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Wednesday, May 30, 2012

The New Frontier

Prevention, PrEP, the whole damn thing — it all boils down to the human impulse to have sex without condoms. Thirty years into an epidemic, that’s still hard to talk about in public without hysteria and morality.

by anon, San Franciso
[name withheld for now]

I have been taking Truvada for two months. 


I’m 39, HIV-negative, and have been sexually active with men since I was 13 years old. So that’s 26 years of condoms, anxiety about HIV and navigating safety with several thousand partners. I’ve been a sex worker for 14 years and in my free time, a sexual enthusiast who loves bathhouses, online hookups and sex clubs. I’m versatile and attracted to a range of men. 

In other words, I’m a good candidate for PrEP.

I’ve remained HIV negative with a combination of fear, will power, good boy training, strategic partner selection and three rounds of post-exposure medication.

Over the years, I’ve realized that most of the prevention messages were wrong: that HIV is not orally transmitted, that HIV is much harder to get for tops, that by and large it’s a fragile virus. These are all things that HIV counselors and prevention campaigns lied to me and my community about by using fear, shaming and millions of dollars. In order to get an HIV test, I would have to go to the principal’s office and take a pop quiz about the five transmissible body fluids and get a finger wagging for the unprotected sex I’d had, which I grossly underestimated in our counseling session.

Fear, for most people, is a short-term deterrent. It’s like crack and it wears off.

HIV prevention, like most American entities, has failed to adopt tactics that are sustainable in the long term to keep people uninfected.

As I learned the truth about HIV (by becoming an HIV counselor myself and working with young street-based injectors) I started taking more risks myself. At a certain point, I felt like my risk tolerance had the potential to get me infected. So I spent a lot of time considering PrEP. I spoke to doctors, friends working at all levels of prevention and poz men on Truvada. I read up on it and finally decided to try it.

I offer these caveats because contrary to government and mental health industry perceptions, I am not suicidal and if there is a problem with my self-esteem, it’s that I have too much of it.

My doctor is a gay man in the Castro who has a lot of patients on PrEP. He treated me with respect, as if my personal research could be helpful to him.

The sex I’ve had in the last two months has been some of the most spiritual, connected and passionate sex I’ve ever had. The persistent anxiety I’ve lived with for so many years is gone.

I have not been using condoms as a top or bottom and have been playing mostly with undetectable HIV positive men. Ironically, undetectable men have emerged as the safest group of people for me to play with. HIV negative men, especially versatile ones, stand the chance of having newly seroconverted with high viral loads. So I’m thoughtful about it. I’m ruling out anyone who does crystal meth. Barebacking and online hookup websites, oft-demonized, are excellent for starting conversations about health and serostatus because people include status and sexual practices in their profile.

Some of you may want to scream BUT PEOPLE LIE! Sure. Sure they do. 



In my experience, HIV positive men do not lie as much. Most of the poz men I’ve been with are extremely concerned about my health, because they live in the midst of their own health condition.

If there is widespread misrepresentation going on among gay men, it’s twofold: 1. HIV negative men lying about when they were last tested, 2. a widespread failure to initiate a sexual health conversation in the first place.

PrEP, for me, has been a great conversation starter with sex partners. 

People want to know more. I put it in my online profiles. There are HIV positive men who can’t wrap their heads around barebacking with me, even if I’m on Truvada. And I totally respect those men for saying so. This is the new frontier.

I have had persistent diarrhea as a possible side effect from the Truvada. I got tested for parasites and don’t have any. But that’s puzzling, because I’ve been on Truvada two other times with no side effects. It might be a food allergy. And this is part of living on new medications: being part of a grand social experiment where you don’t know for sure what causes what.

I am keeping this anonymous now because I have watched some of my friends get shredded in the media for coming out as barebackers. They have been treated like lepers, either by HIV negative people who secretly bareback or HIV positive people who bareback but don’t think an HIV negative person should have that privilege.

Prevention, PrEP, the whole damn thing — it all boils down to the human impulse to have sex without condoms. Thirty years into an epidemic, that’s still hard to talk about in public without hysteria and morality.

Yesterday a large prevention agency worker urged me not to write this blog: “They’ll cut our funding.” For these reasons and more, I’m staying anonymous for now.  This early into taking PrEP, I don’t want that sort of scrutiny and shaming.

When HIV prevention agencies recruit volunteers for HIV vaccine trials, they often use patriotic rhetoric and studio photography to make these people look heroic. Many of the people in those vaccine trials are having unprotected sex to some degree, or they wouldn’t be worth studying.

Instead of denigrating people on PrEP as willful, filthy whores, what if we respected them as people who were willing to venture into uncharted territory for their own health and the good of the world? 

[read posts, watch videos, from 2011]

7 comments:

  1. Your candor is admirable. We all need to hear these kinds of real life tales. And listen without rushing to judgement. Thanks for sharing your particular, brave, thoughtful, risk-taking (but what isn't?), and real story.

    ReplyDelete
  2. Thanks for sharing this. I am both HIV+ and work in both prevention and advocacy for others. I'm often geeting questions about PreP, but have not met anyone here in my area that has personal experience with it. I'm glad atleast to be able to speak of your experience and refer them to this site to possibly learn more from real-life experiences.

    It appears that if anything, there are great "mental" affects that the drug provides. I'm glad that you can experience the fullness of being intimate without the mental strain that accompanies it with the worries of becoming HIV+.

    Good luck and please continue to share.

    ReplyDelete
  3. Thank you for this truly informative report - one I hope many "out there" will get to read and follow suit. I have personally known so many HIV+ co-workers and friends - many who still practice their sexual proclivities with a cavalier "devil may care " mindset.

    Going to various activist events in Washington, DC - especially "The Quilt" was a real eye-openier. I have met many great courageous people over the years and have been a long-time advocate for the Causes, Prevention and Post HIV/AIDS issues.

    It goes without saying that we "straight" guys too are not immune from becoming statistics in this scourge - except ... this "scourge" has taught so many of us more of ourselves and made us more humane and knowledgeable ...

    ReplyDelete
  4. I might be in love with you, Anonymous! :) Thank you so much for sharing your story. It's great to hear your own personal experience with PrEP. So much of what you say resonates.

    "Ironically, undetectable men have emerged as the safest group of people for me to play with. HIV negative men, especially versatile ones, stand the chance of having newly seroconverted with high viral loads."

    AMEN!!!! If I see another highly stigamizing "disease free"/"no poz" message on a profile, meant to be some kind of stand-alone, ill-informed HIV prevention strategy, I might reach through the screen and cyber-throttle someone.

    Sad that you feel like you risk condemnation (and some feel like they risk their funding) for taking concrete steps to protect your health and the health of those around you.

    ReplyDelete
  5. can you say which practice you go to? i've had little luck getting my doc in SF to consider PrEP and would like to move on to someone more open minded.

    ReplyDelete
  6. Thanks for this blog! I found you searching for PrEP side effects. Have been on PrEP for two weeks now and just this week I started experiencing diarrhea on the regular. I was expecting side effects to show up on day one, not 12. As a fellow Bay Area boy, I must admit that it's wonderful not having to constantly worry about being HIV infected, and actually reducing my chances of getting HIV. Btw, your neck is beautiful, maybe I'll see you around Steamworks or 442 Natomas sometime haha.

    ReplyDelete

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