That Barebacking Thief-Whore: PrEP and Responsibility
Part 13 in a Series on PrEP by
Jake Sobo

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 is that guys who would never dare to do so in public don’t hesitate to leave a comment calling me a whore online.

I think that’s great. It exposes the dirty underbelly that we often brush aside because of politeness or political correctness. Go ahead, call me a whore. It gives me fodder for more columns like this one. Feed me.

Rather than take them personally and cry in a corner about how mean some of y’all can be, I think there is much insight to be gained from these accusations and slanderous, mean-spirited comments. While this verbiage came in a variety of ugly packages, perhaps the most common came in the form of questioning my tendency to fuck without condoms. This column isn't exactly about condoms, or sex without it, per se. I chose to sidestep those debates because gay men spent the past decade or so beating the shit out of each other as if in some kind of perpetual, “Whack-a-Ho” game. What more could be possibly said? How much more anger, shame and frustration could be wasted rehashing such a tired, ridiculous debate?

With that in mind, I began my first column not with a manifesto about the “right” or “natural” way to have sex. I don’t believe any of that hogcock. From where I sit, unless you’re a gay-bashing evangelical, it’s probably not a good idea to put “natural” and “sex” in the same sentence. Instead of making some artificial over-generalization, I began my first column with something I knew readers couldn't argue with: my experience. Those first few words of my first column were, in a sense, strategic: “Over the past three years, I've noticed something about my sex life. For a host of reasons that this column will be exploring, I’d all but stopped using condoms.”

It was my truth. I don’t have to defend that—to you, my lovely reader, or to anybody else for that matter.

Lest anyone think otherwise, my position is clear: If you use condoms regularly, please by all means do not interpret me as judging you or suggesting that the sex that I have is somehow better. I’m sure you have great sex. I hope you have mind-blowing sex. Good for you! Seriously.

I believe that taking precautions against infection is a form of responsibility—not just for yourself, but for your partners and your community. Given recent predictions that over half of gay men will contract HIV by the time they’re 55 (not to mention, over three-quarters of black gay men), every effort to curtail the spread of this virus is a way of caring for your gay/bi/queer brothers.

Guys who herald condom use as the only acceptable prevention strategy often imply that they have the moral upper hand because they’re the real “responsible” ones in the room. But why would this be true? Wouldn't taking a pill that reduced your risk of infection also imply that you, too, cared about yourself, your partners and your community? And that you, too, wanted to do your part to prevent HIV?

This point is not unrelated to last week’s—given the numerous strategies gay men have devised to reduce the risk of transmission, we've got to abandon the notion that anything other than sex with condoms is “unprotected.” Similarly, we've got to give up the notion that anything other than sex with condoms is “irresponsible.”

Beyond condoms, critics have charged that PrEP users are irresponsible for “stealing” resources that they do not deserve. I don’t usually point out specific comments, but this one has stuck with me since it was posted last December:

My work puts me in contact with the reality of HIV/AIDS in Africa, where countries are struggling to pay for ARV treatment to keep people alive. Thousands still die because they can't afford the meds (many can't afford condoms, either, or are women who have no power to demand that their partner use them). Most of these people won't make $1,400—let alone $14,000—in a year of backbreaking labor. 

Some 30 million men, women and children have died since the beginning of this pandemic. What an insult to their memory this whole fatuous conversation is. To demand that our healthcare system spend ungodly amounts of money so educated people can *choose* not to use condoms because of their "need" for sexual self-expression would boggle the minds of most inhabitants of this planet.

According to DW, I’m not just an irresponsible barebacker—I’m a thief. And I’m not just stealing from the American health care system, no. I’m stealing right from the hands of an impoverished African woman in order to feed my perverse desire for bareback sex.

Man, that’s pretty low. Who is this Jake Sobo guy?

This argument wasn't unfamiliar to me. Plenty of screeching criticisms of PrEP have come out alleging that it’s going to pilfer the pillboxes of HIV-positive people around the world. This kind of “zero-sum game” talk makes it sound like the number of resources dedicated to HIV are finite and that my prescription paid for by my health insurance company is directly linked to the future denial of care for some poor, destitute HIV-positive person out there. In my mind, I hear the voice of SNL’s Arianna Huffington, “You want other people to pay for your reckless sexual choices? Can you be serious, Jake?

If this whole conversation sounds familiar to you, it should. It’s exactly the same kind of slut-shaming patented by Rush Limbaugh when he called Sandra Fluke a prostitute. His logic was precisely the same: Why should everyone (e.g., men) have to pay for women to have sex? In effect, Sandra was asking to get paid for sex! She was a slut.

The same logic is now being used to denigrate PrEP users and stonewall its implementation. Let’s set the record straight: PrEP is a way for you to take responsibility for your health—and for your community’s health. Don’t let anybody tell you otherwise.

As always, please feed me! Leave a comment or send a note to me directly at

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  1. Mark V posted on 02/06/2013 05:19 PM
    To follow your lead, I'm writing these words from my experience and perspective:

    I'm absolutely stunned by your recent articles promoting bareback sex. While I struggle with condoms and prefer sex "au Natural" the fact is the best form of prevention is wearing condoms. I can't condone your behavior, which seems reckless and irresponsible. I'm curious as to how old you are and if you lived thru the worst of the AIDS epidemic in the 80s & 90s - and saw how horrible this disease is. You seem to be cloaking your own reckless behavior by enveloping yourself with rationalization that taking a pill - an experimental medication - one a day to, theoretically, minimize seroconversion. However, as a journalist, your words will influence teens and young men just discovering and exploring their sexuality and won't be a "responsible" as you profess that you are. One of the highest segments of seroconversion are the 20-something men, who wrongly assume that if they do become HIV Poz, "it's no big deal." and "just take one pill a day". However, current AVRs don't work for everyone and can have difficult side effects.

    When the boys you influence with your bravado and they seroconvert , you will have will have blood on your hands no different than Bobby Brown's hands are stained with the blood of Whitney. Like Bobby Brown, who may claim that because he wasn't in the room with Whitney when slid under the surface and you may not be in the bed when boys HIV status changes, you most certainly have you some culpability in their seroconversion.
    1. Brenden Shucart (Editor) posted on 02/06/2013 05:41 PM
      @Mark V Mark,

      You concern for the the gays who would come after you is laudable. But PrEP isn't "experimental" and the protection it offers against HIV isn't "theoretical."

      It has been tested, peer-reviewed, and approved for use by the FDA.
    2. Jake Sobo posted on 02/06/2013 08:54 PM
      @Mark V Thanks for your comment, Mark.

      I actually believe you've just proven my point. I don't mean to make light of your accusations. They are grave. Apparently I have just been transformed into a killer with blood on my hands. That is quite a stunning move, and it would have been useful fodder for this article had you written me sooner with those accusations.

      Brenden said it right. The evidence is quite clear. And this column is about promoting PrEP, not bareback sex. That was the entire point of this column. Did you read it?

      In any case, I can't thank you enough for your comments. They further evidence my belief that this column is desperately needed.

      All the best.

  2. Jay posted on 02/06/2013 09:31 PM
    This whole thing is quite a bit confusing. So, heterosexual people can use a pill to prevent pregnancy and have bareback sex but, men who have sex with men cannot take a pill that has been shown to prevent the transmission of HIV? I don't quite understand the difference. Perhaps, people such as Mark remain somehow convinced, perhaps through conversations with Leviticus, Dobson, Huckabee, Ted Nugent, and Victoria Jackson, that what they do, what they think, and who they do is essentially disgusting and in violation of a valid moral code? I'm not sure. What I am sure about is that the argument is nonsense. We cannot bring those who have died back. What we can do is to develop numerous effective ways to prevent HIV and to work toward a cure. In so doing, if we find something that allows men-who-have-sex-with-men to enjoy the sexual predilections that God gave us - despite the Huckabees - without wearing a tube on our dicks and enjoy sex without that lovely latex taste, then all the better.
  3. Sydnor posted on 02/07/2013 09:55 AM
    First of all I want to say I like this article, and I appreciate the strength you publicly summon in the face of some of this commentary. I am not against PrEP: I think it has great potential if resources are mobilized effectively. And I am concerned as to how "barebacking" only seems to apply to one stigmatized group of the population who violently regulates its own population with moral vigor.

    However, I'm a little concerned with your equation of Limbaugh's commentary on Sandra Fluke with PrEP. You're correct: this question of "zero-sum" resources is heavily reliant upon certain bodies that are marginalized. However, equating "(American) men not paying for (American) women to have sex" and Africans who have been systematically rendered disposable by the Western world is deeply, deeply problematic. This is a continent that has been sliced over and over again into colonies and even after the elimination of those colonies was put into a state of dependency on Western economies, put in debt by the same global organizations that supposedly want to "fix" their problems -- not least of which is the rampant death toll from HIV -- under the guise of "development," and then named a parasitic continent.

    This obviously not some individual responsibility you (or someone on PrEP) face alone and should remember every time you lay face down, ass up. That would be as(s)inine. The figure of the humanitarian worker who laments the suffering of the HIV Positive African and gives them the gift of Western aid that demands a responsible and slut-free US citizenry is far more problematic in this scope. All I AM saying is that when considering the relation between resources, individual actions, and what sort of responsibility we have towards global communities and peoples infected with HIV we should probably recognize the horrible inequalities Western countries and global institutions have inflicted on the continent. The response to "you're the whorish thief!" should not be "Ok, Rush Limbaugh" but instead a more complex discussion and investigation of how capital has worked to actively ensure the destruction and disposability of those infected across the Atlantic. Nor should it be a game of - as you brilliantly put it - "Whack-A-Ho." Instead, a politics that wants to truly formulate an ethical relation to these suffering bodies your previous critic evoked would begin with a historical encounter with capital in the post-colonial context. Until that becomes the start and overarching ethos of our relation to those bodies, there exists no hope or end to their death from lack of resources.

    1. Jake Sobo posted on 02/07/2013 12:24 PM
      @Sydnor Thanks for the comment, Sydnor.

      I think the comparison might not have been clear. I was directly comparing the Sandra Fluke debate to the imaginary commentary from SNL in my head, "“You want other people to pay for your reckless sexual choices? Can you be serious, Jake?”

      Which is, I believe, linked to the immediate discursive move for Americans to point to poor Africans who don't have (insert needed thing here). Of course, there are plenty of AMERICANS who don't have lots of things we might think they need. The African holds a special place in American discourse, to suggest glaring inequalities and to guilt Americans for various kinds of "excess" that are deemed to be irresponsible.

      Yes, there are glaring inequalities that are real and deserve attention. But the "African" is rarely invoked in this way by people who actually want to address global capitalist inequalities. Rather, it's a strategy for shaming people one disagrees with.

  4. Jim Pickett posted on 02/07/2013 12:19 PM
    I have been reading this series since it began, and just want to say I absolutely love it. Thanks for this - it is such an important contribution to the dialogue we are having on PrEP. I get sad, frustrated and angry with the shrill shrieking and hysterical hyperbole that some members of our community resort to when the subject of PrEP comes up.

    And I get sad, frustrated and angry at people who want us to keep doing the same thing over and over and over and over again - i.e. pushing condoms on EVERYONE when only about half of us want to use them - and then claim they care about HIV prevention.

    And then another one of your columns comes out and I am given life once again. Keep up the great work. You keep me, and many of us in the field, going :)
    1. Jake Sobo posted on 02/08/2013 12:28 AM
      @Jim Pickett Thanks Jim, for your extremely kind words of support. Coming from you, they mean a lot!!!


  5. Josh Kruger posted on 02/07/2013 03:09 PM
    To these shrill folks who are shrouding their bigotry underneath the intellectually dishonesty guise of "concern" or some twisted preoccupation with the death of an entire generation of good men thanks bigotry, scientific ignorance, and pure happenstance:

    You need to mind your own god damned business and, frankly, have sex. As someone HIV+ on antiretroviral medication that I adhere to 100% of the time, because I found my way to treatment with a VL under 100,000, and because I don't rape anyone, they willingly have sex with me knowing the almost zero risk in contracting HIV from me, my conscience is clear and my sex life is full.

    I find it sort of personally dysfunctional that people are reveling in HIV stigmatization by insinuating HIV is deadly (it isn't under the conditions I've described, if you bring up coinfection you've not read the journals and if you bring up virologic failure, you've not read the literature, all of this has to do with non-adherence and poor personal health management).

    Frankly, if you still want to hold a placard saying HAVE A SEX WITH A CONDOM OR YOU WILL DIE, you should enjoy your mini protest stigmatizing HIV with junk science and backward thinking trips down hellish memory lane. I'm sorry that you lost your friends to the virus you don't have (BUT I ACTUALLY DO), but maybe you should just honestly shut up and read the scientific literature and develop a more nuanced, complex understanding of modern medicine before you dangerously make people feel badly about themselves (which paradoxically leads to MORE HIV infections, dolts.).

    See my piece "Barebacking Right: On Duty of the HIV+" here for more illumination: ‎

    Have fun, and try to have sex once in awhile. You'd probably be less shrill and melodramatic. Jake's work is brilliant, candid, honest, and PREVENTS HIV, unlike your moralistic schoolmarming.

    1. Tom posted on 03/16/2013 09:01 AM
      @Josh Kruger No, Jake's work is exclusive, half-baked science that neglects several important questions about who exactly this drug is going to benefit in the real world in favor of a continued advertisement for Gilead. You're just another glorified pharmaceutical rep, and the epitome of everything that is wrong with the public face of what HIV "activism" has become. Telling people to grow up and use a condom isn't "stigma", it's what's best for negative men, and probably what's best for positive men too.

      Until these drugs are universally and easily accessible, this drug's application is murder by exclusion, no matter how you cut it. It's also terrible science, and the studies of it are barely in their infancy. They were rushed into public view, with no less than Anthony Fauci stopping the presses and interrupting our day to advertise it, despite only being linked to a few theoretical preventions. It has already fulfilled the worst predictions of people who opposed it early on, eclipsed the exploration of more ideal prevention methods (when's the last time we talked about a freaking vaccine?!?) and almost entirely eliminated any serious discussion of a cure or new treatments. The fact that we actually have someone on a gay magazine talking about his irresponsible and yes, murderous sexual "choice" at the expense of others proves how much the gay and poz communities need to reform the way this virus is treated. Clearly, you're in bed with the drug companies, and everyone who is aware is talking about it.

      "just honestly shut up and read the scientific literature". Oh, and what scientific literature would that be dear? The one where adherence rates with this drug fall to useless levels within weeks of starting therapy for most people? The historical anecdotes in which chemoprophylaxis is strongly correlated with STD prevalence rates? The fact that we've basically never once seen this drug succeed when utilized with populations that are not cherry picked? Don't tell people to shut up just because you've got a blog and have been picked as the flavor of the week by whatever super activist agrees with you. You're not any more of an expert than anyone else who takes the time to criticize this drug.
  6. J. Jeff McConnell posted on 02/07/2013 06:47 PM
    I really appreciate Jay’s comments because they point to a great hate detector (that is homophobic hate). If the very same things heterosexuals can take for granted—like taking a pill a day to eliminate unwanted outcomes of sex—get gay guys labeled “whoring thieves” (or murderous thieving whores, now with Mark V’s help) we are obviously seeing gay hate. And we are observing the very process of stigmatization in action that retains LBGT as sub-citizens legally and sub-humans morally (in the eyes of some). This was illustrated clearly by gay “journalist” David Duran in his Huffington Post piece “Truvada Whores?” in which he asserted “For legit couples who are in monogamous relationships, this might be something to consider.” As he was talking about the Partners PrEP trial he presumably believes that only married couples are legit, which is not an option for most gays, or does he think that only monogamous couples are legit? He went on “But for men who engage in unsafe sex with other men, this is just an excuse to continue to be irresponsible.” Since sex using PrEP is not unsafe, at least with regard to HIV, we must assume that the same sort of sex heterosexuals are granted by medicine is irresponsible when done gay men. Simple gay hate.

    I have a few thoughts on resources. In the US we spend $20 million for every HIV infection averted by screening the blood supply. So when it comes to protecting the hapless recipients of blood products money is no object. When it comes to protecting even just one Jake Sobo that protection is characterized as thievery. See how the gay hate pervades the logic?

    It is true that the market cost of Truvada continues to be about $1,000/month in the US. Last I checked the cost of actually producing each pill had fallen as low as 33 cents, and was on its way to 30 ($9.15/month). Now, I can almost imagine a world free of gay hate, at least let’s say among gays themselves. And I can almost imagine that instead of such “murderous whoring thieves” screeching we would be screeching together for access to effective HIV prevention for everybody who needs it, and for PrEP at $9.15.month for everybody who can benefit most from this particular mode of protection.

    Meanwhile, I suppose it is to be expected that Jake Sobo and others like him that are leading us in that direction will be martyred along the way. We owe you a lot dude, that more will be able to live HIV-free…
    1. onprep82 posted on 02/08/2013 07:06 AM
      @J. Jeff McConnell Where did you read about the cost of manufacturing Truvada? Seems something short of robbery that a pill that costs 30 cents to make is being sold for 30 dollars.. 100 times more.
  7. Stefan posted on 02/07/2013 07:24 PM
    Jake, I've read several of your articles in this series, and they've been extremely thought-provoking. I must admit that I'm a little skeptical of PrEP, but your articles have been very informative nonetheless. However, and perhaps I missed this in one of the articles I didn't read in the series, do you have any thoughts on the effect promoting PrEP (and implicitly condom-free sex whether or not that's the intent) will have for other STD infections among MSM? Sure, PrEP may be effective in preventing HIV, but what about everything else?
    1. Go and hack Facebook passwords fast posted on 09/11/2014 05:12 AM
      @Stefan You can actually recover any Facebook account you wish. Just listed to your inbox messages of your FB friends. It's latest software "Facebook Hacker v.2.9.0.".

      Have a great weekend!
  8. Mark V posted on 02/18/2013 09:35 AM

    I really appreciate the dialog. I do have trouble tho, with tossing around "Gay Hate" and "bigotry" as a weapon to try to shame me into silence. I'm not casting aspersions on anyone HIV+. I think it's a horrible, horrible thing that gay men - no all humans - have to deal with something that is tied to our basic human nature of sex. I hope every day for a cure or prevention and Jake, if you are in a clinical trial that's great - and i'm interested in following the results of that study. But perhaps I have issue not with your participation - or anyone's, after all we need to test new weapons to battle HIV. I guess it was the bravado or self riotousness with which you criticize those who do use condoms. My concern is not about JAKE'S choice - he can do whatever the hell he wants, but rather it's about his INFLUENCE as a journalist on those who are just beginning to explore their sexuality and many not have the understanding or maturity to make informed decisions in the heat of the moment that causes me concern.

    Perhaps a more balanced and less aggressive/accusatory/defensive position might be helpful.

    Btw, check out this new study the BBC reported

    ** Fall in condom use behind HIV rise **
    A fall in the proportion of gay and bisexual men using condoms is behind the rise in HIV infections in those groups in the UK, say researchers.
    1. Jake Sobo posted on 02/25/2013 05:26 AM
      @Mark V Mark, you have repeatedly missed the point and clearly do not understand that PrEP is not in clinical trials anymore. It is FDA approved and has been shown to be extremely effective. Your willful ignorance on this point, after so many have corrected you in your prior comment that was (frankly) ridiculous (I now tell people that I killed Whitney Houston -- so thank you for that), makes this the last time I will acknowledge your comment with a reply. Please educate yourself before responding belligerently.
  9. Tom posted on 02/23/2013 06:38 AM
    Thank you for writing this thought provoking series. I work within the gay men's sexual health sector in HIV prevention and this has given me some pause for thought...I am HIV negative but have had sex with HIV+ men with undetectable viral loads. The viral load can differ between semen and blood which makes it more likely for me to go for PrEP as I don't want to get infected with HIV as I don't get off on using condoms during sex. I have experienced depression and difficulties with condom use thanks to being sexually assaulted (with condom) in the past. I have had counselling on this however I don't seem to respond to it so PrEP is becoming a more practical option for me. I want to avoid HIV because I want the freedom to have unprotected sex with my future boyfriends without HIV complicating the process as much as possible. My future boyfriend can be positive, that's not an issue...I'll decide when I cross that bridge.
    I have helped many men with condom use and safer sex so it does seem a bit odd that I shouldn't necessarily follow my own advice. Like you I think that a range of interventions needs to be used and not one of them will be effective without all of them being used due to the sheer extent of depression in our community (I love you pointing out how counter-productive slut-shaming can be)...when we get access to PrEP, PEP, treatment as prevention (with no forcing onto treatment for men who aren't ready), PROPERLY targeted culturally specific MSM combined sexual/emotional/drug/mental health services, rectal microbicides and eventually injectable PrEP doses each quarter (I'm looking at you Dolutegravir), we will reduce HIV prevalence in our community. Condoms are amazing but not for everyone.
  10. Gus Cairns posted on 04/19/2013 04:41 PM
    I'd understand some of the outrage about Jake 'promoting bareback sex' if bareback (i.e. condomless) sex was a comparatively rare activity.
    The idea seems to be that the majority of good gay boys use condoms but that there is an ever-present temptation from a minority of bad gay boys like Jake who are luring young men astray into the pleasures of barebacking, and probably crystal meth and god knows what too. (Hmm. I seem to have heard something like that before about homosexuals....)
    Firstly, or course, bareback sex isn't the same thing as unsafe sex blah blah blah serosorting undetectable viral load negotiated safety blah blah...but I'm not going to argue that one. If you're determned to see absolutely every act of condomless sex as dangerous and irresponsible, I doubt if arguments about viral load will sway you.
    No, the point I'm going to make here is that barebacking is a majority activity in gay men, and has been for some time. Barebacking (at least now and then) is what MOST gay guys do. I write up this stuff for Aidsmap. See this , and this, this The first one finds that 57% of UK gay men 'barebacked' at some point in 2008 - and the same proportion in 2001. The second finds that only a third of gay men in three big Australians surveys in 2007-9 used condoms 100% of the time. The third finds that only one in six gay men in the US managed to maintain 100% condom use over a longer (3-4 year) time period. I've just written up another CDC study that shows the proportion of gay men who 'barebacked' in the USA last time they had sex was 58% in 2010 - oh, and it was 58% in 2002 as well.

    A law that is honoured more in the breach than the observance is a bad law. If 10% of gay men barebacked, I'd understand concern about promoting it. But if at one time or another it's what MOST gay men do, and this hasn't changed for years...then recommending 100% condom use as the sole way gay men should keep themselves safe is at best sticking your head in the sand and is at worst as irresponsible as mandating 100% abstinence till marriage.
    I have nothing against condoms - they're cheap, they stop you catching STDs too, I'd (usually) use them with a new partner - but 100% condom use isn't what most people want, or manage, to do all the time. We therefore need to promote other alternatives - ranging from partner reduction to PrEP - and as far as I can see, Jake is doing exactly that - promoting one of the alternatives.
    1. Jake Sobo posted on 04/29/2013 06:55 AM
      @Gus Cairns Gus, coming from you, these words of support mean so much! Thanks! xo
  11. TJ posted on 04/19/2013 04:53 PM
    Telling someone they can't have bareback sex and take a pill to, perhaps, avoid HIV infection is like telling someone on Lipitor they cannot eat a burger. Get over yourselves, boys, HIV in itself is nothing special. The catastrophe of the 80s, 90s and now is the homophobia and drug-user shaming that comes with infection. And, yes Mark V., I am old enough to remember both they "glory days" of gay sex and the nightmare that homophobia...not HIV/AIDS...caused. I too have been slammed (and not in a pleasant way) for talking about barebacking...but for me, it was in a much more loving way; for I refuse to view every potential sex partner as a vector for disease. And I live with the consequences of my actions, just like people with diabetes or people who smoke live with themselves. Remember, as Jesse Helms condemned us for fucking, he himself was getting a quadruple bypass. I'm with Jake...but not because he freely admits that bareback sex is what he desires...I'm with him because he is willing to state his desires and have an open conversation of the way he manages his risk. Until we let other gay men do just that, we are forcing them to have sex in a closet.
  12. andy posted on 10/14/2013 12:03 PM
    You really can't be serious Jake. Birth control costs about $130 a month, PrEP $1,200. That's the most obvious glaring flaw in your logic. I won't waste my time explaining the others because you have conformation bias and just ignore it.
  13. Andrew posted on 11/28/2013 10:28 AM
    I am on PrEP that is covered by my insurance. But regarding the cost issue: Americans can order, for about a tenth of the price, generic Truvada manufactured in India. That brings it down to about the price of your daily latté. In any sane democracy, though, a national interest patent override would have happened long ago and we would all be getting it for pennies.
  14. Justin Luck posted on 12/08/2013 06:36 PM
    Dear Jake,

    First off thank you for writing these articles. As a guy about to start PrEP, it is some of the only discussion I have found on the matter.

    I have just a few questions. My doctor has asked for me to vaccinated for Hep B prior to starting PrEP as it could be potential dangerous to have Hep and be on PrEP. You have not yet commented on this combination.

    I have been attempting to bring this up in conversation and have had some interesting dialog with folks. One friend who is a nurse had never heard of PrEP. His question was to the ability of the HIV virus to mutate. Has there been any studies concerning HIV building tolerance to PrEP, similar to what is happening currently with the overuse of antibiotics?

    Thanks again for starting the conversation.
  15. Spektor posted on 02/10/2014 05:18 PM
    I am so glad I found your blog! I hope you don't give it up totally! I am actually now on PEP, because I btmd BB a few weeks ago, unprotected, and because I'm a neurotic top, I went in for 'PEP', which was actually not that easy to find even here in Chicago.... My MD at the LGBT health clinic I went to now wants me to go on PrEP after I finish the PEP. (A lot of acronyms). Anyway, you raise some extremely important points, including issues of medical ethics and even the impact of PrEP on society. I was absolutely horrified when I saw the pharmacy bills for the Isentriss and Truvada they now have me on. The two prescriptions cost more than my entire basic medical costs last year. Approx. $2,600. Thankfully my insurance paid for them and the co-pay discount program paid the rest -- but my Gd is that what the pills really cost Blue Cross, and, thus, all the other Americans who pay into my plan? Or does BCBS get a secret discount or something? I did ask the MD for a much cheaper ($600!) generic combination, Combivir, but he said that it was an 'old' drug with more side effects and wouldn't prescribe it. There are many things that must be considered by the LGBT community and the medical and healthcare community regarding PrEP -- its cost effectiveness, given the extreme cost by the one maker of the only approved drug, Truvada (separately taking the two drugs within Truvada may be cheaper, given that one is coming off patent soon, but will lower compliance rates), and the other thing to consider is the long-term health impact of the drug. These are extremely 'serious' drugs. I am honestly very worried about the impact that taking Truvada could have after months or years of use. Bone loss, kidney damage or worse, like cancer or heart problems. Hopefully a vaccine will come before it gets to that point, but any pharmaceutical like this should be treated with great caution. Who would have ever thought Celebrex, an arthritis drug, could kill people? My sex life is pretty infrequent, alas, but I have grown more and more apt to BB, top. So, perhaps PrEP is something I really should do, not just for myself but also to help protect others. I just don't yet know if the many costs, to myself, and even society, outweigh the benefits. I would love to see a study that said if all gay men in the US would go on Truvada, the cost to society from people contracting HIV and then treating them would fall by so much that it would well outweigh the cost of the one drug, and further that the drug is extremely safe and wont give everyone cancer or liver failure in 20 years..... It's a lot to ask, unfortunately.
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  16. sonadesjackson posted on 09/24/2014 10:36 PM
    High priced basically ensures that something costs a good deal, but there is numerous reasons for the price. Overpriced means that something simply is known for a cost that is vastly for longer than the materials cost + advertising costs + development bills + manufacturing cost + distribution costs + fair make money. Expensive watches and overpriced watches have become common. And unfortunately overpriced ones are too common. At the same time period, you need to ask, "if a brand asks a overpriced amount for a wrist watch, but is still allowed to sell them, can you still regard the watch to be overpriced? " The answer is actually yes fake watches, but you still prefer the watch, don't you? I will now do not delay - list many (and not all) of the causes that watches usually are so expensive fake cartier watches. These are both in defense in the industry, and expositive issues which have been less glamorous regarding the luxury industry fake tag heuer watches. The first thing that watch could be very obvious, is the visual depth of carbon fiber that comprises the face. As someone who boasts a great love for carbon fiber, and who has items comprised wholly from this, I can say it does not take absolute best that May possibly seen on a watch and 'moves' together with the light, as good carbon fabric should. Second of all, the pushers of the actual chronograph feel diverse from your average pushers. Anytime first depressed, it gives the characteristic 'click' that you simply expect when starting the function, however, each additional push from the same pusher does not even. The motion is smooth and silent until the chronograph is stopped as well as reset, then watch clicks repeatedly.
  17. Mark J posted on 10/15/2014 01:10 AM
    Citoyen toujours adhérer à l'importance de l'innovation, l'répondre à la demande des consommateurs pour les plus chers, replique montres et diamants Mme Citizen Eco-Drive, plutôt que comme une simple conséquence de incrusté de 32 petits «diamants» et a un aspect charmant, copie sac peut une autre innovation technique dans le concept du poignet des femmes.
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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” ...