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And the Hits Just Keep on Coming: A Negative Opinion on PrEP

March 16, 2014

I have been reading and viewing a lot of videos on how PrEP has become the new "condom." Gay men everywhere are openly saying that it's OK to engage in bareback sex with HIV-positive men so long as you take PrEP on a regular basis. These guys sound worse than the bug chasers. WHAT THE HELL is going on within our LGBT community? Is THIS the norm? Is this type of behavior all right to exhibit toward straight people and those negative guys and girls? Are we, within our LGBT community, creating our OWN new issue for those straight people and negative people to pass rightful judgment on how we view sexual responsibilities? REALLY?? The most serious question to ask here is WHY IS THIS OK?

Once more those self-righteous, religious fanatics have fresh ammunition against us gay people, negative or positive. Once more the Republican politicians have ammunition required to pass stricter and crueler laws and regulations on us positive people. And once more those responsible HIV-positive gays have to address and correct this issue IN THE OPEN.

I can only speak for myself when I say that those gay men saying that using PrEP in this method is OK are DEAD WRONG. They are behaving sexually irresponsibly. They want to continue to engage in a sexual vice without the consequences. NO. This has to be addressed and their message and ideas stopped or corrected. That was my first issue.

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Second issue: Why is only HIV a scary thing to have when it comes to two men talking about having sex and then one is scared off when he learns that this other guy is positive? I'm sorry, but I DO THINK that having HIV AND being undetectable is a being in a far better place than having herpes or syphilis or gonorrhea. Seriously, what the hell happened with those viruses? Aren't THEY still scary? I am not proud to address this but I've had a few of the other stuff AND they hurt my body far more than my HIV has.

It is the year 2014 people. And, from what I've been seeing and hearing we are not moving forward with HIV education, awareness, and prevention. It seems to me like nobody really cares. Oh ... you have HIV? NO PROBLEM ... I will just drop some PrEP in me and we can f%^$k bareback. Or, oooh ... you say you have HIV? Oh nooooo ... I don't wanna catch THAT. But, it's not that big a deal if you have herpes or syphilis. REALLY?

I realize that by openly writing about these issues I am probably stirring the pot so to speak. Frankly though, I feel a responsibility to share my point of view. We have TWO pink elephants in our LGBT living room and I for one am calling them out. So, if any of you fellow LGBT people, negative or positive, have something to add to what I am saying all I ask is that you come at this discussion maturely, respectfully and intellectually. We are all in this fight together. Let's have a mature open forum and discuss the pros and cons on both of these matters if you feel the need to say something. But, PLEASE say SOMETHING.


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Reader Comments:

Comment by: Sasha (Los Angeles) Fri., Apr. 18, 2014 at 8:09 pm EDT
Hello Enrique,

I like your thinking! You are absolutely correct. People need to take responsibility for their health and the health of their partners. We need to do everything possible to ensure that we are not spreading or catching disease.

I know it takes a lot of the fun and spontaneity away but failing to be safe and responsible can hurt many people.

stay responsible and strong!
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Comment by: Seer Clearly (Denver, CO) Thu., Apr. 17, 2014 at 5:17 pm EDT
Enrique, I couldn't disagree with you more. With HIV, we're talking about a public health problem. Any solution that works to reduce infection rates should be used, irrespective if it irritates the moral sensibilities of some people, including yourself.

You pretty much lost me to your argument when you said "...sexual vice without the consequences." There are two judgments in there, both of which are completely relative to your personal opinions and biases.

First of all, you say sex is a vice. I say that is your unquestioning acceptance of religious/right-wing judgmental programming that you haven't managed to free yourself from. You as much as confirm it by supporting your argument with the idea that we don't want to give the "fanatics" any weapons against the gay community. It appears we have enough people in our own community judging us that we don't even need enemies outside of it!

And, secondly, you say that people have to suffer "consequences" (I take it negative ones) from having sex. My heart goes out to you if that has been your experience. My experience of the "consequences" of having sex is deeper, better connections with people I come to care about and more fulfilling connections inside my community. I don't have "exes", I have an extended family. Nobody should have to suffer negative "consequences" for having sex, which is exactly why every tool in the toolbox for preventing the spread of STDs should be on the table. Including PrEP.

I don't think of STDs as a negative "consequence" (which sounds like "punishment" - God smiting people for being sinful), but rather a public health problem that needs realistic solutions that don't include asking people to give up sex... which they won't do anyway unless they're horribly repressed.
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Comment by: Ray (Minneapolis, MN) Thu., Apr. 17, 2014 at 11:03 am EDT
I'm sorry but as much as you claim to not be judging people and their behavior, your very language in fact IS being judgmental.

I'm sick and tired of folks (especially other LGBT folks!) complaining about how "straight" people use the sexual and social behavior of some members of our demographic against us.

Yet "straight" people are not perfect either. They get STD's and have failed relationships/marriages. They deal with the issues of monogamy vs. non-monogamy as well as infidelity - yet no one is clamoring to strip them or deny them their rights and liberties.

HIV impacts ALL of us, not just Gay men.

Sexual behavior is not a black & white issue, there are many shades of grey as to what motivates people to do what they do.

Attacking with blatant or hidden shaming messages does NOT help.

And to shove monogamy as the only way to live your sexual life is not going to work. Humans have never been entirely monogamous and monogamy is a social protocol that has been put forth as a control mechanism driven more by issues of property and inheritance rights and establishment of paternity in patriarchal societies. That protocol being enforced on a glaring double standard, men getting a wink and a nod, while women get the full wrath of society's ire and shaming.

If you want a relevant respectful discussion regarding PrEP and sexual behavior, it would be best to not start off with such a clearly biased and judgmental attitude.
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Comment by: Johnny Shutterw (New York, NY) Wed., Apr. 16, 2014 at 10:14 am EDT
Take a chill pill! First of all some studies seem to show, you might be safer having sex with an HIV positive person, protected or not, if they are on HART and are undetectable, rather than with someone that was negative at their last test. Since you say you did your research you should know this. Personally, if I was on PrEP I'd be sure to have any unprotected sex with an HIV positive person that was on treatment and undetectable before doing it with someone that was negative last week or the week before and not on PrEP! You need to read more and open your ears and your eyes. Sounds like you’re saying if someone is negative it is ok to have unprotected sex. Wrong! That is worse than having sex with and HIV positive person on meds and undetectable… at least you know their viral load; you have no idea if the negative person is even still negative… As for worrying about the religious right, to hell with them! If the gay community starts worrying about what the religious right thinks all is lost. Yes safe sex is the best practice, but stuff happens, so if someone is worried about the possibility of losing themselves in the moment they should take PrEP and enjoy their sexuality the way they like it! Personally, if it was me, and I was on PrEP I’d only have sex with HIV positive people with undetectable viral loads for soooo many good reasons. And remember, your destiny is predetermined.. Not much you can do to change it. We are only here for the ride; we really aren’t in control of it, even though many of us think we are…
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Comment by: Marc Paige (Fort Lauderdale, FL) Tue., Apr. 15, 2014 at 10:40 pm EDT
Enrique, you are absolutely correct in bringing up the other STD's that are easily transmitted through bareback sex, and those other STD's can create lots of problems. I think your essay boosts the argument for monogamy, when you are lucky enough to find a great partner or husband.
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Comment by: Mark Adnum (Chiang Mai) Tue., Apr. 15, 2014 at 9:33 pm EDT
A perfectly calm, rational article about the limitations of PrEP (it's inability to offer any kind of protection from all manner of other very nasty diseases) met with the usual hysteria you'd find at some kind of meeting of some overcooked local church group, for example:

"The author of this hysterical rant doesn't seem to have any kind of grasp of the actual efficacy of PrEP. It would seem that it is not the religious right who is so busy passing judgement, but the author himself."
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Replies to this comment:
Comment by: Johnny Shutters (New York, NY) Wed., Apr. 16, 2014 at 12:13 pm EDT
Bravo!!


Comment by: Andy (New YORK) Tue., Apr. 15, 2014 at 9:13 pm EDT
Thank you for this voice of reason. It's actually the way most people feel despite the high profile press releases that keep getting ran as news articles.
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Comment by: Scott (Tucson , Az) Tue., Apr. 15, 2014 at 8:56 pm EDT
Enrique you are absolutely correct . The pill is being pushed as a savior . It isn't it is a pharmacy company push for more market . For the amount it costs for a monthly supply of Truvada we could empower many more people to better care for themselves and their partners and deal with the underscoring issues. For those in sero discordant monogamous relationships if the positive partner is undetectable and you use barriers / protection transmission rates do not change when adding Truvad PrEP . Despite the hysterical rants PrEP has not proved its efficacy Adherence levels are inadequate even with all the xtra counseling funneled into this . Keep yourself Safe & Strong .
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Replies to this comment:
Comment by: Johnny Shutters (New York, NY) Wed., Apr. 16, 2014 at 12:14 pm EDT
Nonsense!


Comment by: Mike (Spring Hill, FL) Tue., Apr. 15, 2014 at 10:31 am EDT
You are right - Unfortunately effective communication will not be administered until a loved one of someone with political influence or presidential power has been effected? Our Government has turned a blinds eye to the concerns of its own population while still providing aid to other countries and financing private Industry(s) so called "Managed Health Care". "We the people" no longer have a voice and are being "screwed" by our own Government.
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Replies to this comment:
Comment by: Johnny Shutters (New York) Wed., Apr. 16, 2014 at 12:16 pm EDT
This is not just the case for HIV, but for everything... So what does this have to do with the guts of this article?


Comment by: Genia (Lewiston, Maine) Thu., Apr. 10, 2014 at 7:42 pm EDT
What I like about PrEP is the extra coverage it provides to someone in a long-term monogamous relationship with a poz partner. When you are with someone poz things like condom breakage, slippage, etc. can happen this would add protection for those things.
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Comment by: Seer Clearly (Denver, CO) Thu., Apr. 10, 2014 at 5:22 pm EDT
I got down to the part about "vice" and realized that this blog was more moralizing and judgment, rather than an effort to understand and deal with eteology of HIV infection. I read articles like this and wonder how anyone can write 1000+ words on the topic without accepting reality about the situation, much like the "self-righteous, religious fanatics" the author condemns.

The fact is that people are barebacking, whether anyone else likes that they are doing it, or not. So the public health concern is how to address transmission when barebacking occurs, not shaming, cursing, judging, or humiliating people into not doing it... which has been shown repeatedly not to work. And don't forget educating them into not doing it: it isn't working because education isn't reaching everyone, and there is no assurance that they will behave in accordance with such education. In fact, I assert that people on barebacking PrEP had to have been educated in order to make the choice, so prior education didn't seem to have the desired effect of stopping the barebacking. So calling sex a "vice" says more about the author's self-judgment than it does about whether enjoying sex is appropriate for each individual or not.

From a purely public health standpoint, PrEP is going to work a lot better than the alternatives - with one exception: making sure that the stigma of the virus is lifted enough to allow everyone who needs testing and treatment to feel comfortable getting it.

The latest research shows 0 (zero!) percent transmission from people under treatment, which is a much better statistic even than those showing PeEP's effectiveness.
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Replies to this comment:
Comment by: Johnny Shutters (New York) Wed., Apr. 16, 2014 at 12:17 pm EDT
Yes the writer of this article is not very clear on the facts and is ranting and raving about something he knows almost nothing.


Comment by: JMarks (NYC) Sat., Mar. 22, 2014 at 1:44 pm EDT
This is probably one of the mostjudgemental, ignorant, and least researched opinions I've read on PrEP as prevention. It is obvious to any halfway informed reader that you substitute reason and education in order to satisfy some irrational fear and sense of superiority.

First and foremost, who the hell do you think you are to be passing judgement on anyone else for their sexual practices? Should we stop the progress of medical technology because it might lead to sexual practices in others that you find distasteful?

Next, your supposed concern for the ways that the right wing will perceive us now doesn't matter at all. Let me repeat that, THE OPINIONS OF THE RIGHT WING DO NOT MATTER. PrEP is not used exclusively for the good of the gays. It sounds like all the hostility for the gays is coming from you.

And hey, if you want people to take you seriously as a resource for sexual health you should probably recognize that syphilis and gonorrhea are NOT viruses.

There's much more I can say, but I have neither the time nor the patience to sit down and write it all out.
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Replies to this comment:
Comment by: Enrique (Arizona) Sun., Mar. 30, 2014 at 3:45 pm EDT
WOW. Chill out. First off, this is my opinion on the matter. Second, I am referring to the HIV as the ultimate virus. Sounds to me like you feel a little guilty for YOUR private behaviors. I am not here to judge, just here to write and express once and awhile. I wrote this piece as an open discussion, not to attack anyone like you have me.


Comment by: Brian (Santa Rosa,CA) Wed., Mar. 19, 2014 at 5:36 pm EDT
I just read an article on Gawker about PrEP and that got me researching the whole subject. In fact, I may write a research paper about it for school. I think PrEP via Truvada could easily bring about a schism in the LGBT community. I liked the article you wrote as one point of view. I'm not trying to promote another site, but this article was really balanced and real, but there are alot of risks. http://gawker.com/what-is-safe-sex-the-raw-and-uncomfortable-truth-about-1535583252
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Comment by: Randall (NYC) Tue., Mar. 18, 2014 at 10:19 am EDT
The author of this hysterical rant doesn't seem to have any kind of grasp of the actual efficacy of PrEP. It would seem that it is not the religious right who is so busy passing judgement, but the author himself.
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Comment by: Alan (San Francisco) Mon., Mar. 17, 2014 at 6:29 pm EDT
I grow weary of those who polarize this issue by stating absolutely that PrEP is “the new condom”. It's as though the conversation can only handle two unnecessarily contrary points of view ... one, the condom; two, the daily pill.
First, they’re not exclusive of one another despite some people’s best efforts to separate them. Condoms reduce transmission of other STDs; PrEP can’t. But, hey, neither does oral birth control, and some women take that every day too.
Second, gay men have found MANY ways to reduce their risk of HIV. Some clinical study data back up these varying levels of reduced risk. We should talk about the range of these methods as well: treatment as prevention, sero-sorting/positioning, knowing a partner's status, fewer sex partners, cum on me not in me, gloves with fisting, lube not spit, etc., etc.
What’s often not talked about during these (de)moralizing moments is that using condoms has its own failure rate. They’re good … great even. But they’re not perfect. Most gay men already don’t use condoms consistently, and some infrequently if at all. There’s a spectrum of reasons why that’s the case, from fumbling around during sex to trust issues to partners lying or not knowing their true status. PrEP is taken in a calm daily moment when your head is clear and rational and preemptive. That’s a very different head space for protecting yourself from HIV.
It’s peculiar how many ignore ALL the data during these either/or moments of finger-pointing. And just as conveniently, they ignore that “condom whores” exist too. Why is it ok for those who use a good though imperfect intervention like condoms to slut around, while it’s not ok to use PrEP with all the clinical data that supports its use? Here’s the rub: people use both!
PrEP is A prevention tool, not THE tool. It’s not for everyone; PrEP educators state that often. Those who I have spoken to did not make this decision lightly. The great majority are being more responsible by deciding to take PrEP.
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Comment by: Roger (London) Mon., Mar. 17, 2014 at 10:50 am EDT
PrEP is not "the new condom" - PrEP is for those who do not use condoms. This being said, engaging with the rest of the argument is rather pointless.
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Replies to this comment:
Comment by: Enrique (Arizona) Tue., Mar. 18, 2014 at 11:21 am EDT
In response to Roger. THAT was my point buddy. Those who don't use condoms and use PrEP IN THAT respect IS safe to say that they are using PrEP as a condom. Also, there was another point I was writing about. Please read ALL the way through. This is not an attack on people or an argument. Like it says in my blog, it's an open discussion.
Comment by: Seer Clearly (Denver, CO) Thu., Apr. 10, 2014 at 5:27 pm EDT
I disagree. PrEP has a certain efficacy, and condoms have one too. Use both and you're even safer.. a LOT safer. I know many who do use both.
However, there are also those who use neither, eschewing both condoms and PrEP. There is more diversity among people than can be explained with such a simple phrase as "PrEP is the new Condom." This just points out that medical research needs to continue, but more importantly, people need the psychological help to make caring for themselves, their health, and the health of their sexual partners important to them.


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The U.S. military's "don't ask, don't tell" policy got Enrique Franco kicked out of the Army. It also, oddly, was the reason he found out he was HIV positive.


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