Wednesday, June 11, 2014

Defense of Gay Promiscuity in the Age of Marriage Equality and Truvada (a rant)

American style puritanism bubbles up in all kinds places. Who would've thought that the gay community is anguishing over a new tool to prevent HIV infection.  For those of you who don't know, a new drug named Truvada, if taken according to a doctor's orders, will reduce the rate of HIV infection by 95%.  The regimen, known as Pre-Exposure Prophylaxis (PreP), is a once daily pill.  The idea of PreP is angering AIDS activists, public health officials and busybodies everywhere.  All three groups believe that gay men will become whores and sluts if they take this pill. 

AIDS activists tend to be angry by nature, so to see them upset at any new pharmaceutical breakthrough in the HIV epidemic is to be understood. They tend to meet pharmaceutical "wonder drugs" with a healthy dose of skepticism. Big Government dragged its feet in the early part of the epidemic, Big Pharma cashed in with wonder drugs that saved millions of lives. While wiping out plenty of (gay) guinea pigs in the process.  The high price of those drugs were mostly subsidized by Americans in the form of the Ryam White Care act and high costs to insurers for HIV meds.  Big pharmaceutical companies did very well during this epidemic, and I'm sure they'll do well in the next one.  In my opinion AIDS activists always fear that a preemptive cure, like a vaccine, will leave them to rot on the vine, like polio victims after a vaccine was invented. 

Public Health Officials bemoan the failures of behavior modification programs, to help gay men reduce their giving up sex altogether.  I was once approached by a group of CDC researchers who asked me "what can we do to get gay men to stop having sex?"  It was a serious question, brought up by serious men, who thought there could be a cure through some magic behavior change therapy.  Sadly, 500,000 deaths show that not even the threat of death can make people give up that intrinsically human activity of sex. I totally get why the public health establishment is worried. Once more the "medical model" has trumped the failure of public health in the late 20th century. Behavior modification attempts around issues such as diabetes, and HIV have been dismal failures with 1 in 11 Americans with diabetes and over two million estimated infected with HIV.  In my opinion the enitre Public Health Establishment should do some serious soul searching on its giant failures in keeping this nation healthy. 

Finally the busybodies, who really piss me off.   First I'd like to say "fuck you" to any busybody who bemoans "a return to promiscuity" by gay men who take Truvada.  I'd like to say "fuck you" to anyone who thinks that insurance companies should not cover it. A prevention pill a day, is still cheaper than an HIV infection.  This idea that gay men can use a pill to control a fear, to make sex healthier, more enjoyable and less anxiety ridden is anathema to them. This is the exact same argument used against women who take birth control.   This idea to bemoan a hedonistic orgy for those on Truvada is sad and counter productive. Firstly, sex never went away despite declining condom use and increasing HIV infections. Sorry busybodies, there were gay orgies before, during and probably after the HIV epidemic. I remember the busybodies upset that ads for HIV regimens made people look too "healthy" and "active" and carefree and not portray HIV positive men as sickly victims.  These are the sex shamers, who feel the purpose of sex should be to make your long-term monogamous relationship better or whatever.  The ones who are ashamed to use the term anal sex and admit in same sentence that it feels awesomely good for all involved. So against promiscuity? then shut down GRNDR, bathhouses and sex clubs. Start some kind of sex police. The busybody's idea that "promiscuity" in gay men is so wrong, because gay men should be like our daughters? What is the actually number of sexual partners that define promiscuous?  More than one or less than 1000?  

To wrap it all up. I think Truvada is just one more tool that gay men can use to prevent HIV. It's advantages are as follows:
1. It forces gay men to have a conversation with a Doctor or Medical practitioner about HIV risk.
2. It encourages testing for HIV, because no doctor or Medical practitioner would prescribe Truvada without an HIV test first.
3. If a person is tested for HIV and is positive, they can get into treatment and hopefully reduce the spread if they are responsible, or if they're undetectable the likelihood of transmission is reduced if they continue unsafe behaviors. 
4. Finally any extra tool in the prevention arsenal is a good thing.