Feeling Deja Vu: PrEP As The New Condom
Part 5 In A Series On PrEP By PositiveFrontiers.com
Jake Sobo
11/15/2012

Back in the 1980s when gay men in New York were dying left and right from an unidentified disease, a group of activists took a stand to argue for condoms. We didn’t know what was causing AIDS at the time – HIV hadn’t yet been identified – but that didn’t stop AIDS activists Michael Callen and Richard Berkowitz from putting together a pamphlet, “How to Have Sex in an Epidemic,” that encouraged gay men to consider adopting safer sex strategies like using condoms to stay safe.

That pamphlet came out in 1983. It took years for public health institutions to take up the condom message. Let’s revisit a boring but enlightening scientific paper published in 1993 –a fucking decade after Callen and Berkowitz published their groundbreaking advisory to gay men – that urged caution in promoting condoms:

Until more is known about condom effectiveness, condom use promotion may have both positive and negative effects… Condoms will not eliminate risk of sexual transmission and, in fact, may only lower risk somewhat… Empirical data (reviewed in this report) indicate that a 90% reduction in risk due to condom use may be overly optimistic. The protective effect as estimated from human studies, regardless of use definitions, indicates a possible 69% reduction in risk. (p. 1642).

Were gay men listening to what this ivory tower, out-of-touch researcher had to say about condoms? No. We listened to our gay brothers who were quickly figuring out that using condoms for anal sex was an extremely effective method for staying negative and staying alive – all while having meaningful, productive sex lives.

Public health types were scared for years about condoms. Could gay men be trusted with them? Was 90% efficacy worth promoting? Beyond just questions about their effectiveness, many (including some gay activists like Larry Kramer) were really wondering why gay men couldn’t just stop fucking. From their perspective, sex was a frivolity that gay men should just be prepared to give up – like knitting or eating out on weeknights. What these critics refused to understand was that sex is not a hobby. It is a vital part of how we make meaning and derive pleasure from our lives.

Reading through numerous heated Facebook discussions about my post last week, “Learning to Fuck with Poz Guys,” I was overwhelmed by an unsettling sense of déjà vu. So much of the hostility towards PrEP and experiences like mine boil down to the same kinds of fears that in the 1980s and 90s drove many in public health to stay silent on condoms while thousands died. Is it effective enough? Won’t it just drive gay men to fuck more irresponsibly? And for god’s sake, can’t you just use a condom and act like an adult?

I couldn’t’ believe the irony of it all. The arguments used against PrEP today are the same god-damned arguments used against condoms in the 1980s and 90s. Almost every single gay man who condescendingly lectured that I needed cognitive behavioral therapy to learn how to use a condom was (almost exclusively) in their 50s and 60s. These guys knew what it meant to have your sexual choices questioned and despised in the face of the epidemic – they had lived through the madness of the 1980s and 1990s.

Look, I get that some of you guys lived through a horrible time that haunts you to this day. I can’t even imagine what it was like – I don’t want to imagine it. The thought of my best friends dropping like flies while the government refused to even acknowledge we were dying is harrowing. But I’m in my late 20s. I didn’t live through that time. Would you really wish it on me?

I don’t view my decision to start taking PrEP as some kind of perverse license for irresponsibility. On the contrary, it was my way of taking responsibility for my health and the health of my partners. PrEP isn’t 100% effective, but let’s not forget that condoms aren’t either. The CDC estimates that condoms are 80% effective at reducing the risk of infection. What was the efficacy for Truvada, again? Oh, right. Between 92% and 99% when taken daily. Let’s not get it twisted: PrEP can be just as (if not more) effective than condoms. Yes, you have to take the pills for them to work. But last I checked, you also had to use a condom for it to be effective.

I live in the 21st century HIV epidemic. I invite my critics to consider joining me. We can’t go backwards – and thank god for that. PrEP is my future, and it will be for many of my gay brothers. Just like condoms, PrEP is a way for us to try to stay negative. 

 

Jake Sobo is a pen name used for anonymity. Jake has worked in the world of HIV prevention for nearly a decade, and is eager to share his experiences taking PrEP. Having closely followed the development of PrEP from early trials to FDA approval, he was excited to give it a shot when it was approved for use among MSM for preventing HIV.He has spent the better part of his adult life having as much sex as possible while trying to avoid contracting HIV, and started taking PrEP as a way to help him stay negative. He is well aware that the drug is not 100% effective and that he could test positive; while he hopes that does not happen, he knows that he can rely on his numerous HIV-positive friends to deal with that situation should he seroconvert.


 «  Return to previous page
 »  Send to a friend
Subscribe to channel

Leave a comment:

showing all comments · Subscribe to comments
  1. Alex posted on 11/21/2012 09:37 AM
    Condoms are actually more efficacious than 80%, when used correctly.
    1. Jake Sobo posted on 11/21/2012 11:16 AM
      @Alex Hey Alex,

      Thanks for your comment. I get what you are saying here. I understand that the data is more complicated that it readily appears. Let's note a few important things:

      1. The "80%" figure is based on people (heterosexuals) reporting that they used condoms "consistently." (link to study: http://www.ncbi.nlm.nih.gov/pubmed/11869658). We can only know if people used condoms based on what they tell us. We can't watch them.

      2. With the Truvada figures, we actually know when they take the pills; we can measure it in their blood. So the "92%" and "99%" figures that I've talked about are from measuring when people actually had the medication in their blood -- which indicates that they did in fact take the pills.

      So you're right to note that comparing these figures is sticky. I did it anyways because the 80% figure is the best we can get for condoms. Could they actually be more effective? Yes. But that's why I said "PrEP can be just as (if not more) effective than condoms." It's probably impossible to definitively say which is more or less effective, precisely. But it seems clear that PrEP protection approaches the protection offered by condoms.
  2. Tom posted on 11/27/2012 06:08 PM
    Is there anyplace where we can escape advertisements for this recreational drug? Please, for the love of god, if we just let the pharmaceutical companies keep their f***ing patents into perpetuity, can we at least then stop hearing about how a drug that will infect neg, deprive poz and possibly unleash a torrent of resistant strains is "just progress"? You people have already paid off the FDA and government while the rest of the world has watched in horror, do we have to keep hearing you misrepresent this as "just another tool in our tool box"?
  3. bad credit motorcycle loans posted on 07/18/2013 04:31 AM
    Thanks for your comment. I get what you are saying here. I understand that the data is more complicated that it readily appears. Let's note a few important things Regards!
  4. moxie posted on 09/08/2013 04:20 PM
    But why not use condoms and Truvada? Together, your risk would be next to nothing! Isn't that how it's supposed to be used anyway? I just don't understand why one would
    As a neg hetero ally, I don't want my friends, loved ones, or anyone in the LGBT community viewing Truvada as a replacement for safer sex...I really wish you wouldn't either, as this is one of the first links that pops up when one googles Richard Berkowitz. I wish you and your partners the best for health, and consider getting tested for CMV if you haven't already (commenters and blogger alike).
  5. Andrew posted on 11/28/2013 08:23 AM
    One commenter objected to Truvada for PrEP as being recreational drug, which seems to get to the gist of a lot of people's problem with it: that there is something wrong with recreation. It comes down to the old American puritanical idea that if something is enjoyable, it must be evil. On top of this, a generation of safe sex messaging has left a generation of gay men deeply mixed up, confusing for them the ritual of using a condom with the purpose of it, namely to reduce risk. For both these reasons, even a 100% effective PrEP drug would never be acceptable for these men. For them, it would make casual sex too enjoyable and would encourage barebacking, which for them has become a synonym for evil regardless of the risk involved.
showing all comments
   MORE FROM THIS SERIES

My Life On PrEP

  • The Time For Debate is Over. The Time to Implement PrEP is Now.
      So much has changed since when I began writing this column last October. When I started “My Life on PrEP,” most people were wholly unfamiliar with the concept and its implications for HIV prevention. Apart from the spiteful attempts of AIDS Healthcare Foundation director Michael Weinstein to do everything ...
  • Syphilis, Gonorrhea, and Chlamydia, Oh My!
    One of the most consistent criticisms of this column over the past six months has been that some perceive me to be taking STIs other than HIV for granted. Like the birth control pill for women, Truvada doesn’t protect against anything but HIV. So if PrEP promotion is correlated with ...
  • Stop and Go PrEP: Will it Work?
     A couple of months ago, I wrote about the question of when somebody taking PrEP might consider discontinuing its use. A few readers e-mailed me to ask a related but different question:  what if you stopped taking Truvada when you weren’t having sex, and started taking it again later? ...
  • Putting the Nail in the Coffin of Condom-Only HIV Prevention
    Dearly beloved, we gather here to say our goodbyes. For over thirty years, condoms have been our only lifesavers in the face of HIV. Gay men invented their promotion at a time when death was the only seeming alternative. When treatment did not exist. When Kaposi’s sarcoma was a visible ...
  • The Unexpected Struggle to Make Doctors Allies in PrEP
    If you had asked me back in September when I started writing this column what I thought the biggest obstacles facing PrEP would be, it would not have immediately occurred to me to add doctors to the list. Of all the various parties that need to be onboard for PrEP ...
  • Fucking the Future
    Every year around the New Year, a friend of mine— we’ll call him Thomas—gives a presentation about the sex he had during the previous 365 days. It’s a geeky-whore mix of PowerPoint slides and statistics, as well as steamy photos and lurid anecdotes. Every year for the past six years ...
  • That Barebacking Thief-Whore: PrEP and Responsibility
    I’m fast approaching the four-month anniversary of “My Life on PrEP,” a milestone that I imagine equal parts of you are either thrilled or disgusted to see pass. You've made your views about me and my ideas plain, which I have honestly appreciated. One of the wonders of the internet ...
  • No, Seriously—Quit Saying 'Unprotected Sex'
    Author’s Note: When this column was written Wednesday, the study’s “Zero Feet Away” report was not publicly available. Jake received a copy of the report Thursday, just as this column was about to go to print. The link is included in the story below. Last week, The Huffington Post did ...
  • I Thought PrEP Would Put a Stop to Freaking Out About HIV—I Was Wrong
    When I first starting taking Truvada last October, I thought that I would finally be done with the incessant freaking out about HIV and self-diagnosing that many HIV-negative gay men go through on a regular basis. If you are (or have ever been) an HIV-negative gay man, you likely know ...
  • Transforming Reluctance Into Action: Getting Positive About PrEP
    One of the things that I’ve always found somewhat maddening about the public discussion about PrEP is the downright reluctance—nay, pussyfooting—that colors so much of it. It seems nobody is allowed to speak about PrEP without adding a slew of conditions. PrEP “might” be right for you. PrEP “could” ...