straights or gays. Public policy needs to take that into account or it risks irrelevancy.

Matt
April 10th, 2014 | LINK

Saying that people can do one thing and should not do another is a “religious” approach? If you want to talk public policy–by your logic public policy is itself impossible, if we cannot talk about what people should and shouldn’t do. People should refrain from unprotected casual sex, because it causes suffering, misery, and death — (check the CDC: AIDS remains a leading cause of death of young black men *today*.) There’s nothing “religious” about it.

Mark King is not advocating unprotected sex? The “romantic, emotional, spiritual act of intercourse without a barrier” (his words)?

Accepting that something is an existing behavior that is not going to go anywhere is a CHOICE. We do not say that about war, or racism, or, indeed, about homophobia–yet all these things have been with us and have been the norm for most of human history (with exceptions). Deciding that unprotected sex is not going anywhere is what people decide when they are not willing to change or deal with the work of changing–what’s really meant is “well, I’m going to keep doing it.”

Matt
April 10th, 2014 | LINK

@Ben — the USA Today article makes it clear that the people defending/using Truvada are people who don’t wish to use condoms. Note the guy who’s an “enthusiastic Truvada user” who talks about “responsible condomless sex,” leaving such a concept undefined, of course!

At the root of it all is the belief that somehow we can solve the problem of HIV and other STDs without changing our behavior and choices. I can understand why this belief is very appealing to a lot of people. “I want my problems to be solved without me having to actually change my behavior.” And not only that, but increasingly men who not only practice but promote unsafe sex want to be affirmed in that choice.

Matt
April 10th, 2014 | LINK

“Just because not everyone is going to use a medication responsibly or in the way we would like doesn’t seem enough of a reason to muzzle its discussion at clinics as a potential method of addressing a big problem.”

What evidence is there that even 10% (to pick a statistic at random) of the drug’s users intend to use it in a responsible manner? The USA Today article you linked to doesn’t provide any (it suggests the opposite) and you don’t either. If you want to have a discussion, provide some evidence! But instead, your entire post consists of implying that people who disagree with you are the equivalent of racists or are self-hating gays. You have no argument.

Matt
April 10th, 2014 | LINK

Do you really think anyone with the desire and discipline to take Truvada daily is going to skip out on using condoms?

I’m having a hard time finding a single person arguing for Truvada who isn’t a vocal proponent of unprotected sex.

A scan of the articles on Truvada picked up by Google suggest that it is promoted heavily by people who openly do not practice safer sex — Rich Juzwiak, the Gawker unprotected sex apologist (I wonder how many young men, thanks to his normalization of the practice, have found themselves positive?) for example, who says he has unprotected casual sex “on occasion” yet considers himself “always safe” because, apparently, he doesn’t feel that he risks things “too often.” There’s also an article about a serodiscordant couple in which one of the two members of the couple makes porn films featuring unprotected sex.

Matt
April 10th, 2014 | LINK

One of the worst things about this piece is the claim that “our mothers” liked to have unprotected sex. Notice how the difference between regularly having unprotected unsafe sex with random guys you do not love and have no intention of ever seeing again and having sex in the context of, say, a monogamous marriage is totally ignored. The whole piece is a disaster of ignorant and deliberately misleading analogie. Speak for yourself about your mother. What an impoverished view of human sexuality this piece represents.

Mark F.
April 10th, 2014 | LINK

I think there is little question that Truveda and other anti-viral drugs increase unprotected sex because they reduce the risk of contracting HIV. But, so what? Overall, they are a good things. Why all this moralizing and shaming? People are entitled to make informed decisions about their sex lives. I have barebacked a few times this year , despite being HIV negative. But I made an informed decision. If you don’t like it, too bad. I’m not going to be shamed because I have not used a rubber every single time I’ve had anal sex.

Matt
April 10th, 2014 | LINK

“But I made an informed decision.”

What’s informed about it? And what does this even mean?

Being aware of the consequences of an immoral action does not lessen culpability for taking that action, it heightens culpability.

You were informed that you were running risks with your health? Is that what you mean? But HIV is a collective issue. It’s not just about you, and what you want; HIV affects everyone. It affects your sexual partners, and it affects all of their future sexual partners, and so on in ever widening circles. AIDS remains a leading cause of death of young black men to this day (the CDC confirms this). Black men are at especially high risk of becoming infected *precisely* because rates are already so high in black communities, causing every single encounter to be higher-risk; in this way, each new infection builds on future infections, rates increase overall, and everyone is affected. Your actions have consequences not just for you, not just for your primary sexual partners, but for all of us. The nature of communicable disease is that it spreads beyond our individual ability to control it; therefore, your choices impact people beyond yourself; therefore, when you act as if it’s your life or your health to throw away, you hurt the people whose lives you may help to take with you.

ebohlman
April 11th, 2014 | LINK

I think it would be productive for everybody in this thread to try a thought experiment: what if we were talking, not about chemoprophylaxis, but a vaccine against HIV? Would your positions be any different and if so, why?

Jim Burroway
April 11th, 2014 | LINK

I think Ebohlman makes a great point. Something to think about here.

I also wonder what the reaction would have been back in 1996 when HAART first came out. What if they had understood that they already had the building blocks for a prevention tool against infection? Can you imaging the demands to make it available ASAP for everyone, and not just those who were HIV+?

As a seronegative man with an HIV-positive partner, I am appalled at all of the slut-shaming that goes on against people with AIDS, as well as against those who are taking responsible steps to protect themselves.

Hue-Man
April 11th, 2014 | LINK

Since I just got booster shots for Tetanus/Diphtheria, Pneumococcal, and Hep B yesterday (at zero cost to me thanks to socialized medicine), I would get an HIV vaccination on the same basis, i.e. I’m not an anti-VAXer and I don’t have the same concern about long-term side effects. Either the vaccine is effective or it isn’t.

On the cost side, my provincial government will do the math but the BC Centre for Excellent in HIV/AIDS estimated the lifetime treatment cost per capita of HIV at $368,000 in 2008. http://www.cfenet.ubc.ca/news/releases/increased-coverage-with-hiv-therapy-could-reduce-transmission-and-generate-health-care

Of course, they would be able to negotiate a lower price than “retail” but there seems to be enough range for vaccine developers to make money.

On the ethics and putting aside exposure to other STDs, there should be the same issues as my Hep B booster or seasonal flu vaccine – zero or near zero – since a virus is a virus is a virus.

My caution about Truvada is unaffected.

L. C. Burgundy
April 11th, 2014 | LINK

Really, BTB has devolved to approvingly posting links glorifying unprotected anal sex? What is up with this place lately? Stick with the original research and ditch trolling your readers.

Gene in L.A.
April 11th, 2014 | LINK

L.C. Burgundy and Matt, I do not see BTB “glorifying unprotected anal sex.” The ad hominem is flowing freely today. Let’s not attack each other, but instead talk about the issues. Disagreeing with your position is not equivalent to endorsing–much less “glorifying”–its opposite.

Ben
April 11th, 2014 | LINK

It’s a biased article with a few anecdotal quotes trying to paint every Truvada user as a sex crazed barebacking slut sleeping around every night with multiple new partners.

In the end, even if that were true, what is more important? Results, or your moral high ground?

We have had decades to let “just put down the spoon” take an affect on rising obesity rates, no effect.

We have had decades for the religous right to “abstain til marriage” to make contraception and abortion unnecessary, to no effect.

How many decades do we need to wait to see that humans are going to make imperfect decisions, and sometimes we need to use our collective conscious to make available plans, laws, science, medicine, etc that addresses these problems?

Do you really think a few decades of moral shaming is going to all of a sudden work with anal sex when it hasn’t for obesity, teenage pregnancy, and other STDs?

Jack
April 11th, 2014 | LINK

Isn’t there something morally questionable about expecting insurance to spend $13,000 a year so you can have more satisfying sex?

Randy Potts
April 11th, 2014 | LINK

@Jack, that’s a good point. One thought is that if we do decide it’s a public policy priority to encourage sexually-active gay men to be on PrEP then we need to also work to bring bring down the cost, which can be done if a generic is brought out faster, for example.

Jim Burroway
April 11th, 2014 | LINK

Isn’t there something morally questionable about expecting insurance to spend $13,000 a year so you can have more satisfying sex?

Anti-gay activists boil everything we are down to “just having sex.” And now, quite a number of gay people are boiling the decision to go on PrEP down to just “having more satisfying sex.” While cost is a legitimate concern, it should be dealt with separately from the question of PrEP itself and the attitudes surrounding those who make the decision to go on it.

Is sex nothing but recreation? For some, perhaps, and more power to them. But as Randy asks, where is the evidence that an HIV-prevention message that was devised in 1986 is still the only appropriate message today, given the rising rates of infection.

But I reject the idea that sex is nothing but recreation. What’s more, I believe that we are every bit as entitled to a satisfying sex life as anyone else. That’s the point of King’s article that Randy pointed to.

This is an important message for those in serodiscordant relationships, but should not be limited just to them. Just as every woman can decide to go on the pill or IUD for whatever private reason that she wants, whatever the moralizing that may come at her from those who don’t approve.

Ben
April 11th, 2014 | LINK

“Just as every woman can decide to go on the pill or IUD for whatever private reason that she wants, whatever the moralizing that may come at her from those who don’t approve.”

Well put!

Richard Rush
April 11th, 2014 | LINK

Jack, to play devil’s advocate:

Isn’t there something morally questionable about expecting insurance to spend $xxx on HPV vaccine so you can have more worry-free sex? (We already know that lots of True Christians™ do feel that way)

Isn’t there something morally questionable about expecting insurance to spend $xxx a year on cholesterol lowing medication so you can have more satisfying meals?

Isn’t there something morally questionable about expecting insurance to spend $xxx on multiple vaccines so you can have a more satisfying social life?

To me, the only legitimate distinction between your example and mine is the exorbitant cost of PrEP. I see nothing more or less moral about having satisfying sex than I do about having satisfying meals ~ even if they involve a wide variety of partners and/or foods.

Alfie
April 11th, 2014 | LINK

Your analogy to the contraceptive pill is interesting but only works so far. Most, not all, women take the pill to control WHEN they want to be pregnant. Truvada isn’t taken to control when you want to acquire HIV. Both are lifelong but at least the kids get to go off and lead independent lives….HIV will be with you forever and ever. Truvada is not without some side effects (as is the pill) and so it should be taken with care. Personally I think there is a place for PrEP: discordant couples, those that feel vulnerable e.g. an HIV positive partner who insists on unsafe sex.

Some of the points raised are interesting but for me there are a few fundamental differences. It’s almost like we’re saying that safe sex is basically no sex and that why we need another alternative such as Truvada because we’re sexually trapped by condoms. Not true. People should be encouraged to have safe sex all of the time and that is an enormously important public health message. Some condoms could prevent a lifelong viral infection that WILL have an impact on your health. I think the average guy man who takes care of their sexual health will not need PrEP. It’s not like we don’t know that unprotected sex is very risky. What the discussion is how much should we accommodate those who absolutely refuse to have safe sex? HIV physicians have tip toed around this issue for quite a while. We don’t need any shaming but we do need to be a little bit more aggressive in our safe sex education.

Joe Beckmann
April 11th, 2014 | LINK

This is a much, much bigger story than you’ve actually broken. Almost 20 years ago nurses discovered that, if they stuck themselves with a potentially dangerous needle, all they had to do was a dose of AZT (when it was the only thing around). Almost 10 years ago doctors knew that HIV+ people in treatment had a low enough viral load to make their risk of transmitting the disease minimal at best. And at about the same time doctors discovered that Post-Exposure Prophylaxis (PEP) works almost as well as Pre-Exposure: a regimen of antivirals will kill the new infection before it gets established.

In spite of this the HIV “establishment” prefers to promote condoms. It is appallingly obvious that they are afraid of themselves and of the reality that virtually any anti-viral that works (many more than Truvada, particularly from Brazil and India) will work to kill the transmission before, during or after exposure through sex, needles, or “a party.”

Nothing is perfect, so sanctimonious purity will probably keep you really safe. But, compromising sanctimony, a shot or a pill before or after will protect you if you’re HIV-, and maintaining your dosage will protect your partner if your in a sero-discordant relationship (long, short, or temporary).

chiMaxx
April 11th, 2014 | LINK

Bareback sex IS normal and natural. There is nothing natural about a condom. They don’t grow on trees. Part of the sex drive is not just to feel pleasure but to share our seed.

HIV is not a moral judgment. It is a disease.

People do not have bareback sex because they have a death wish. With rare exceptions, they do not do it because they want to acquire or spread a disease.

A significant number of people are having condomless sex, at least sometimes, or STDs and HIV wouldn’t be spreading at the rate they are. If those people are HIV-negative and on PrEP and taking it regularly, they are NOT having unprotected sex: PrEP *IS* protection against acquiring HIV; it just happens in the morning when you shave and brush your teeth rather than during the moment of passion. (Would they also be wise to use condoms to protect against other diseases? Certainly, but that’s a different issue.)

If these people having condomless sex are HIV positive and correctly and regularly taking a antiretroviral therapy (ART) that consistently reduces their viral load to undetectable levels, they are not having unprotected sex; The recent Partners study demonstrates that antiretroviral therapy (ART) *IS* protection against spreading HIV: http://www.healthline.com/health-news/hiv-no-virus-transmission-in-mixed-hiv-status-couples-031014 .

People using PrEP and ART correctly are protecting themselves and their partners against HIV whether they use condoms all, some or none of the time. This is true whether these people are consistently monogamous, sleeping with someone new every night, or somewhere in between.

As to insurance companies: They can do the math. A year of low-dose Truvada (the current PrEP regimen) is less than a year of ART. ART is for the rest of the patient’s life, while the cost of PrEP will come down when Truvada’s patent runs out.

Matt’s arguments are immoral.

Only you and your doctor can decide if PrEP is right from you. There are costs; there are more doctors’ visits, you have to take it every day; there may be side effects–those are all worth weighing as you consider the question. What isn’t worth weighing is messages trying to shame you for how, how often or with whom you have sex. Don’t let shaming from Matt, the AIDS Healthcare Foundation, friends, peers, yourself or even your doctor stop you from considering PrEP as either an additional or an alternative form of protection against HIV.

Alfie
April 11th, 2014 | LINK

I would question why people have unprotected sex. I would say a lot of it is that there is less fear of dying from HIV/AIDS due to the huge improvements in ART.

A year’s supply of condoms is a lot cheaper than PrEP or ART and you don’t have to take a drug which is for a disease that you don’t actually have.

Randy Potts
April 11th, 2014 | LINK

@Alfie, I agree that the analogy is not perfect, but the question “What the discussion is how much should we accommodate those who absolutely refuse to have safe sex?” is the same question that could be asked regarding women and the Pill, when instead we choose in 2014 to trust women with their own health decisions. Groups like Planned Parenthood do suggest that women use condoms, and they do educate about the Pill’s inability to protect from STDs, but they don’t put a judgement on women who rely solely on the Pill for protection. What I’m arguing is that gay men are not an especially hysterical group of people who behave more irresponsibly than other sexually active adults, and education efforts and advice from clinicians need to reflect that.

Michael Ditto
April 11th, 2014 | LINK

For the folks n the US who are worried about spending thousands of dollars and those outside the US speaking sanctimoniously about their low-cost and free Truvada, the United States just completed a massive systemic healthcare reform colloquially known as Obamacare. We now all have guaranteed access to health coverage that includes prescriptions, and there are few if any insurance plans that don’t cover Truvada, including Medicaid. Most plans have a mail order option that gets you three months for the cost of two copays. It is also likely that HHS will at some point classify PrEP as preventive medicine (what a concept!) thus making it available without cost to everyone, just as birth control is.

chiMaxx
April 11th, 2014 | LINK

Alfie:

PrEP is very effective protection against acquiring HIV. ART is very effective protection against spreading HIV. Both are very effective protection. Sex while on ART or PrEP is therefore *not* unprotected sex, regardless of whether condoms are used.

People are having sex without condoms now for the same reasons they’ve been having sex without condoms for all the millennia before June 1981.

Fear is great at causing people to change their behavior in the short term but sucks at causing long-term behavior modification. That’s human nature. And, yeah, fear doesn’t work as well now as it did in the 1980s, when every walk through a gay neighborhood put you face to face with the brave and scary sight of others living their lives with Ks and severe wasting and people’s datebooks were full of funerals.

Timothy Kincaid
April 11th, 2014 | LINK

I have a friend who has discovered that his insurance will cover PrEP. What’s more, since it is a preventative measure, he doesn’t even have a co-pay. Now he just needs to call his doctor and sign up.

This is, in his case, a very good thing.

My friend would be among the first to tell you that he’s a slut. Happily. He really enjoys sex and doesn’t have time to work on a relationship at present so Grindr and Scruff are his near and dear friends.

He hates condoms. For all the reasons that everyone else does: loss of sensation, diminished intimacy, breaking the mood, etc. He also is a top and makes some efforts to either sero-sort or note viral load. So whenever he feels that he can, he doesn’t use condoms.

Now we can all lament the fact that my friend is a slut or that he doesn’t use “safer sex” consistently and wring our hands and wag our fingers. But he doesn’t care what you think. He doesn’t care what I think. He mostly cares what his dick thinks.

He’s also an otherwise very focused and driven person (guess what, not everyone who hates condoms lacks discipline or character). He will have little problem adding a pill to his daily regimen.

So pretty much the choice is between saying, “bad! bad! bad!” or supporting his decision to hugely reduce his chances of sero-conversion.

I’ve taken to regularly asking him if he’s seen his doctor yet.

Priya Lynn
April 11th, 2014 | LINK

“So pretty much the choice is between saying, “bad! bad! bad!” or supporting his decision to hugely reduce his chances of sero-conversion.”.

I can and will do both.

Richard Rush
April 11th, 2014 | LINK

I totally agree with chiMaxx. Here’s my personal story:

During my initial years in the gay world, beginning in 1969, I was very sexually active with a multiplicity of partners (saying “slut” would be fair) for most of twelve years. I never used a condom, none of my partners ever used a condom, and furthermore, I never heard anyone ever talk about condoms.

Then in 1981 I met my husband, and have been 100% monogamous for 33 years. I truly believe that meeting him saved my life. And, to this day, I have never used a condom.

In the highly unexpected event that I became single again, the chances are high that I would still not use a condom, as I find condoms to be a major sexual turnoff. But, I certainly would use PrEP. If PrEP did not exist now, I’d like to say I’d use condoms, but I’m not so sure.

From my perspective, preaching about condom use is not a whole lot different than preaching about abstinence.

Nathaniel
April 11th, 2014 | LINK

Amongst all the debating about moralless sluts and the sanctimoniously chaste misses a massive group in the middle. One of the (many) reasons HIV is on the rise in young black men is the shaming men who have sex with men (MSM) receive from their community. This is the same reason teen pregnancy and abortion rates are high in the evangelical community. When we make sex and the desire for sex to be a shameful thing (either in general or specifically between people of the same sex), we also shame the practices that would make sexual activity safer. I am still embarrassed to buy lubricants with my partner, afraid of the judgments of the cashiers, because, for that brief moment, our sex life becomes someone else’s business. Imagine the embarrassment of a teen trying to buy condoms (I went through that too, when I became sexually active); imagine the embarrassment of a teen showing up prepared with a condom, to a scenario they aren’t even suppose to want. Imagine the even greater embarrassment of a teen who has to go through a doctor (dealing with multiple people along the way) and a pharmacist to get and fill a prescription for a preventative pill; but at least you can take it privately, and avoid potential embarrassments when the sex actually happens. If Truvada/PrEP are better than nothing, why are we adding another layer of shame to an already problematic situation? If they are not better than nothing, where is your evidence? Before we can even have an adult discussion, we need to stop shaming sexual activity. Then, we can start asking the questions that can be easily answered with research.

Speaking of research, I would add my voice to those concerned for side effects and long-term effects of taking HIV preventative medication. My personal concern would be for how this could affect viral evolution and the long-term effectiveness of these drugs, particularly if efforts are no longer being put into creating viable replacements. However, I know that is not Randy’s particular concern for this piece, and questions like mine come after we get over the fact that people have sex and some people have sex less safely than others.

Tom in Lazybrook
April 11th, 2014 | LINK

Guys,

A few points.

1. There is zero, repeat zero, evidence that barebacking is safe. Even if you are taking chemo. Even if you don’t get HIV, you may contract or spread other STI’s. While your body is your choice. Understand that we as a community have a stake in what you potentially spread in the community. A new form of HIV? Hepetitis C? MDR Syphillis?

Even if you bareback, there is no rational basis to advocate that behavior in others, save a desire to find barebacking partners more easily.

So yes, if you advocate barebacking, you are a problem. And you should be shamed as some selfish whore who puts his sexual gratification above all else, including the health of the person you are sleeping with and your own health.

Shaming of bareback advocates is in order.

2. Truvada has side effects in a significant number of people, some of which are serious. Kidney and bone loss are included in that list.

3. Truvada is a useful tool for after the fact exposure and for monogamous couples in serodisconcordant relationships.

L. C. Burgundy
April 11th, 2014 | LINK

Seriously, this article that was linked doesn’t glorify unprotected sex? That’s what the entire bloody article is about: How awesomely superior unprotected sex is.

“gay men engage in the romantic, emotional, spiritual act of intercourse without a barrier”
“This double standard is ludicrous. Your mother barebacked. It is a natural and precious act that has been going on, quite literally, since the beginning of mankind.”
“Maybe you have the uncanny ability to enjoy sex while your penis is wrapped in latex.”
“We accepted that we would use condoms – at the time it was the only “safer sex” option that existed – until whatever time the crisis abated.”

Also pardon my skepticism at pumping other-wise healthy gay men full of a daily dose of expensive pharmaceuticals to accommodate anything-goes. If this was a $100 one-off vax for 10 years of protection, I’d be more excited, but it’s really 3650 pills, taken one a day, plus $130,000 for ten years of protection. Maybe it makes sense for sex workers or those at high risk of sex assault. Maybe for one half of a serodiscordant pair. But all gay men? Uhhhh…

But hey, the good ol’ carefree barebacking 1970′s will be back – until the next supervirus or completely treatment-resistent syphilis, Hep C, etc. is on the scene. Oops, sorry, I’m “shaming” people again. The whole supposition that widespread PRePping will not lead to risk compensation – which is not at all a “moral” judgment by the way, but rather scientific – is completely nuts. To wit: The second article link was basically an anthem for PReP so we can trash those gosh durn rubbers that all gay men loathe anyway. Yep, no risk compensation possibilities there!

Ben
April 11th, 2014 | LINK

Where has anyone, anywhere advocated Prep for every gay man?

The point is that it should be up to each person and their doctor, and the rest of the gay community should be no more trying to shame them, than religious fundamentalists shaming any gay sex at all, or unmarried teens using the pill.

The self righteousness from online commentators is sometimes astounding (cue the irony meter, I know).

Randy Potts
April 11th, 2014 | LINK

The whole point of bringing women and ideas of hysteria into this discussion is that it should help us look at this from a different viewpoint. If, as has been said in this feed by Tom and others, there is no such thing as safe sex without a condom, then every woman who gets pregnant has obviously practiced unsafe sex and should be shamed for doing so. We used to do this as a society, shaming all women who had sex outside of the bonds of marriage and we decided, eventually, that this shaming was, A, not working, and B, unbearable in a society that pretends to treat people equally.

What I’m suggesting is that we look for models that already exist, such as how Planned Parenthood and other groups treat sexually active women, for how we might approach PrEP at the clinical level. If it’s not appropriate to shame women for having unprotected sex, as all women who have children must at some point do, then how is it appropriate to shame men, straight or gay? We are not any more hysterical than women, nor are women any more hysterical than straight men. Among straight people the term “barebacking” does not exist; it’s known as sex.

A sexually active gay man who visits a clinic for advice and testing should be met with education about all the different approaches possible and armed with facts about what techniques he can use to protect himself from infection of any kind; after that, we need to give that man the same benefit of the doubt we have in recent decades given women. Anything less than that means our fight for equality is not really over, even, and especially amongst, ourselves.

Matt in VA
April 11th, 2014 | LINK

Now we can all lament the fact that my friend is a slut or that he doesn’t use “safer sex” consistently and wring our hands and wag our fingers. But he doesn’t care what you think. He doesn’t care what I think. He mostly cares what his dick thinks.

I’d like you to acknowledge the tremendous privilege this represents. Do you think all the HIV-positive people in the world are in a position to “not care what others think”–the people who depend on governments and NGOs keeping them alive through antiretrovirals and health care?

Think about ACT/UP. ACT/UP’s message was that the straight world needed to stop ignoring the plight of gay men dying en masse, that the straight world and the dominant straight society needed to come to our aid, stat.

Why exactly is that, when we as gay men apparently do not see the need to consider anyone else other than ourselves and what our “dick thinks”?

There is an incoherence here. The greater society is responsible for keeping us alive, yet we are not responsible for making better sexual choices.

Your friend doesn’t care what people think. Well, all of us who put ourselves in positions where our very lives are at the mercy of public health care, of the research scientists at the CDC, at politicians, we are all dependent in a profound way on what other people think. Your friend might be wealthy and able to pay his own way, but the majority of HIV positive people are not.

Trent
April 11th, 2014 | LINK

The discussion sounds desperate to try and blame policy for the increases of HIV infection among gay men. Studies suggest a majority of infections are from the primary partner. If your partner has unprotected sex and brings HIV home, shame exist on itself without anyone shaming you. Lgbt can argue amongst themselves over truvada, but remember minors are protected against adults discussing sex. So how are kids to learn there is a resurgence of HIV infection among them. Again, we come back to policy. Gay men are arguing about truvada while activist and politicians are staying quiet on the soaring HIV increases among youth (kids), minors. Policy, sure go ahead and scream about sex ed. If you have kids in school you know they talk about HIV and STDs. No, parents are not going to allow talking about how you can get HIV from fisting. I disagree with those who loudly yell how we need comprehensive sex ed. Teaching children every sex position and kink is not the solution in solving STDs. Teaching youth how high the rates are and having politicians address the problem with the public will help. Teaching youth that you make bad judgments and decisions when high on drugs and alcohol will help. Shaming every gay man to take truvada won’t. You have to take resources from the elderly or education or the homeless to pay for truvada. You have to take money from the defense department. Go ahead and fight for the funding to pay for gay men to be able to have sex and not get HIV. Save some funding for the other STDs truvada doesn’t protect. Save funding for who knows what will happen with the next regime which takes over. Staying quiet on the increases among lgbt youth will never help.

chiMaxx
April 11th, 2014 | LINK

Before 1981, barebacking was just called sex.

PrEP IS protection against acquiring HIV.
ART IS protection against spreading HIV.

Therefore:
Condomless + PrEP/ART ≠ Unprotected (with regard to HIV).

Are there numerous other pathogens that make using condoms a good idea? Hell, yes.

Nonetheless, someone who is made the conscious decision to take PrEP every day as directed and follows through clearly does not put “his sexual gratification above all else.”

And LC Burgundy, like it or not, but all four of those statements you quote are true. Even when it’s down and dirty and raunchy in a room with 50 other guys, sex is romantic and emotional and spiritual, and condoms really do diminish that sense of connection. Your mother barebacked or you wouldn’t be here. Condoms do diminish the physical pleasure in sex. And condoms were sold in the 1980s as the best option we had until they found a cure or a vaccine.

Condoms are protection
PrEP is protection.
Both work. Both have unpleasant side effects. Make your own choice which one suits you best, or combine them for super-duper protection.

Matt in VA
April 11th, 2014 | LINK

A pill that protects against one particular STD is not enough. If the basic mechanism for transmitting disease continues to be employed — and unprotected anal is a very effective mechanism — then other diseases, other bugs, will come along to exploit that, because evolution is a real thing. That’s not moralizing, that’s not religion, that’s science. Again, I encourage you to look at the CDC alerts about the increasing drug resistance of various STDs.

It’s not merely a matter of your body, your choice–it’s a matter as well as how many people you might bring down with you.

If you believe that ACT/UP was right in its advocacy, that society as a whole, even the mainstream straight society, even the Republican holding the purse strings in Congress, has a responsibility to take care of people who are sick and dying, then consider what responsibilities you, or your friends, have in turn. If you believe that you don’t have responsibility — that it’s a matter of “what your dick thinks” — then, again, consider checking your privilege.

chiMaxx
April 11th, 2014 | LINK

Matt:

The numbers of HIV infection show that the Condom Code HAS NOT WORKED, that it DID NOT WORK even at the height of the disease. The numbers of new infections didn’t start coming down until there were treatments that brought the level of the virus down to undetectable levels.

What do they call doubling down on the same failed strategy and expecting it will turn out differently next time?

Priya Lynn
April 11th, 2014 | LINK

I don’t believe you Chimaxx, based upon how successful promoting condom use has been in Africa in reducing AIDS.

Matt in VA
April 11th, 2014 | LINK

What do they call doubling down on the same failed strategy and expecting it will turn out differently next time?

The failed strategy is the “50-man” Dancer From the Dance-style sexual culture of the 1970s that you wish to promote.

chiMaxx
April 11th, 2014 | LINK

Matt in VA:

That culture NEVER went away. It never will. There will always be people in it. Few people stay in it their whole lives. Some people never participate. But a lot of people take a plunge to try it out for a few months or a few years–for all sorts of reasons. Straight people, too, in pickup culture.

Do we just write those people off? Or do we offer them protection that works for them, so that those who decide after a few years to go back to a more sexually modest life for themselves have a chance to remake themselves without a deadly disease?

What if Timothy’s friend 10 years from now decides to settle down and be monogamish? Do you *want* him to have to bear the Scarlet A of AIDS to mark his immorality? Or do you want to give him his best chance to come out the other end of that life of sexual profligacy without HIV and with a chance to settle down with another HIV-negative partner?

To me the slut-shaming, bareback-shaming stance seems to revel in treating a deadly disease as a deserving mark of shame rather than as an epidemiological problem that we want to attack with ALL of our available resources.

Timothy Kincaid
April 11th, 2014 | LINK

Matt

If your argument is that he owes it to ACT-UP – who fought hard to advance drug research – and to the research scientists at the CDC to NOT use what research has found, I don’t think he’ll find much logic in that.

And appeals to “privilege” really have little effect on those who do not feel that they have some burden of guilt due to the hue of their skin. Most people who were born poor and worked hard all their lives (such as my friend) laugh at that.

chiMaxx
April 11th, 2014 | LINK

Shaming can feel good to the one doing the shaming, but it doesn’t work: It more often pushes people to stop listening to you than to change their behavior.

People are more like bonobos than other animals. Sex is social. Acknowledging that fact is not promoting it.

It pains me to see PrEP pushing a part of the HIV prevention community to adopt the stance that in the 1980s and 1990s was the province of only our worst enemies–leveraging the spectre of disease to shame other men over sexual behaviors they personally disapprove of and treating disease like a scarlet letter of shame.

Yes, condoms are good. Yes they prevent against a whole host of other diseases the PrEP doesn’t I’ve said so repeatedly and never said anything different.

But we never were able to get everyone on board the “use a condom every time for the rest of your life” bandwagon, and we never will. I want to use the tools we have to protect those people against HIV, too.

chiMaxx
April 11th, 2014 | LINK

addendum:
“But we never were able to get everyone on board the “use a condom every time for the rest of your life” bandwagon, and we never will. I want to use the tools we have to protect those people against HIV, too.”

That’s something we all benefit from, because if they never catch HIV, they will never pass it on.

Timothy Kincaid
April 11th, 2014 | LINK

chiMaxx,

good point.

Even if some folks care nothing at all for those Horrible Sluts who really should get what they have coming (how dare they be negative when other people much less slutty are not?!?), you’d think that they would at least be happy that the Horrible Sluts aren’t going to pass on the virus to the poor innocents who fall victim to their charms.

Trent
April 11th, 2014 | LINK

Homosexual sex is a public health issue. Telling people that it is natural and right leads the next generation more delusional. Coming of age and engaging in homosexuality puts youth at greater risk. This generation of young people have been told homosexuality is love. Do straight parents teach their children that sex equates love. Is the 13 year old aware of the twist, turn, kinks, STDs, groups, varied sub cultures of lgbt. No, not at all or could he/she. Most alarming is this generation is ignoring the next coming of age lgbt youth by fearfully, criminally hoping the masses stay quiet on std rates for lgbt.

Lgbt rights advocates know that the public is buying into the live and let live, love is love crap while at the same time paying for the meds to keep them alive.

one bad batch of meds goes out and hundreds of thousands of gay HIV infected men could die. Contaminated medication has unfortunately been recalled after it was to late before.

This next generation of lgbt youth coming out has no idea of the infection rates among them and think love is love. Blinded by the same people screaming for their rights.

We are winning you hear. Yes you won the same disregard for marriage as heteros. The same right to get STDs and commit adultery. You won the equality of no one valuing marriage, remember that the next time you’re cheated on or you stray. You won the right to be legally responsible for a childs life. who came into the world having lost what no child should lose, their mother and father. Remember that child you won the right to have, is growing up in the most std infected sexually active generation. You won your rights and the right to fight for your entitlements. the victim, every person is fighting for the same money you need to keep you and your family alive.

Matt in VA
April 11th, 2014 | LINK

rather than as an epidemiological problem that we want to attack with ALL of our available resources.

Having unprotected sex regularly with strangers is using zero of our available resources.

Regular use of condoms has not been tried and found wanting, it has been found inconvenient by people who “think with their dicks” (not my words, note) and left untried.

Mr. Kincaid, if you lived in a village in Africa, would you try to stop a friend who was shitting in the water source from which other people drank? Some taboos are necessary. Does this hardworking, “I can’t be bothered with a relationship” friend of yours learn the income and citizenship of every person he meets on sex apps? Does he know that he’s not putting at risk the people for whom HIV remains, TODAY, a death sentence? The very nature of an epidemic, of communicable disease, is that it spreads beyond one’s individual ability to control it; what we do here in the US with our health insurance and our first-world hospitals and doctors directly affects what happens on the rest of the planet where the majority of people live. The commenter who talked about how some European countries also cover the cost of Truvada–what about Africa, Asia, and South America, where the ravages of HIV and AIDS are most severe? Are any of you harboring advance word that Mark Zuckerberg or Warren Buffett is going to bankroll the $100,000+ over ten years PER PERSON of this new drug? Or is something that is only to be enjoyed by Western, industrialized, rich countries, and apparently in particular by men who are quite open about forgoing condoms, with the consequences pushed off to the poor people on those other continents? That is what I mean by privilege. Hey, Mr. Kincaid, maybe your friend has gone with you on one of those gay cruises, and even docked in one of those poorer countries and found someone there who he was, you know, willing to take a couple hours out of his day for, but no more, because he’s a busy man! And maybe they could have had unprotected sex, and your friend could have come back to the US, while the other man could have continued living his life in a place where he’s dependent on Bill Gates to keep him alive, in a place those couple hours your friend was able to spare from more important things is the difference between life and death.

Matt in VA
April 11th, 2014 | LINK

Even when it’s down and dirty and raunchy in a room with 50 other guys, sex is romantic and emotional and spiritual, and condoms really do diminish that sense of connection.

Sounds like the 1970s all over again. Bring it right back, bring it back hard, right? Hundreds of thousands of gay men have died. Was your “sense of connection” worth it? Those men suffered and wasted away and died in ways that NOBODY deserves. If this is a spiritual experience for you, then it is in the same category as the “spirituality” of Aztec ritual human sacrifice.

If condoms were just something introduced among gay men in 1981 because we found AIDS around us, well — why 1981? Note that, given the incubation period for HIV/AIDS, that was too late to save the lives of tens of thousands of gay men. And now we’re supposed to put ourselves in the same position again, when we know bugs can come out of nowhere, when we’ve already experienced that once? Who’s the one suggesting we stick with a totally failed strategy, again?

Dustin Fibres
April 11th, 2014 | LINK

Will someone rebut Tim Lusk and Neil?

Matt in VA
April 11th, 2014 | LINK

If Truvada has a PR problem (and obviously even the company that manufactures it thinks so) I’d say a concise diagnosis of the problem is that it is something like a cholera prevention drug whose main champions are the same people who write paeans to shitting in the drinking water.

chiMaxx
April 11th, 2014 | LINK

I think 30 years of trying (the LA Cares: Play Safely campaign started in December 1984) is enough time to demonstrate beyond a shadow of a doubt that we are never ever going to get enough gay men to use a condom every time for the rest of their lives to stop the spread of HIV, and that it is time to recognize that reality and add other prevention messages to the mix. Even if they only go to a “privileged” group, if it keeps them from getting HIV it reduces spread of the disease to the rest of the herd.

Ryan E
April 11th, 2014 | LINK

The morality of condomless sex is irrelevant to the goal of eradicating HIV. Thirty years of ‘use a condom every time, no matter what, even in a LTR because you never know if he’s cheating’ has failed. Straights still have condomless sex, despite the millennia of consequences of having a bastard. Some gays didn’t use condoms at the height of the epidemic. Truvada is a tool for those who won’t/can’t wear condoms to avoid HIV infection. Every man should use condoms for anal and oral sex, every single time, and dental dams for rimming, and not kiss, so he can avoid the many STIs that exist. We all choose our level of acceptable risk. Truvada is another option that we can choose to use, or not.

Ryan E
April 11th, 2014 | LINK

I understand the passion around anything related to HIV. Much of this is related to age.
Guys 40+ remember when guys were dying constantly, and they can’t understand why anyone would not use a condom.
Thirty-somethings may have known someone who died, maybe not, and aren’t as absolute on guys using condoms.
Twenty-somethings likely don’t know anyone who died and AIDs deaths are about as real and relevant to them as the Challenger disaster.
Teens are teens. They make stupid decisions about all sorts of things.

Truvada could help make the consequences of decisions you find stupid a little less permanent. It offers another tool to help END the epidemic. There is no good reason to not offer this to guys who want to make an informed decision.

Matt
April 11th, 2014 | LINK

I think 30 years of trying (the LA Cares: Play Safely campaign started in December 1984)

Why stop at 30 years back? If we’re going to look at history, why stop there? It might be convenient for us, as gay men, to only look to the recent past, but why assume that the rest of the world will? If our message is, “expect that as long as we gay men are allowed to identify as such and live even somewhat freely, we will continue to engage in and defend the same 1970s-style-orgy practices that set off a worldwide epidemic, with more to come (look out, sub-Saharan Africa! Have fun!),” maybe the rest of the world will decide that their early way of treating us (the one that dominated, with some exceptions, for most of recorded history) was the better way.

If you’re going to say, well, this is the way it’s been ever since gay lib, so this is the way it has to be FOREVER, it seems to beg the question of why we only need to look at the way things have been since gay lib, doesn’t it?

Trent
April 11th, 2014 | LINK

Regarding women and the pill, they haven’t figured out how to abort HIV!

Timothy Kincaid
April 11th, 2014 | LINK

Ryan E,

I’m certain there is an age component. My friend is in his mid-30′s. I’m 50.

Matt,

I think that you have now clarified that it is not Truvada to which you object. Nor is it even a dismissal of the condom culture.

Rather, you have a moral objection to “70′s style orgy practices”. You are entitled to that objection.

However, your absurd rants about traveling to some third world country to engage in sex with a local are off-point and not serving your argument well. And a person’s choice to protect themselves with PrEP is metaphorically about as far from shitting in drinking water as one can get.

I’ll now let you have the last word on the subject. But as you jump to do so, please take note of the shark.

Tom in Lazybrook
April 11th, 2014 | LINK

I’m not against sex. I’m against barebacking. Its ridiculous to affirm or enable it.

The Truvada pushers could be positioning the drug as one that should be used WITH condoms. But instead, many have been pushing them as a replacement for condoms.

I’m seeing a marked and dramatic increase in people who have lost their damn minds. The people I’m running into (and away from) aren’t using Truvada because they are worried that they’ll forget to use condoms – They’re just not using them at all. And are PROUD of that.

chiMaxx
April 14th, 2014 | LINK

Tom in Lazybrook:

1. No matter how big your sample, recognize that it is not necessarily representative.

2. These people have probably been having unprotected sex most of the time for years and just not been talking about it or have been looking for any excuse to dump them because they hate them for whatever reason

3. Even–no, ESPECIALLY–if you disagree with these people about how they have sex or why they want to go on PrEP, you should be encouraging them to STAY on their Truvada and take it faithfully every day. It will reduce the number of them who get HIV by 95-99% and therefore reduce the number of partners they will pass it on to. Disapprove all you like, tell them they should be using condoms to protect themselves against everything from chlamydia and gonorrhea to syphilis and Hep C, but encourage them to stay on their PrEP regimen because it WILL protect not just them but all their partners against at least HIV.

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