Today, there’s more than one way to have penetrative sex in which the risk of HIV transmission is dramatically reduced—using PrEP and condoms are two. PrEP, for the uninitiated, stands for pre-exposure prophylaxis and describes an antiretroviral regimen that HIV negative people can take to protect themselves from contracting HIV up to 99 percent (of the hundreds of thousands of people on PrEP, there are four reported cases of people who adhered to the regimen daily and yet still contracted the disease).
PrEP, which for now in the U.S. is available only via Gilead’s combo drug Truvada, is particularly popular among gay men. Because of the way AIDS ravaged the overall population of sexually active gay men in the ’80s and ’90s, and continues to disproportionally affect certain groups within that population like black and Latino men who have sex with men, the idea that people can take a pill that effectively eliminates the risk of HIV is scary to people. Since the FDA approved Truvada as PrEP in 2012, we’ve been hearing a lot of Chicken Little-type arguments about the advent of a new dawn of condomless sex within gay men (instead of the sky falling, a chief concern is an as-yet-unknown microbe rising from out of nowhere to start killing people left and right). We’ve been hearing arguments about why gay men, who spent decades terrified of sex, should stay terrified of sex. It can be very hard to untangle reason from sex negativity, the “ick” factor of gay sex (that even affects so many gay men) with a general concern for one’s community.
So what to do with Patrick William Kelly’s New York Times op-ed “The End of Safe Gay Sex?,” whose headline is built on the assumption that the only kind of safe sex is that which is had with condoms, and whose argument is based on the idea that PrEP is doing a disservice the population whose lives it is protecting. Besides ignoring it outright—a wonderful strategy for dealing with whatever serving of bullshit the world wants to give you on any given morning (literally, go meditate, direct your thoughts elsewhere, live your best life in your head)—I’m inclined to go through and respond to some of its assertions. I don’t think the answer to the real problem of rising STIs is discouraging PrEP, and I don’t think any amount of condom propaganda is going to make people want to use condoms (because... look around). I certainly don’t think at anyone’s next raw orgy someone’s going to announce, “Hold up, because according to Patrick William Kelly...”. I think a piece like this, like so many pieces these days, lives in its own bubble of self-righteousness serving only the virtue of its writer, whose own attitudes toward sex and what an actual condom feels like against his skin are conspicuously missing from his work. That’s to say that this piece about condoms is worth poking some holes in.
June is Pride Month, a ripe time to reflect on one of the most startling facts about our sexual culture today: Condom use is all but disappearing among large numbers of gay men.
I guess this is startling if you’re a condom manufacturer, or if you somehow believe that condoms are magic and have solved all of the world’s sexual health problems. Spoiler alert: They haven’t. STIs like syphilis have been on the rise in some metropolitan areas (like New York) since the early aughts and HIV has not gone away. In fact, instances of new infections after the 1996 approval of protease inhibitors have been fairly stable amongst men who have sex with men—this was true more than a decade later, as Advert reports that for that population in the U.S., they hovered at about 26,000 per year between 2010 and 2014. Clearly, to fight the epidemic, something else was needed.
Kelly cites a recent study linking PrEP to increased instance condom abandonment, references the American Healthcare Foundation’s nefarious and unreasonable campaign to eradicate PrEP (spearheaded by Michael Weinstein, an outlier major AIDS activist with a virulently anti-PrEP stance), and notes:
The Centers for Disease Control and Prevention has replaced “unprotected” with “condomless” sex.
The dangerous implication is that PrEP alone may ward off all sexually transmitted infections.
That’s not the implication! The implication is that what “safe sex” means is evolving thanks to medical technology! The implication is that the priority is keeping people safe from HIV, which will kill them, as opposed to something like gonorrhea or chlamydia, which will affect the majority of a non-reproductive male population with a dick drip or ass ache until it’s either treated or, after a few months, passed through the body. No one wants an STI (I mean, the world of fetishes is wide and wavy, so actually probably at least one person does want an STI, but you get what I mean), and rising rates are a strain on public health resources for sure. But let’s not be dense—the CDC, like every other public health organization and advocate in an official capacity that I’ve ever heard speak on the matter, recommends PrEP in conjunction with condoms. It’s right on its website:
PrEP is a powerful HIV prevention tool and can be combined with condoms and other prevention methods to provide even greater protection than when used alone.
Kelly transitions to a discussion about “cultural amnesia” that essentially takes gay men to task for not being scared of sex anymore, as if that’s some sort of virtue to uphold and kids today just don’t get what made being gay cool. I think even the PrEP-wariest AIDS survivor would tell you that the culture of fear and death was about the worst thing about being gay in the ’80s and ’90s.
Kelly describes coming out in 1998 at the age of 14, and how back then “condom use, therefore, was never a negotiating chip.” Bullshit. I’ve talked to people to lived through the plague and they told me even in the darkest years of the mid-’90s before the introduction of protease inhibitors—while rates were skyrocketing, the media had moved onto other topics, and there was no hope in sight—there was “condom fatigue.” Many people don’t like using condoms! People want to experience sex, a natural expression of human desire, in its most natural state. That’s just how it is. And no amount of reasoning or shaming or picking at people is going to undo that. That’s why we need and have PrEP. It doesn’t solve all the problems, but it sure can solve a big one as long as people like Kelly aren’t getting into your head and shaming you with their “But what about”s.
Liberated from the stigma of AIDS, gay men, many people think, are now free to revert to their carnivorous sexual selves. In this rendering, the condom is kryptonite, a relic that saps the virile homosexual of his primordial sexual power.
Literally nobody thinks this. They just like how raw dick and ass feel.
AIDS is no longer a crisis, at least in the United States, and that is a phenomenal public-health success story.
At last, it is finally revealed that this guy has no idea what he’s talking about. The very publication he’s writing for printed a feature last year, “America’s Hidden HIV Epidemic,” on how HIV continues to ravage black populations in the United States, particularly those in rural areas. HIV has similarly affected Latino MSM. That’s a crisis!
One more thing from Kelly:
While we debate the utility of latex, what are we to think about the millions of sex workers, injecting-drug users and marginalized populations (in particular, black men who have sex with men) without adequate access to costly and coveted drugs like PrEP?
We’re to think, “Let’s get them on PrEP.” There is a group based in New York right now dedicated to breaking the patent that Gilead has on Truvada, as the pharmaceutical company’s stronghold leads to price gouging and inaccessibility. The answer is not to throw up our hands and say, “Oh well, better get back to pretending like condoms are the only solution.” The past four decades have shown us that they are not—Kelly’s piece is so consumed with preserving this notion of gay culture without actually doing much work to take its temperature.
I’m not advocating a complete rejection of condoms. Use ‘em if you like ‘em! The complete rejection that I am advocating for is that of the kind of senseless handwringing that Patrick William Kelly’s stands for. It helps absolutely no one.