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Posted by LGBT Weekly
WORLD AIDS DAY SPECIAL FEATURE
BY MATHEW RODRIGUEZ
For many years, the truth is, there has been no difference between saying “I am a sexually active gay man,” and “I am constantly afraid.”
I came out to my mother at age 15, and she told me to make sure I did not get AIDS. I was born in 1989 and my father had been living with HIV since late 1988 – a few months into my mother’s pregnancy. Protease inhibitors were still years away. My father passed away from an AIDS-related illness in 2011. Though I did not see the plague years up close, AIDS took my father from me.
For a long time, I was constantly afraid that I would disappoint my family by getting HIV. If the American dream is to do better than your parents, then contracting the same virus that had a hand in killing my father would not be the way to do it.
Because of this, for as long as I have been a sexual being, I’ve also been invested in HIV prevention. I have stayed awake thinking about whether semen permeated the skin of a condom, counting on my hand how many weeks since my last HIV test and declining intimacy when my wisdom teeth were removed. The first time I had sex, it was with a stranger who I had only met once. He was good looking and I was fed up with the big scarlet “V” for virgin on my chest. We did it quick and dirty. There was minimal pleasure but as I walked home I felt no different. In that moment, when I let a stranger inside me for the first time, I used a condom.
Condoms continue to be there for me when I need them. When I feel like I need a physical barrier between me and the person I’m being intimate with. Even as a PrEP user, condoms are still part of my sexual repertoire. As I tell some of my friends, just because I have a security system on my house that does not mean I’ll just leave the door open and let anybody in.
Let me backtrack for a moment. Pre-exposure prophylaxis, or PrEP, is a form of HIV prevention in which someone who is HIV negative takes medication in order to stay negative. Right now, the only form of pre-exposure prophylaxis is Truvada, a combination of two drugs – tenofovir and emtricitabine – that between them have three decades of sound scientific research.
PrEP scares people. And for good reason. There are legitimate concerns regarding the side effects, public health ramifications, the stigma of HIV, access to insurance, primary care doctor education – the list goes on. Notice one of the legitimate concerns I did not list was PrEP’s efficacy. I am willing to have an open, nuanced conversation about almost any aspect of PrEP including conjecture about how it will affect peoples’ lives. But we can’t have that conversation if we don’t acknowledge one truth: PrEP, when taken every day, is extremely effective at preventing the acquisition of HIV.
In that sense, PrEP really is a hell of a drug. The specter in the room with us at our most intimate moments – the threat of HIV – is no longer scary. PrEP is Glinda telling the Wicked HIV Witch, “You have no power here”!
The concept of PrEP is not exactly novel. People take pre-exposure prophylaxis for malaria all the time. The process is identical. I took malaria pills before I went to Nicaragua to protect me from malaria. Now, I take a daily Truvada pill to protect myself from HIV. Why? HIV prevalence in America in the gay community, especially among men of color, is high. We are not exactly America the Beautiful – we are America the viral, America the infected, America the at-risk. With 50,000 new infections a year since 2004, we haven’t made a dent in the epidemic in some time.
Now, what a world we live in! The arsenal we use to fight HIV is growing, and will continue to grow if scientists and prevention activists have their way. No matter what your flavor, your preference or your proclivity, prevention options beyond condoms are a positive thing. Talking about prevention may soon be like the child’s game of “show me yours, I’ll show you mine” – what I show you may be different, and you may have questions, but we can walk away without begrudging each other’s mode of prevention, even if yours isn’t as pretty, sparkly or new-fangled as mine.
At some point, dangerously, our community seems to have calcified around the condom – a method of prevention – rather than the idea of prevention itself. I’ve said many times, don’t get me wrong condoms are great. Long live condoms. Condoms are like Cher – she’s been around for gay men forever, and while she’s a staple for many, there are many for whom she will just never do the job. And I don’t begrudge people who can’t adhere to condom use. I do have a problem with Cher haters, though.
Perhaps the two most private parts of a person’s life are their sexual and mental health – mostly because talking about these two things publicly might make one a persona non grata. Right now, a battle between sexual health and public health is being waged in our community. For many men, pleasure, wholeness and sexual satisfaction – paramount to many for a healthy mental life – are now in reach because of PrEP. As noted queer author Eric Rofes said in a 2004 interview, “Most men, I expect, engage in unprotected sex because of the meanings they take away and the pleasures the act provides them. Like it or not, using a condom likely changes the meaning and the practice of anal sex in significant ways. For some men, the meaning and pleasure comes from having another man’s sperm deep inside his ass. If you add a condom to the picture, that meaning and pleasure will not occur.”
In this sense, PrEP may be making our community healthier. Perhaps more of us are being touched and loved in ways that make us feel whole. Perhaps being touched, really touched the way we want to be touched, is the key to finally beating back the HIV fear induced trauma that every gay man lives with each day.
Those who are weary of PrEP feel it is not only going to make STIs more prevalent in our society, it is giving us permission to do something we simply ought not to do; have unprotected sex. Of course the real question is – why do we think we ought not to have condomless sex? Condomless sex is the most natural sex. It’s sex the way God, or whatever deity you believe in, intended. Just because it is the most natural, does not mean that one shouldn’t practice prevention. We need to make an enemy of STIs, not condomless sex.
Recently, I interviewed a San Francisco woman who took PrEP in order to conceive a child naturally with her husband, something she had not been able to do after 14 years of marriage. Her doctor told her she would absolutely not allow her to go on PrEP and have unprotected sex with her HIV-positive husband. Even worse was that her doctor had just come back from maternity leave. She thought about how easy it must be for her doctor to judge her choice to have condomless sex with her HIV-positive husband to have a child – yet she had a baby waiting for her at home. This woman wanted the freedom to be treated like an adult; to mitigate her own risk.
How do we show love to our loved ones? Sometimes, showing love means embracing trust, giving people room. If we really love each other, if we are to continue together as a community, we can only do so with the ability to love each other so completely that we allow each other to experience pleasure in the face of risk, to feel pleasure when it might be the scariest reality and to be intimate with each other when a safety barrier is there, but cannot be seen.
Mathew Rodriguez is the community editor for TheBody.com. His writing has been featured in The Advocate, Slate, The Huffington Post and the International Business Times. He has spoken about HIV nationally and internationally, at the New York Public Library, the International AIDS Conference and in New York City’s Times Square. This November, he was named to POZ Magazine’s POZ 100 – the list of the 100 most influential youth working in HIV in America.
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