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.