Growing Up on PrEP: Evan J. Peterson's PrEP Diaries and the Call to Confront Outdated Fears of HIV
Evan J. Peterson's The PrEP Diaries is a charasmatic exploration of the life of one middle-class white gay man in the United States. In a series of achronological funny-to-painful stories, vignettes, interviews and musings, Peterson shares how pre-exposure prophylaxis (PrEP) changed not only his current-day sex practices but also his own understanding of his personal sexual trajectory after a 1980s childhood. Peterson told TheBody.com that he added the subtitle A Safer Sex Memoir to the book because it's about how he negotiated safety with sex his whole life -- experiences ranging from awkward dating as a youth, sexual assault, embracing relationships with people with HIV, and, most pervasively, anxiety about HIV infection that often vastly exceeded his actual risk as a condom-using top.
"I had to commit to honesty in my book," Peterson told TheBody.com. "And the thing is, I know that the PrEP conversation is revolving around things like condomless orgies. That's not what turns me on.
"I don't think I'm a statistical outlier," he added. "I think there's a lot of us -- especially with our sexualities shaped by the AIDS crisis -- who don't fit the stereotypical profile of 'dude who likes it up the butt.' And I just wanted to be really honest about what I actually do."
In this highly readable but often painfully honest memoir, Peterson re-examines his life from a new standpoint: Now on PrEP and at effectively zero risk of HIV, he examines the crushing concerns about HIV acquisition he's had his whole life.
Peterson also explores the complexities of HIV denialism (including conversations with a beloved family member who passionately believes that HIV doesn't cause AIDS), the intersection of sexuality and spirituality, and online cruising (in addition to its PrEP theme, the book could also serve as an engaging primer for those seeking to understand the new world of hookup apps).
When Peterson began having nightmares of becoming HIV positive, several months after starting PrEP, he sees the powerful "cultural paranoia" that still remains in his psyche. The book pivots from this personal experience to a powerful call to unroot societal stigma against HIV in a full-chapter "interlude," in which Peterson delves into these nightmares and their pervasive cultural roots.
He calls on today's gay communities to take their next collective step forward to confront and expel outdated ideas of what it means to prevent or live with HIV -- just as earlier generations (including today's long-term survivors and allies) confronted the challenges at the emergence of HIV as an epidemic. You can read a full chapter in this excerpt of The PrEP Diaries.
Chapter 7: Interlude (Waking Up)
The nightmares came and went for a few months. I don't know how many dreams; I had at least three, perhaps many more that my sleeping brain absorbed and didn't convert to waking memory.
As I recall, they didn't begin until two or three months into my PrEP regimen. Once they did, they distressed the hell out of me. The ones that made it out of my hippocampus were disparate, but they all followed the same basic pattern:
I'm with others. Sometimes they're friends, sometimes a doctor or a nurse. I receive the news I'd dreaded for years before getting on PrEP: Your test came back positive. You have HIV.
In these dreams, I've been on Truvada long enough to have that 99% effectiveness rate. I panic.
But I was safe -- I don't even have much anal sex -- I'm always the top -- I always use a condom -- How is this possible?
In dreams, all is possible. Things don't behave the way I expect them to. In dreams, I see written words, but I can't read them, and it's like being suddenly struck with dyslexia or some aphasia. I can't read what the doctor wrote down, or what's on my computer screen in my test results, but I know it means I'm HIV positive.
Sometimes I think, Ah! I bet I'm dreaming. Wake up, Evan. But dreams are tricky. Sometimes I get caught in a dream loop, a series of scenes in which I realize I'm dreaming and I wake up, even get out of bed, but I'm still in the dream. It's like the curse that Neil Gaiman's Sandman, Morpheus, inflicts upon those who've crossed him. They're doomed to eternal waking, only able to wake up inside yet another nightmare.
In dreams, there's an oversimplification of symbols, or else a confusion of them. The certainty of my recurring PrEP nightmares is that, despite my best efforts, despite religious swallowing of daily Truvada and using condoms and cutting down on other risk factors, I still end up HIV positive. The panic leads to a desperate inventory of the past few months, trying to figure out what went wrong.
Did I forget to take it one day, or several days in a row? Who did I have sex with recently? Did I somehow have unprotected sex and not even remember it? Was I drugged and raped? Did I step on a dirty syringe? Did I check a payphone coin return and get pricked by a trap needle?
After I wake up into this external world and not just another dream, the feeling of panic and desperation lingers for a few minutes, coupled with that sense of being responsible for my own blunder. Don't most people feel this after a particularly emotional dream?
As my friend Anthony, a psychotherapist, says about the content of dreams, "Your Superego isn't there to lecture your Unconscious." My Superego is one version of myself, a story of who I'm supposed to be. My Unconscious, however, can't give half a shit about that story.
I don't know how much waking life feeds into our dreams, or for that matter how much our dreams steer our conscious choices and reactions. What I do know is that dreams are both irrational and ultra-rational. Sometimes dreams make no sense at all, but sometimes they simplify everything down to yes/no, live/die, escape/suffer.
When I have a nightmare in which I've contracted HIV despite taking multiple scientifically-proven precautions, I'm not thinking about how shitty it is for me to consider HIV one of the worst things that could possibly happen to me. I'm not thinking about my poz friends who are healthy, happy, and living long lives. In nightmares, I don't stop to think that my health is protected by insurance, and that I should be grateful for my middle class advantages.
In real life, HIV and its treatments are remarkably less destructive than they were 30 years ago. In real life, people with access to proper health care are rarely collapsing into gaunt, lesion-riddled victims right in front of us. In real life, people aren't burying half their friends and praying that the plague won't get them, and American children aren't contracting HIV from blood transfusions.
My unconscious doesn't live in "real" life. My unconscious is a horny, judgmental, nervous teenager with a churning imagination. Thank goodness she doesn't have a credit card. This is why I don't take Ambien.
The payoff of the nightmares is in what I can learn and how I can grow more resilient. The PrEP-failure terrors teach me that I am indeed still affected by the common fears that people blast onto the internet. That cultural paranoia remains with me, albeit overpowered by the optimistic, rational, and informed sections of my mind. While I can articulate the scientific facts, the successful studies, and all the people I've met who haven't contracted HIV since getting on PrEP -- even after dropping other forms of precaution -- I know that deep in my childlike unconscious mind, I'm still banging my head to Marilyn Manson songs and fearing that sex will kill me.
That's what we're really talking about here: the lingering, widespread fears that HIV is the same thing as AIDS, that HIV is inevitably deadly, and that unprotected sex will kill us. Even failed attempts at protected sex will kill us. A condom breaks, a bitten lip or canker sore creates an open wound in the mouth, and your clock begins to tick.
The gay community has to grow up at this point. I can't speak for straight people here. They have their own way of working out HIV, which varies further along racial and economic lines. But I can speak for gay dudes, at least for the middle class with health care access: We have to grow up when it comes to PrEP and HIV.
Our emerging culture found the opportunity to grow up when the virus first became understood, and we did grow up some. We were forced to look out for one another, to advocate for one another, to have uncomfortable conversations that would help and protect one another. We sacrificed some immediate gratification and comfort for the greater good, individually and as a community.
Maybe we stopped there. Maybe we backslid, made mistakes, got frustrated. Maybe we stopped using condoms, started again, figured out whether we wanted monogamy, polyamory, abstinence, open relationships, or orgies. The older generation of queers did a great job of keeping the community strong through the trauma. Gay culture across the world grew up a lot. Now, we need to keep growing.
America, as a nation, had to grow up after September 11. Our tumultuous cultural adolescence of the 20th century resulted in a wariness of authority and conformity. September 11, however, meant another national growing-up was needed. Like a recently legal adult going off to college and getting blindsided by a sexual assault, the collective psyche of our culture needed to deal with this trauma and figure out what kind of culture to be in the aftermath. Clearly, we're still working on this: war, racism, and doomsday cults are as old as human tribes, but we've found new ways to keep them fresh and glamorous since 9/11.
The international gay community, on the other hand, already went through our personalized September 11, but it lasted 20 years. This applies to the rest of the queer community as well: even though lesbians weren't contracting HIV at anywhere near the rate of men who have sex with men, lesbians still buried their friends and dealt with the homophobic fallout of AIDS. Trans and bisexual folks can fall into all the previous categories and more; don't fail to recognize them or the fact that trans people often get the worst of whatever's directed at the gay community, whether they're gay or not. Even through all of this, our shared community has survived and flourished.
In the past few years, more and more queer people in the world have received the human rights of marriage, health care, and safer schools. Queer and trans people are showing up more and more often in the media, but less and less often as villains, clowns, and victims.
Now, we have Truvada. Instead of a tragedy that necessitates maturity, the gay community is now facing an opportunity to keep growing up after a scientific breakthrough. Straight people went through this with the birth control pill. We're going through it with PrEP.
I don't want to live in an adolescent world of fears about what will happen if I have sex. I want to live in the reality of information, education, and confident decisions. I want to live here, now, where I have every advantage to prevent HIV while still having healthy, intimate relationships. We're finally there.