My quest for PrEP

Timothy Kincaid

November 5th, 2015

truvadaToday Larry Kramer, the grandfather of ACT-UP, released a scathing indictment of the current status of AIDS research. And though he was in parts incoherent (gonorrhea statistics don’t speak to AIDS research funding), his frustration has merit. Bureaucratic structures don’t lend themselves well to efficiency and as decades slip by with the oft-promised cure remaining just out of sight, it becomes easy to agree that the National Institutes of Health are “more interested in Alzheimer’s than AIDS and Congress is not interested in AIDS at all”.

Kramer is the king of rage. His anger has propelled a life-long fight against institutional power, even as Kramer has gained access to levels that most of us could never achieve. And though many of his demands over the years have been met, his bleak view has never been at loss for a target of his fury.

But, frankly, a life lived in outrage is exhausting. And my temperament doesn’t allow me to see the world through the prism of loss and lack.

Like Kramer, I lived through the years of fear and frustration in the 80’s and 90’s and have lost friends to AIDS, though likely not on the same scale. And I too have seen Very Exciting Breakthroughs For A Cure that turned out to be anomalies and overblown wishes. I now approach each new cure-around-the-corner claim with the skepticism of the man who discovers that he did not, after all, buy the Brooklyn Bridge.

But I have experienced the arc of the epidemic. I recall when nothing was known about Gay-Related Immune Deficiency (as it was first called) and then when the Human Immunodeficiency Virus was identified. I know the growing panic during the two-week response period. I remember the breakthrough of the mid-90’s when the “drug cocktail” of antiretroviral treatment caused the death rate to plummet. And since then I’ve watched a plodding but steady progression towards management and sustainability and prevention.

There has been amazing progress.

Yes, HIV continues to impede the full potential of lives. Even in the best of cases, it brings a tedious drug regimen, social stigma, and the fear of unknown possible side effects.

But unlike Kramer, I just can’t see the glass as half full and draining rapidly. Irrespective of whether the NIH appoints a new head of the Office of AIDS Research in a timely manner, I still see the glass as three quarters full with a steady drip increasing the level.

And one of the more recent developments that has given me hope that the viral endemic can finally be beaten has been the two pronged approach of undetectability and insusceptibility.

For most (but not all) HIV infected persons, current drug treatments reduce the level of virus in the body to such a point that it cannot be detected. And the practical reality is (though officials are hesitant to stake this claim) those with undetectable levels of HIV are not transmitting the virus to others.

And more recently, within the past couple of years, it has become evident that pre-exposure prophylaxis (PrEP) in the form of a daily dose of Truvada can cause an HIV negative person to be virtually immune from contracting the virus. By virtually immune, I mean percentages in the high 90’s, a better success rate than condoms. Though anecdotes do not speak definitively, at this point the collective street-knowledge of PrEP is nothing short of astonishing. As a small example, an acquaintance of mine who is seriously dedicated to condomless receptive anal sex and who was one of the early participants in PrEP tested negative again yesterday after a couple years of regular “unsafe” sexual practice.

In combination, these two therapies may not be the cure that Larry Kramer and the rest of us hope for, but if correctly targeted and implemented, we could see HIV in America go the way of tuberculosis in a generation.

Of course, that requires thoughtful and committed leadership. And I do have skepticism about the commitment of government to properly design or implement such a plan.

I suppose it’s possible that a driven and charismatic leader will be appointed to the Office of AIDS Research who will throw political expediency out the window and press towards targeting the communities that most need regular and thorough testing and who is willing to buck powerful elements of the AIDS industry who have a vested interest in opposing PrEP. I suppose someone could don a cape and come to our rescue.

But the history of the AID epidemic suggests otherwise. For the most part, power and government have impeded rather than advanced response. It has been mostly gay men, and their allies (let’s never forget how lesbians stepped up to a crisis to which they are least directly threatened) who have been on the forefront of knowledge and power, who played personal guinea pig, who recrafted the social acceptability of practices within their own community, and who fought in the streets for the right to take drugs that would save their lives.

So I suspect it will be up to the gay community to create a culture in which all of those who HIV positive are tested and place on appropriate medication (and fight for the funding to make this a reality) and all those who are sexually active outside of a monogamous relationship and who are negative go on PrEP (a likely tougher funding fight). We will have to be the ones who make “Truvada whore” a badge of responsibility and sexual freedom.

Yes, we will need to be conscious of possible side-effects and aware that all drugs impact different bodies differently. But – at least so far – it appears that until a cure for AIDS is discovered, PrEP is a promising approach to personal protection and community health.

So it’s time to do my part. It’s time for me to join the Truvada whores, time to take PrEP.

Over the past months, several of my friends have gone to their doctors and signed up. They are all happy with this choice and found it to be a painless process. I’m not so lucky.

My employer provides me with health insurance through Blue Shield of California (for which I am appreciative). My plan is an HMO and though that is more limiting than a PPO, it hasn’t really impacted me much. Until now, I have no complaints. Or, not many.

When the plan was implemented, Blue Shield assigned me to a primary care physician based on location. And as I live near Koreatown, my doctor operates out of an office which caters primarily to older Koreans.

I’m not Korean, but the diplomas were from reputable schools and as my medical history is not complex, I figured that any doctor can provide basic care and I had no reason to change. And, frankly, it felt a bit prejudiced to discount a doctor’s ability to treat me simply because I’m not in his target demographic.

And for the most part, all has been fine.

Yes, there was the time he pressured me to become vegetarian (ummmm, no!). And, as I discovered in the waiting room, I’m not a big fan of Korean soap operas. But he was attentive and personable and I just don’t see a doctor that much.

On my last visit, I told my doctor that I was interested in PrEP. He had no idea what I was talking about so I asked him to look into the subject so that we could pursue that direction. He said nothing.

Finally, having waited for months without a response, I called my doctor’s office and explained to the receptionist that I’d like to see the doctor and would like to discuss PrEP with him and could he please be ready for this. She said she’d ask the doctor.

The receptionist called me back. And said I should find another doctor. One that deals with HIV. Because my primary care physician wouldn’t want to give inadequate care.

It’s probably only my imagination that heard “go away, go away, don’t touch me”.

But fair enough. I’m certain that his knowledge of his community allows him to be aware of cultural particularities which give him greater insight into the care of his specific demographic. And I probably would be better served by finding a doctor who is familiar with the trends in the lives of gay men and specific medical issues of which to be aware.

Besides, I live in Los Angeles. There are more than 25,000 doctors in this county. How hard can it be to find one that specializes in gay health (or “men’s health” as it is sometime euphemistically called)?

As it turns out, it’s not so easy.

My insurer’s website easily allows you to search for another primary care physician. You can search by gender, language spoken, medical specialty, or name. You can even put in other search terms. But gay and LGBT had zero results.

So I turned to Yelp. Here, results were more promising. Several reviews discussed whether the doctors were welcoming of gay men and women. Some even discussed PrEP. Best of all, Yelp’s ad generator gave me the names of medical groups who specialize not just on gay men but on getting them onto PrEP. Yay!

Back to the website I went. The most prominent men’s health group didn’t show up. But fine, another did. So I submitted my change request and waited.

Nothing.

So back to the website I went and sure enough, my primary health group is still the Korean group.

This time I didn’t rely on the doctor’s name showing up in the grid to mean that I could select that doctor. I called or emailed the doctors instead. And it turns out that none of them accept Blue Shield HMO. Zero success.

Back to online searching. Viola, there are handy guides to tell one just who does administer PrEP in LA County. But sadly, they seem to either be upscale and take PPO or other high end insurance plans or else they cater to those less fortunate and take Medicare. For someone who has (what I’ve assumed to be) a perfectly fine but no frills plan, there seems to be nothing.

In desperation, last night I called Blue Shield. And the lovely young women who handled my call agreed to search their database for doctors in LA who take my insurance plan and who specialize in PrEP (who knew it had to be a specialty?). After 20 minutes holding, she came back to tell me that she had no success. But she promised to keep trying and to call doctors until she found me one.

However, I’m not over-confident of hearing back. Because when I suggested that she broaden her search to include gay health or men’s health she became flustered and confused. I’m guessing that in whatever culture she live, one doesn’t say the words “I’m a gay man” out loud.

But I’m not giving up. I do have some leads.

One of the doctor’s offices – one that doesn’t take my plan – generously came up with some names of others who might be able to direct me. And the local LBGT center is a resource that I can approach. Word is that they’ve opened a new outreach office in West Hollywood whose sole purpose is to get gay men on PrEP and I’m hopeful that they might be able to help.

I am confident that eventually I’ll find a doctor that takes my insurance plan who is willing to provide this regimen. I live in a city that is, for the most part, inclusive and welcoming of gay people. I have many many options and opportunities.

But I cannot imagine trying to go through this process in a red state. Or in rural California. Or in a city without an established gay community.

So maybe Larry Kramer has a point. PrEP should be available to every gay man – or every other person in a high risk demographic – through every doctor in the country, not just the handful who “specialize” in gay health. We would not find it acceptable if this level of difficulty were faced by those who sought preventative measures for anything else? Why is it acceptable that doctors can turn away patients simply because they “don’t deal with HIV issues”?

Maybe Kramer’s right. Maybe it is time for a little rage.

NancyP

November 5th, 2015

Try the Gay and Lesbian Medical Association provider list:
https://glmaimpak.networkats.com/members_online_new/members/dir_provider.asp

NancyP

November 5th, 2015

The rage ought to be directed toward those providers who claim “conscience” clauses – the same jokers that avoid treating identifiable GLBT people are the ones that refuse to prescribe or dispense oral contraceptives, IUDs, etc. Yet they expect non-judgmental treatment for their alcohol or painkiller or cigarette addictions, etc.

Timothy Kincaid

November 5th, 2015

Thank you NancyP for the resource.

Ben

November 5th, 2015

“Bureaucratic structures don’t lend themselves well to efficiency” Major citation needed. You just can’t help yourself but slip in right wing rhetoric even when talking about something else.

Every *single* bit of pharmaceutical breakthrough in the past 100 years has been fully or majorly tax payer funded. It is only when a drug or treatment is profitable that private industries buy up the researchers or patents and distribute it for profit. With public goods like health, private industry is the enemy of public health, as we can see from America’s abysmal healthcare system, which just so coincidentally is the only private healthcare industry in the developed world. (save for Germany’s which is regulated at a level that would make your brain spin).

Further, when production lines from east and west germany of similar products were compared, it was the East German communist factories that had higher efficiency than their west german private versions. It is not the structure of the company, but the ability to fail through lack of customer participation that matters.

You are simply wrong, again, about how to structure fair and efficient systems. If the US system has been slow to act on AIDS research (and it has) it was because of right wing, religious, fundamentalists mucking up the debate, *not* because it was a government bureaucracy. (which of course, giant bureaucracies exist in private companies as well, but somehow their inefficiencies *hello HP* never count as strikes against capitalism.

Ben

November 5th, 2015

Also isn’t it just funnily convenient that the hassle of finding out how to get Prep covered by your private healthcare company isn’t proof that they are inept? Guess inefficient bureaucracies get a pass if they are generating profit for the few right wing old white CEOs that own the company, just not if it’s a tax payer funded org.

Jim Burroway

November 5th, 2015

Ben, I didn’t see Timothy’s comment about bureaucratic structures being particularly right wing. Especially since he spent the better part of his essay describing his encounter with a private bureaucratic structure. As one who has had to navigate quite a bit of my own *private* health care system’s bureaucratic structures, I think it’s pretty self-evident that they don’t lend themselves to efficiency.

Timothy, please keep us posed on your progress. Thank you for writing this.

Jeff

November 5th, 2015

I know this may sound a little odd. Have you called planned parenthood? They may not be able to provide primary care but may be able to help. when I was living on the outskirts of philly sprawl they were a lifeline in finding an LGBT friendly doctor even if that wasn’t her specialty.

Timothy Kincaid

November 5th, 2015

good idea, Jeff. Thanks

Mark F.

November 5th, 2015

“Further, when production lines from east and West Germany of similar products were compared, it was the East German communist factories that had higher efficiency than their West German private versions.”

That explains the vastly better standard of living in the East and why they had to build a wall to keep people from West Berlin out. Why it was a virtual paradise, if you didn’t mind minor inconveniences like the secret police and a one party state.

Ben

November 6th, 2015

“That explains the vastly better standard of living in the East and why they had to build a wall to keep people from West Berlin out. Why it was a virtual paradise, if you didn’t mind minor inconveniences like the secret police and a one party state.”

Firstly, I commented only on efficiency.There were of course other problems with East Germany. Second, a fairly large number of East Germans who lived through the situation say they preferred it to today’s capitalist society. The black and white “communism bad” view that most Americans have been force fed is not only false, but prevents one from learning from history.

Jim, the reason it’s right wing, is because he only mentions inefficient bureaucracies (which is in itself a myth) when it pertained to a government org, but skips right over any criticisms or inefficiencies when describing the experience dealing with a private organization as the meat of his post.

Priya Lynn

November 6th, 2015

Excellent commentary Ben.

NancyP

November 6th, 2015

I agree, try Planned Parenthood. First, many PPs have extensive outreach to gay men, and are likely to be actively prescribing PrEP. Secondly, PPs tend to have a high percentage of LGBT employees. Not only would the staffers know of every LGBT-friendly general practitioner and every HIV specialist in town, as part of their job to provide referrals, but it is likely that the staffers would themselves get care from some of these providers.

fannie

November 6th, 2015

Just because it’s mentioned in this post, Kramer’s rant is indeed incoherent and his accusations directed at the NIH and state of AIDS research seem largely unjustified.

While the lack of a cure is indeed unfortunate and frustrating, HIV/AIDS is one of the most well-funded diseases at the NIH.

The Office of AIDS Research, which he references with contempt, is also the only disease-specific Office within the NIH Director’s Office (which then allocates funding to the various Institutes and Centers for research/grant purposes).

Also, unless I’m mis-reading Kramer, it sounds like he’s maybe opposed to PrEP? So, I’m not sure he would agree with you that PrEP should be available to all gay men (or those in high risk groups).

fannie

November 6th, 2015

I would also add that in terms of access to PrEP, gay men could model some of their advocacy on women who sought access to birth control pills from the medial establishment in the 1960s. Particularly if some of the “old guard” gay men within the HIV/AIDS movement, or other gatekeepers to resources, are opposed to PrEP.

The pill is mostly normalized and uncontroversial in US society now, but that wasn’t always the case.

Lord_Byron

November 7th, 2015

Kramer isn’t nearly as bad when it comes to opposing PrEP as Weinstein at the AHF. AHF is kind of a sleazy organization in a way. Someone recently was discussing how an organization they work for recently turned down a grant from AHF because if they accepted AHF would get access to the names and results of individuals who came in to get tested. Then with the whole condom issue in CA the organization has attempted to violate HIPPA and demand the medical records of porn stars.

I really don’t understand the issue here. It almost comes across as if they think younger generation should suffer because this wasn’t available when the epidemic first began. They can’t say with a straight face that if this had been available early on they would not have taken it. Fuck, I wish I had started PrEP when it first came available a couple years ago. It would have saved me thousands in medical bills.

It’s really strange to think that you need to specialize in something to prescribe PrEP. Of course you are suppose to test regularly if you go on PrEP in case you do become infected and need something that works better.

At least on the bright side of the cure they believe that a drug designed to fight cancer may be able to reactive latently infected cells so the drugs can target them.

Tom in Lazybrook

November 7th, 2015

I’d question if the doctor is receiving some sort of benefit based upon the lack of proscribing pills or treatments.

At any rate, I’d file a complaint with the state insurance commissioner claiming denial of service based upon your sexual orientation (let the doctor and insurance company sort out why he wouldn’t talk to you about a CDC recommended pill and why BCBS can’t find you someone who will discuss Gay health issues). I’d also file a complaint with your public health director. Insurance companies creating barriers to CDC guideline compliance can create huge health problems.

Best of luck on getting your pills.

If you’d like there to be less of a stigma about Truvada, then sell it as part of a safer sex regimen that includes condoms in casual sex. Just my $0.02.

Priya Lynn

November 7th, 2015

“If you’d like there to be less of a stigma about Truvada, then sell it as part of a safer sex regimen that includes condoms in casual sex. Just my $0.02.”.

Two thumbs up.

Lucrece

November 7th, 2015

I just wanted to say that the CDC reports a protection of up to 90% reduction.

And that’s a best case scenario where the regimen is taken religiously.

Statistically speaking, 10% to contract HIV is still an immense risk. Nobody would rationalize engaging in a sexual practice if they had a 10% chance to contract cancer.

Condoms are not an option, it’s that simple. The CDC prescribes condom usage for PrEP.

What’s more, this happy gambling by some people who just want a pill to not need to use a condom gets annoying when the practice ends in more careless sex and new infections that are then reliant on state and government funding for their rather costly, life-long treatment.

PrEP also do NOT protect against other venereal diseases, so not using a condom while on PrEP is downright foolish.

This is probably why doctors don’t even want to deal with this crap, because there’s an activist community keen on fucking around without a condom and throwing around a hissy fit about being slut shamed when they refuse to take measures that maximize their health outcomes.

People can whine about sexual freedom when they, and not the government, is paying the full bill for HIV contraction.

Gossar

November 7th, 2015

A reduction of 90% does not imply a 10% risk; just as a 30%-off sale doesn’t mean everything is $70.

I’m not an epidemiologist, but wouldn’t a 90% decrease take the CDC’s estimate of 50,000 new HIV infections each year down to just 5,000/yr.
http://www.cdc.gov/hiv/statistics/overview/index.html
http://www.cdc.gov/hiv/prevention/research/prep/

Lord_Byron

November 7th, 2015

Lucrece,

First, you come off as really judgmental and it appears, to me, that you are assuming that those who are taking PrEP are not using other protection and are basically sluts. In fact your post is just full of generalizations. Also, daily usage of PrEP in a couple different studies have shown reduce change of infection between 92 and 95%.

“In an email, Dr. Robert Grant, a top H.I.V. researcher at the University of California at San Francisco and the lead investigator for the iPrEx study, called the 99 percent figure “our best estimate of the H.I.V. risk reduction when men and transgender women who have sex with men use PrEP daily.” (PrEP, or “pre-exposure prophylaxis,” is the practice of using antiviral medication like Truvada to prevent H.I.V. infection, rather than to treat it.) Dr. Grant noted that lower estimates, such as the 92 percent figure, include results for people who were not taking the drug daily.”

from another study
“Tested on more than 1 600 HIV-negative men, including gay men, bisexuals, transgender women and men-sleeping-with men (MSM) at 11 research sites on four different continents, the latest study found that PrEP provided 100 percent protection among participants who took the pill four times or more every week.”

Then there is the fact that there will most likely be an injectable slow-release version of PrEP available in the next couple years which will basically make this fool proof.

Lucrece

November 8th, 2015

I’m not assuming they’re sluts, speak for yourself.

I’m assuming that people who would desperately use a narrow treatment as an excuse to bareback when barebacking involves more than just HIV strikes me as a horrible idea to support and let propagate.

But of course, there’s tons of money to be made on this new drug and the marketing that will go in selling it to gay men as safe sex made easy.

eddie

November 8th, 2015

Wow ! ! ! Really interesting story as well as the comments. Please keep us updated to date on what doctor office and service you finally end up with. Best of luck and good health to you (and comment writers as well)

enough already

November 9th, 2015

1) I grew up just down the street (literally) from the DDR. Spent a lot of time there as a child. Got banged up falling out of tree there once. Excellent medical treatement.
That said, the BRD provided enormous medical resources to the DDR, regardless of the political weather.
I’m going to leave it at that, but those of us who actually knew East and West Germany are not going to accept broad brush stroke descriptions from either perspective.

2) I’ve had it up to here with nastiness from people like you, Lucrece. Personally, I’m monogamous. My best friend is working hard to his 3K men before we’re sixty. I was attacked in the gay community for the ultimate perversion of monogamy throughout the late seventies. I’m not going to just sit there and let you criticize gay men who chose to have condom free sex. It’s none of your business how other people live their sex lives.
None.
Zero.
Grow up, focus on your own life and stop acting like your personal beliefs are the index of ‘correct’.
3) I’ve taken the time to read quite a few studies and this 90% nonsense is bullshit. Taken properly, we’re in the virtually no failure range on HIV.
4) The ‘other’ STDs which one might catch are treatable. I participate in not one but two of the world’s most deadly activities – I own donkeys and I drive a car in the Rocky Mountain West. Don’t hear too many lectures on that, though.
5) I was active in ACT-UP! back in the day when we really did make a lot of noise and were quite disruptive. None of us, not one single one, has anything against PrEP.
6) It’s easy to criticize Kramer. After all, he’s actually doing something. Anyone who does anything is always going to be a target for criticism.

Finally, I support Timothy 100% in this. We don’t agree on much, but he’s spot on for this. Maybe Boxturtle should do their own version of Truvada Whore T-Shirts? I’d buy one. It’s scandalous that someone living in Orange County can’t find a decent doctor.

Priya Lynn

November 9th, 2015

“2) I’ve had it up to here with nastiness from people like you, Lucrece. Personally, I’m monogamous. My best friend is working hard to his 3K men before we’re sixty. I was attacked in the gay community for the ultimate perversion of monogamy throughout the late seventies. I’m not going to just sit there and let you criticize gay men who chose to have condom free sex. It’s none of your business how other people live their sex lives.
None.
Zero.
Grow up, focus on your own life and stop acting like your personal beliefs are the index of ‘correct’.

It most certainly is our business when people do things that hurt others. If its not our business when people don’t use condoms to have promiscuous sex then it wouldn’t be our business when people don’t use seatbelts or put their children in car seats or a seatbelt. The wellness of others is always our business.

If you think we don’t have a right to be concerned about the well-being of others then it is YOU who needs to grow up.

I’m 100% behind Lucrece here. You, you’re out of line.

Priya Lynn

November 9th, 2015

Promiscuous people who don’t use condoms increase STDs in the population in general, and that concerns ALL of us.

enough already

November 9th, 2015

Priya,
Which puts us right back at the good old: Gay men having sex= Icky.
Right?
It’s none of your business how gay men have sex with each other.
At.All.
Zero.
You have positively no right to dictate to gay men how we live our lives. You don’t like the way we live? Great, don’t have gay sex.
You and Lucrece believe you have the right to tell gay men how to live our lives. You could not be more wrong.
Aids is caused by a virus, not by two men having sex.
O! Ye gods and little fishies, why should this even have to be pointed out in 2015?
How dare you claim the right to tell gay men how to live their lives!

Priya Lynn

November 9th, 2015

“Which puts us right back at the good old: Gay men having sex= Icky.
Right?”

That has absolutely nothing to do with it although I don’t blame you for being hypersensitive to such an idea.

I feel exactly the same way about promiscuous heterosexuals.

“Aids is caused by a virus, not by two men having sex.”.

I can’t believe you’re resorting to such a childish retort. That’s no better than saying “guns kill people, people don’t kill people”

Neither I, nor Lucrece claim to have a right to tell gay men (and heterosexual men (you conveniently left that out to further your false narrative)) how to live their lives, what we absolutely have the right to do is to have concern for the wellness of others and encourage them to take prudent steps to enhance their wellness. This is no different than encouraging people to wear seatbelts when driving or to avoid eating too much.

Gay and bisexual (and heterosexual) men having condomless sex with large numbers of partners increases STDs in the population as a whole, including the heterosexual wives and girlfriends (and husbands and boyfriends) of such men putting the non-consenting population as a whole at greater risk – this is everyone’s concern.

We ALL absolutely have a right to be concerned about others’ wellness and to encourage them to protect that wellness.

I’m not going to argue with you further, I’ll leave you with the last word if you want it.

Priya Lynn

November 9th, 2015

And by the way, I used to have a penis and I had sex with 3 men at the time and I used condoms when I did it, so spare me the “this is about men having sex=icky” line. I also used condoms when I had sex with women I wasn’t in a monogamous relationship with.

Priya Lynn

November 9th, 2015

“I had sex with 3 men at the time”.

Not all at the same time, LOL.

Lord_Byron

November 9th, 2015

enough already,

I should point out that gonorrhea has become almost untreatable. It is evolving to a point that only the most hard hitting antibotics work against it.

NancyP

November 9th, 2015

The Korean community in the USA has a large percentage of members in Korean-run conservative churches which function as a cultural focus (Korean language services and social events). So, although you live in big-city CA, the Koreatown social mores may have a whiff of small town Anywhere (CA, TX, MO, KY, etc). The doc may not have many out gay patients and certainly doesn’t keep up with anti-viral pharmacology. Yes, he should know something. However, no general practitioner knows everything.

enough already

November 9th, 2015

Priya Lynn, Lord Byron,
Right now, just this very week we have conservative Christians (Rod Dreher’s blog posts are an example) uniting with conservative Gay people (Breitbart’s Milo Yiannopoulos’ endorsement of the Drop The “T” is an example) in their argument that the high suicide rate amongst transgender people is reason enough to stop supporting them in their hysterical mutilation.

Such wonderful people, those Homocons and conservative Christians, no?

On this, I know there’s not a 0.000001mm difference between Priya and myself in our reaction. Probably not much more between Lord Byron and myself, either.
Despicable people is about the most this website will allow me to say about these vile vermin who attack our transgender brothers and sisters.

Yet, when it comes to those icky gay men, well, they just have to be reigned in for their own good and that of society.

I was kidnapped and thrown into the nuthouse where I was electroshocked, subjected to ice-baths, had psychopharmica injected and beaten for three horrid weeks by people who feel the same way about gay men as you do. I wasn’t even 16 years old. The day my parents’ lawyers rescued me was the best day of my life. All of that was done to me by psychologists, all of them ‘good Christians’, who all justified their ‘treatment’ as being for the good of the whole community.

That’s the next step in your logic.
You know, your thoughts on that matter spring to the final solution. It does sound better in my native tongue:
Der Staat muss uns vor uns selbst schützen!

Ja, das ist des Pudelskern schon näher.

Pity there’s no HTML for one of the Germanic fonts used so much to express those thoughts in the 1930s.

Inform people about the risks of unprotected sex? OK.
Impose your distaste of gay men on us? Not. Happening. We’ve been down that road before.

enough already

November 9th, 2015

To the editor: Thanks!

Lord_Byron

November 9th, 2015

enough already,

I wasn’t arguing with you.I was just pointing out that gonorrhea is becoming a harder to treat infection, but that is an issue for many kinds of bacterial infections.

I agree with you on your point about LGB people that want to toss T individuals under the bus.

enough already

November 9th, 2015

Lord Byron,
These diseases are a real problem. My vet is using sulfamides much more than she used to.
If we don’t figure out some new pathways, we’re going to really, really be in trouble.
I just get very, very alarmed by people who do the ‘icky gay male sex’ thing. It’s been a conflict in our GLBT community for a long time, sometimes to a greater and sometimes to a lesser degree.
As for our transgender brothers and sisters, back in the horrid early days of the plague, it was the mothers of gay men and transgender friends who did the most for us gay men. They have earned our support.

Nathaniel

November 11th, 2015

Enough, Priya said her piece on how she feels about gay men. Stooping to Nazi comparisons is unwarranted, and demonstrates a lack of comprehending what she has actually said. You are absolutely right that some of the anti-PrEP noise is coming from anti-gay-sex perspective, but that is not the case here. In fact, I don’t think Priya is even suggesting that PrEP should be denied altogether, just reminding everybody (as if we haven’t had this argument on this site several times already) that it should be part of a regimen of protection (“part of this balanced breakfast”).

Priya, I don’t think seat belt or bike helmet laws should exist (except for minors). We don’t have laws regulating how much or what people eat. We all hear and agree that a responsible PrEP slut would absolutely use a condom, and any other method, along with PrEP, to prevent disease transmission. True, there are those that abuse the protection. But let’s be honest: they are not likely to provide themsevles much protection otherwise anyway. Someone taking PrEP is better than someone taking not measures at all. However it seems like you are suggesting PrEP itself is the problem, and the only protection people need or should use is condoms. But we also know condoms are not 100%. This is the same sort of argument for the pill (and other pregnancy-preventing measures). No, it isn’t a magic bullet. No, it shouldn’t be used alone. And No, it shouldn’t be made unavailable because some people will abuse it, use it improperly, and end up in trouble. (I suspect early arguments about condom use were similar) No protection is perfect, but denying any protection because it is imperfect is ludicrous.

Lucrece, we take disease and death causing risks all the time. Driving is far more deadly than airplanes, but we still drive. Bacon causes cancer, but nobody is going to stop eating it on those grounds. Sex can result in pregnancy and disease transmission, but we still do it. Now, we can do it safer than ever.

Ben, I missed the part where Timothy wasn’t complaining about private bureaucracy. It is a well known fact that bureaucracy tends towards self perpetuation, not efficiency. Nothing is perfect. He is clearly starting to have issues with his insurance and his doctor, issues he hasn’t experienced before that are, in part, a result of the bureaucracy. There is no need to read politically biased narratives here.

Priya Lynn

November 11th, 2015

“Priya, I don’t think seat belt or bike helmet laws should exist (except for minors). We don’t have laws regulating how much or what people eat. We all hear and agree that a responsible PrEP slut would absolutely use a condom, and any other method, along with PrEP, to prevent disease transmission. True, there are those that abuse the protection. But let’s be honest: they are not likely to provide themsevles much protection otherwise anyway. Someone taking PrEP is better than someone taking not measures at all. However it seems like you are suggesting PrEP itself is the problem, and the only protection people need or should use is condoms.”.

No, I have in no way and am in no way suggesting that PREP is a problem or that the only protection people need or should use is condoms. I agree PREP is better than no protection at all.

I never made a suggestion one way or another regarding the apropriatness of seatbelt laws. My point was encouraging someone taking PREP to also use a condom is no different than encouraging a person to wear a seatbelt and buckle in their children regardless of whether or not the law requires it. In other words, there is nothing in anyway inapropriate about encouraging PREP uses to use a condomn as well contrary to what Enough Already was saying.

Prep doesn’t protect against other STDs and it is unwise to rely on it alone and its bad for society in general to rely on it alone.

You’re reading a surprising amount of stuff I never said into what I wrote.

Nathaniel

November 11th, 2015

Priya, I can only see how such things can be read into what you say. We are in agreement. I suspect Enough agrees with you more than he believes as well. It is just hard to discuss points of agreement and actual disagreement when you can’t get past points of misunderstanding, misinterpretation, and “reading in to things.”

Priya Lynn

November 11th, 2015

Yes, I didn’t read Enough’s previous comment(s) but I did read yours and was quite surprised to hear he called me a Nazi. I can’t imagine thinking showing concern for others makes one a Nazi.

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