The Truth Behind Truvada
"The whole idea of PrEP requires acknowledging that men want raw sex and they’re gonna have it even with the risks involved. One of the major points of my book was that, for some men, increasing the risk makes sex more exciting, so that HIV/AIDS prevention programs that think in terms of risk reduction are kinda missing the point. But to acknowledge that we want raw sex entails a big risk in itself, because that doesn’t fit in with the image of the good, responsible gay man who dutifully practices safe sex. To ask about Truvada for PrEP can feel like a failure for some gay men or an acknowledgement that they want to do something that even the mainstream gay community has coded as immoral. It removes the excuse factor for having bareback sex (I was too drunk/too high/too caught up in the heat of the moment). Thus part of what is challenging about Truvada for PrEP is owning your fantasies in the cold light of day, not just when your dick is hard.
-Tim Dean, author of Unlimited Intimacy: Reflections on the Subculture of Barebacking
Rich Juzwiac writes in The Gawker: “What goes on outside the research environment? I talked to a few other guys who were taking Truvada as PrEP, as I had, and found the results mixed. One, Mike*, almost exclusively bottoms and is in a couple. They enjoy bringing in a third (a top) from time to time, and when they do that, they usually bareback. Here’s how Truvada changed their shared sex life, according to Mike:
"Since I started taking Truvada, we have had less sex," he told me. "Because we do prefer to bareback, we are less apt to have the random Scruff hook-up with a condom than we are to just wait and do it with the guys we trust. So while many people think, ‘Oh you’re on Truvada now, you’re just going to take loads all the time.’ It hasn’t been the case."
I asked a friend of a friend, Ben*, if he found that his Truvada use incentivized barebacking.
"I wouldn’t say ‘incentivize,’ but I would say it increases the threshold for me to use a condom," he replied. "There have been situations in which I haven’t used a condom where maybe I would have [otherwise]. So yes, that would be a downside, but I say that having done a lot of research on the effectiveness of condoms."
Figures range, but Planned Parenthood points to this meta-analysis of 25 different studies of condom use in heterosexual couples, which concludes, “Generally, the condom’s effectiveness at preventing HIV transmission is estimated to be 87 percent, but it may be as low as 60 percent or as high as 96 percent.” None of those numbers are as high as the highest numbers analyzing Truvada’s efficacy, and the surveyed sex in those studies, by the way, was likely to be overwhelmingly vaginal and not the riskier anal variety. There’s been no such meta-analysis on gay men, though a sort of exit poll of men who’d been diagnosed with HIV in a clinic in Seattle suggested that consistent condom use was 76 percent effective in preventing new HIV infections.
"Consistent" is the key word here. The anti-Truvada argument, after all, is that the drug doesn’t work, because some gay men won’t use the drug consistently. But why does it make sense to hold Truvada to a standard of perfection? Condoms are something else that a lot of gay men don’t use: A 2012 George Mason University/Indiana University study of men who have sex with men concluded that "one in three acts of anal intercourse between men are condom protected in the U.S." A recent study of young gay men in London by the University of Westminster found that eight out of ten of them had bareback sex with a stranger.
"Condoms aren’t enough," Pickett told me in a phone interview. "If condoms were enough, we wouldn’t be having this discussion, we wouldn’t have a global pandemic, we wouldn’t have 2 million new infections a year, because everyone would just embrace condoms and use them each and every time they had sex."
Pickett pointed to a variety of reasons why people fail to use condoms, among them getting caught up in the moment and “forgetting,” or not having a strong enough erection.
I’ll add another reason to that: Condomless sex is just better. The best sex I’ve had, sex that has made me understand gay culture in new ways, has been raw. I generally don’t have problems with condoms, but on a sensory level, I’d always rather not be wearing one.
For all the statistical and medical issues I looked into surrounding Truvada, the heart of the question was barebacking. That is what we talk about when we talk about Truvada. That is why we don’t always like to talk about Truvada.
Truvada discussions have a way of devolving into the worst sort of online shouting matches. Discussing gay sexuality, especially of the promiscuous sort, is not easy. The culture has swung from the bacchanalia of liberation to the life-or-death insistence on sexual responsibility in the shadow of AIDS. Sometimes it feels that we’ve learned responsibility too well. There’s this belief that we’re going to scare the straight people repulsed by our sex away from granting us our rights. There is an urgent mandate to behave, which means not engaging in risky sex and for god’s sake not talking about it.
Before you condemn the community or irresponsible gay men, it is probably helpful to think about these words from Pickett:
"You’re here because people barebacked. Your grandmother was a barebacker. That secretary in your office, when you’re invited to her baby shower, she’s a barebacker. You’re bringing gifts for someone who engaged in risky fucking behavior. What the fuck are you doing? She’s a bad person. We would never [say] that. We’re like, ‘Yay! You’re pregnant! What is it? Woohoo!’ With a gay man, it’s like, ‘Oh my God. You’re reckless, you’re careless, you’re insane, you’re self-destructive, you want to hurt yourself and others.’ And we ignore the fact that gay men have the same needs to feel close and intimate and pleasure. For a lot of people, condoms get in the way. That just is. That’s just a fact. And if you can use a condom yourself and that doesn’t interfere, again, great for you. Hallelujah! Keep doing it. But if you can’t, that’s not a mark against you."
Read the rest of this excellent article here