“If having sex can kill you, doesn’t anybody with half a brain stop fucking?”
Dr Emma Brookner’s question in Larry Kramer’s play The Normal Heart is a cymbal-crashing line that resonates even after the scene is over — at least in the 2012 production I saw at Toronto’s Buddies in Bad Times Theatre.
Of course the answer is no, it’s not quite so simple — even for Emma’s gay friend Ned, who takes up her call for abstinence and then promptly falls in love. He soon learns that even mono-gamy is no defence against AIDS.
But her words also reverberate because they are ideologically weighted down, typifying a stigma associated with gay men’s sexuality that remains pervasive today, even (possibly especially) within our own community.
Stigma is central to the discussion surrounding the use of pre-exposure prophylaxis (PrEP), a daily medical regimen that is being used by HIV-negative gay men as a way to stay that way (read our full coverage). The emergence of PrEP, a drug that has the potential to once again significantly change how we have sex, is being hailed as a game-changer in the history of HIV/AIDS.
But an in-depth Xtra investigation reveals questions around its effectiveness, not to mention widespread ambivalence among sexually active gay men. Perhaps this is not surprising. Even though the pill, Truvada, is not yet approved in Canada for use as PrEP, I’m not sure it would be widely taken up if it were.
For one, studies seem to indicate that it’s effective only if taken consistently every day. It also comes with a hefty price tag: more than $850 a month unless you’re covered by the right insurance plan.
And then there’s the other issue of access — to non-judgmental doctors willing to prescribe Truvada as PrEP to sexually active gay men.
Interestingly, uptake among gay men has been tepid in the United States, where the Food and Drug Administration approved Truvada for use as an HIV preventative in 2012. Lisa Capaldini, a doctor who treats gay men, noted in a recent New York Times article about PrEP that she’s seen “very little interest” among her patients. While the same article highlighted stigma from healthcare workers as one possible reason for this, it also noted stigma among gay men. Apparently a new word for PrEP users — “Truvada whore” — is being used on gay social networks.
When will we stop stigmatizing one another? If we have HIV, if we like to bareback, if we participate in group sex — somehow gay men continue to stigmatize other gay men for all these reasons. And now we’re stigmatizing those who acknowledge they sometimes bareback and therefore want to ensure they can do it as safely as possible.
Here’s the reality: about half of us do not consistently use condoms with casual sex partners. This is according to a 2008 Public Health Agency of Canada study that also found that more than three quarters of men who sleep with men (MSM) in Canada said they’d had at least one casual sex partner in the six months prior to the study. It’s worth juxtaposing this finding with a similar study that found between 11 and 23 percent of MSM in Canadian cities have HIV.
The fact is, many of us would not choose to use PrEP even if it was cheaper and more readily available. It doesn’t make sense for everyone, including those who always fuck with condoms or have easy access to post-exposure prophylaxis (PEP) if they do slip up.
Even so, after several decades living with the blight of HIV, we know that we still love fucking and we’re not going to stop just because it’s risky. So can’t we get half a brain and have an honest discussion about PrEP without stigmatizing each other?
Watch our four-part video series on PrEP:
Part 1: Can a pill a day keep HIV away?
Part 2: A condom-free future?
Part 3: The controversy behind PrEP
Part 4: Why aren’t gay men taking PrEP?
Why you can trust Xtra
