Last month, Scruff, the popular mobile hookup app, unveiled new profile options that will allow users to disclose their safer-sex practices more easily. The drop down menu presents three HIV prevention methods: condoms, pre-exposure prophylaxis (PrEP) and treatment as prevention (TasP). Scruff users can select one of those options (PrEP or condoms or TasP), select a few combination options (PrEP and condoms or TasP and condoms) or choose to leave the field blank. The new feature has the potential to promote disclosure of HIV prevention practices upfront and facilitate connections between app users with similar approaches to stopping HIV transmission. Notably, it more easily allows individuals to indicate that they use only PrEP or TasP and choose not to use condoms.
New menu options that promote transparency and normalize disclosure of HIV prevention status are certainly welcome, and, with any luck, other mobile apps will follow Scruff's lead. For many men who have sex with men (MSM), it is often unsafe to discuss our HIV prevention practices openly and with full honesty. We often feel the need to self-censor because our sex lives are already under such intense scrutiny. We dare not draw further attention to ourselves by saying that we do not use condoms 100% of the time. Hopefully, these new choices will help Scruff users make selections that are more in line with their actual prevention choices.
Even with amazing, game-changing innovations such as PrEP and TasP, it is still emotionally dangerous for MSM to disclose that they do not always use condoms. Over the course of the HIV epidemic, health care workers, frontline HIV prevention workers and fellow community members have all been trained to police the condom practices of MSM and say whatever it takes to change our behavior. To avoid negative and painful conversations about condom use, it is often easier to tell others what they want to hear and leave it at that.
And yet we know that -- even before PrEP and TasP were widely discussed -- the majority of MSM in the U.S. were not using condoms every time they had sex. A few years ago, the Centers for Disease Control and Prevention (CDC) released findings from the 2011 National HIV Behavioral Surveillance survey for gay, bisexual and other MSM, which showed that 57% of those surveyed were brave enough to admit that at least once in the previous year they had not used a condom with someone of unknown HIV status. True to form, when these results were released many media outlets reacted with shock, reinforcing the view that this is an unacceptable disclosure.
Much of this condom-centric stigma has poisoned conversations around PrEP. As has been noted in several PrEP studies, stigma remains a formidable barrier for many HIV-negative individuals trying to access this new HIV prevention technology. Recently, NPR reported on how sex-negative attitudes and HIV-related shame are impacting PrEP access for many MSM in Latino communities. A key component of that stigma is the fear that PrEP users will use condoms less.
For those of us who are HIV positive, undetectable and not consistently using condoms, the stigma is still so strong that it is frequently unsafe to openly disclose our actual condom-use practices even though there is no realistic risk of us transmitting HIV. Because many states still have laws that potentially criminalize HIV-positive individuals who have sex without a condom, even when they are undetectable, there is strong pressure to report consistent condom use whether or not that is actually the case.
The stigma related to HIV prevention choices can make it challenging to ask for what we want and state our preferences directly on hookup apps and websites. The disclosure process can be stressful, and the potential for miscommunication is high. While some of us have learned to adapt to the stigma, many of us need to find ways to minimize the time we spend focusing on HIV on hookup apps, and maximize the time we spend swapping naked pictures.
The ability simply to choose PrEP or TasP up front will help many of us avoid the HIV prevention coming-out process and filter out those who would otherwise attempt to police our behaviors. It will also bring app profiles more in line with the current prevention landscape and the conversations that MSM are actually having. I personally appreciate that Scruff has opted to make "TasP" the choice rather than "HIV undetectable," because it takes the emphasis off of the virus and places it on the solution. Again, the goal is to spend less time thinking about the virus and more time swapping hot photos and actually hooking up.
Undoubtedly, there will be critics who will clutch their pearls as MSM dare to be more transparent about their HIV prevention choices. But for many of us, every opportunity to step further out of the closet about our sexual practices moves us away from a culture of shame and silence and closer to a sense of personal empowerment. One Scruff menu certainly won't do away with HIV prevention stigma, but it is a step in the right direction.
Jeremiah Johnson is the HIV prevention research and policy coordinator for Treatment Action Group (TAG), an independent research and policy think tank fighting for better treatment, a vaccine and a cure for AIDS.