Yep, I’m Another Truvada Whore
I originally wrote this on May 10, 2014 as an opinion piece for a gay publication that did original reporting. The piece has long since been removed from the internet, but in light of Instagram’s shameful decision to reject a PrEP awareness campaign to promote awareness among queer Asian and Pacific Islander communities in New York as “too political,” (the same week Mark Zuckerberg defended politicians being able to blatantly lie on Facebook) I thought I would resurrect the essay. Having been on PrEP for well over five years now, the stupidity of hiding this life saving information from communities that could benefit most is beyond shameful. Just as it was for me five years ago, the Facebook group PrEP Facts: Rethinking HIV Prevention and Sex, founded by activist Damon Jacobs remains a critically important repository and sounding board for all things PrEP.
Let’s talk about PrEP.
I’m slightly resistant to writing this piece, because it requires me to reveal some personal truths that have nothing to do with my politics, (which I’m very used to expressing with little reservation). But a somewhat bizarre conversation is happening around a new use for a not so new drug on the market. And much the same way as gay activists from Harvey Milk to Frank Kameny once proffered, coming out of the closet is the quickest and best way to turn a homophobic tide, it seems like there is a new tide, and a new closet from which to emerge.
Pre-exposure prophylaxis (PrEP) is a relatively new HIV prevention approach where HIV-negative individuals use anti-HIV medications to reduce their risk of becoming infected if they are exposed to the virus. In 2012, despite efforts to derail it, Truvada became the first and only medication approved by the Food and Drug Administration (FDA) for HIV prevention.
The use of PrEP is being hailed by some, including physicians as one of the most promising new drugs in the reduction of new HIV infections, which now total about 50,000 a year in the U.S. according to a recent Associated Press story that focused on PrEP or its brand name, Truvada. (Update: An estimated 38,700 Americans became newly infected with HIV in 2016 according to CDC, and the extent to which their data can be relied upon.)
As the AP story put it, the remarkable efficacy of Truvada has led to a “rancorous debate among gay men, AIDS activists and health professionals over its potential for protecting uninfected men who engage in gay sex without using condoms.” And how remarkable exactly? In a 2012 study, even in those patients who didn’t adhere perfectly, their risk of contracting HIV still dropped by more than 90%. Yes, you read that correctly — 90%. For those taking Truvada daily, as prescribed? A whopping 99%.
The latest battle lines around PrEP have been simmering for a while already. And as expected, the usual suspects, like the divisive Andrew Sullivan, are front and center of the discussion.
But a reckless quote in the AP story by Michael Weinstein of AIDS Healthcare Foundation, in which he called PrEP a “party drug” and those taking it “Truvada whores,” catapulted the issue, sparking appropriate outrage along with much needed conversation on the one hand, and petitions calling for Weinstein’s resignation on the other.
One can appreciate the uphill struggle it has been to get youngsters to take HIV seriously, or view it as anything more than a mere inconvenience, when their only real reference to HIV and AIDS have been glossy magazine ads touting the latest HIV medications with visual depictions of gorgeous, healthy, perfectly sculpted men scaling mountains with bikes on one shoulder. Which is infinitely better than scare tactic shock messaging that demonizes men with HIV or AIDS, as sick, deformed tragedies to be pitied at best, if not avoided at all costs.
Against that backdrop, coming out of the PreP closet stories by the likes of Lucas Films porn studio owner and actor Michael Lucas, (coupled with his decision to compete in the rapidly growing bareback porn market — and bareback porn star inventory — by ditching condoms once favored along with studios like Titan and Falcon, who continue to produce condom-only porn), frustrate the efforts of current HIV prevention strategies, which continue to advocate for condoms or abstinence, despite their demonstrable limited overall effectiveness in reducing transmission.
Lucas’s porn star status, and financial incentive to promote the virtues of safer, guilt-free barebacking dilutes his message and thus his potency as an appropriate PrEP messenger.
Andrew Sullivan’s holier-than-thou sanctimony can be a royal pain in the ass to many people, but he is able to elevate a conversation that penetrates mainstream media. And although Sullivan is HIV positive, and thus not part of the constituency for whom PrEP is an available HIV prevention strategy, he has been touting preventative medication since 2006, and credit is due where credit is due.
SF AIDS Foundation strongly supports PrEP, and has teamed with a slew of other agencies to promote its use and make it available, including Jake Sobo, an pseudonymous, sexually promiscuous HIV negative man, who early on reclaimed the PrEP whore label. And while it’s great that Jake Sobo unashamedly documented his PrEP life, his anonymity perpetuates the very thing he wants to eliminate. That there is shame involved in using PrEP. Something to be hidden or unspoken.
So, before further ado, let me say it loudly and clearly — I am a Truvada whore. There, I said it. The kind of slut-shaming around those using the drug is also quite odd, but more on that shortly. With recent predictions that over half of gay men will contract HIV by the time they’re 55, being called a whore is a paltry price to pay.
But what really is going on, and why Weinstein’s comments lit such a fuse of outrage, is that he attempted to demonize a potentially revolutionary HIV prevention tool rather than cop up to the abject failure of HIV prevention messaging. And his complicity in it. The failure of which, ironically, for better or worse, sustains his relevance and enables him to command six figure compensation packages. ($398,650 to be exact, according to some digging by activist Michael Petrelis). Without AIDS, who needs AHF? It has been an issue for AIDS, Inc. ever since HIV became a manageable disease and no longer a death sentence.
Weinstein’s comments were not only idiotic and counter productive, they were designed to mock and humiliate people for making intelligent, and not necessarily easy, choices. Using, no less, the same tactics one would expect of the recently deceased Fred Phelps of the Westboro Baptist Church, not the head of an organization who receives much of its funding on the premise it will help gay men, not attack and punish them, at best, if not preclude them from gaining access to tools that allow them to make the best possible health choices.
Part of the reason his intended barbs did so little real damage is that they sounded too much like Rick Santorum talking about birth control. Or like Rush Limbaugh calling Sandra Fluke a slut. Party drugs evoke images of Molly and GHB cocktails, or crystal meth fueled circuit parties. If men responsibly taking Truvada tablets once a day constitutes a party, I shudder to think how fucking boring spending a night with Michael Weinstein must be.
But there is no denying that the slut shaming tactics being employed AIDS Healthcare Foundation, in addition to the money they wasted trying unsuccessfully to get the FDA to reject PrEP, flies in the face of scientific evidence, and is morally reprehensible. If the notorious homophobe Scott Lively wanted to do the most damage to gay men, he’d have Michael Weinstein helm AHF. (Update: To this day, as recently as April 2019, AHF continues its almost demented crusade to demonize PrEP and perpetuate its own relevance by making money off of HIV/AIDS.)
The slut shaming from the gay community, despite the demonization efforts perpetrated by Weinstein, is quite difficult to wrap one’s head around. First off, there’s this notion that PrEP should only be available to men who are in sero-discordant relationships, where only one partner is positive, and not for sluts who deliberately bareback and eschew condoms altogether. It’s a moot point. Once again, Rick Santorum is better suited to pontificate on what sex is acceptable. Coming from the gay community, the hostility is more difficult to wrap one’s head around, and one more reason why I am stepping out of the PrEP closet.
There’s also finger pointing designed to induce guilt at those who would take Truvada to satisfy their voracious, reckless sexual appetites while so many in Africa are deprived the same life saving drugs, which is a ridiculous argument at its core. The reasons for a lack of access to Truvada in Africa have nothing whatsoever to do with the access and availability here.
As a single, sexually active man with a candid and collaborative professional relationship with my primary care physician, I make it my business to take whatever steps are available to me to protect myself. Last week I was vaccinated for meningitis, which he recommended based on a recent spate of cases in California and New York. Like hepatitis vaccinations, for men like me, the meningitis vaccination was a no-brainer.
So what about PrEP? I had read the latest literature on it, and of course, have been exposed to the latest debates. But despite my relatively active sex life, there were still some legitimate concerns I had before I made the decision to start taking PrEP.
First, aside from the litany of potential side effects pharmaceutical companies are required to list by the FDA, was the toll that taking medication has on one’s kidneys and other organs. Truvada is no exception. Taking Truvada is not as simple as popping a pill once a day, but requires also getting tested for HIV, screening for other sexually transmitted infections, and being monitored for kidney health four times a year. Not a problem for me, since I monitor my health that way anyway, but certainly a commitment nonetheless.
Second, I risk having it as a line of defense against another potential strain of HIV if my body builds a tolerance for it that reduces or eliminates its effectiveness for me.
And finally, and perhaps more challenging, was facing the fact that despite my ability to remain negative over a pretty active twenty five year sex life, my sexual practices and preferences demand nothing less. I owe it to myself and I owe it to my partners. And more than ever, I care less about the status of my partners, because protecting myself is my responsibility, and mine alone.
As my doctor cautioned strongly, despite the extraordinary efficacy and success rate among those taking it in compliance with the prescription directives, it is not a fail-safe, one hundred percent guarantee against contracting HIV, and should not be viewed as an alternative to taking other precautions, including condoms, but rather as a complement. As a doctor, that’s the advice I would want and expect. But there’s no denying, in the absence of condoms, it’s a fucking good alternative, pun intended. And one I am grateful for.
And before I am bombarded with comments, let’s face it, as a birth control measure, condoms are not a guarantee against pregnancy either, but we don’t see sex educators refraining from promoting it as a pretty damn good start.
And so with PrEP, why on earth wouldn’t I use it if I know that it’s acting as a powerful weapon in my protection arsenal? Because despite car accidents, I still drive, and although seat belts aren’t guaranteed to save my life, I wear them. And despite my best intentions, and embarrassing as this truth may be, when it comes to fucking, sometimes I’m still ruled by my dick instead of my brain. And in those unguarded moments, I am giving myself the best protection science currently has to offer. Stigma be damned.
At the end of the day, I’ll end up sleeping a lot better at night than Michael Weinstein should. And I’d rather be labeled a “Truvada whore” than be a reckless, self righteous alarmist with unnecessary seroconverted blood on my hands.
http://www.huffingtonpost.com/2014/04/07/truvada-gay-men-hiv_n_5102515.html
http://betablog.org/video-three-prep-myths-busted/
http://dish.andrewsullivan.com/2014/04/10/why-arent-gay-men-on-the-pill-ctd/
