If PrEP Could Bring Us Into the Post-AIDS Era, Why Am I Still So Worried?
I was 13 years old in 1984, right in the throes of puberty, and positive I was dying of AIDS.
That I hadn't engaged in behavior that carried any risk of HIV transmission didn't matter. That I had-Once! Only once!-participated in the things that curious young boys occasionally try with one another after a late-night viewing of Risky Business on VHS and a few sips of gin and Diet Slice from a parent's liquor cabinet didn't matter. I had no idea how AIDS was transmitted-for all I knew, it was generated whenever two boys touched each other's dicks, like electricity-and that didn't matter either.
What mattered was that I had done sex-adjacent things with a boy, I'd enjoyed it, and because I'd enjoyed it, it would kill me in a slow, torturous way that would bring shame to my family. And so it was that, moments after I ejaculated in the presence of another human being for the first time in my life, I was overcome with such guilt, shame, and terror that I vomited. And because I knew no better, I was certain that vomiting was a symptom of AIDS. I was sure that I would die, probably sometime later that same weekend, and that my death would completely wreck my family's summer vacation plans.
Because I'd enjoyed it, it would kill me.
There was, shall we say, not a surplus of practical HIV/AIDS information available to the average 13-year-old Catholic gay boy at the time.
The New York Times article about the "gay cancer" had run three summers before, and since then, the disease had gone from being called Gay-Related Immune Disorder (or GRID), to Acquired Immune Deficiency Syndrome (which had the dual effect of acknowledging that it was no longer strictly a gay issue and also putting a popular diet candy out of business). But though it was no longer strictly limited to gay men, AIDS in the popular imagination continued to be a gay disease. By 1984, the deaths of gay men (and, to a lesser degree, intravenous drug users and sex workers) were beginning to snowball, and those deaths were both gruesome and the subject of jokes that adults you trusted would tell.
I spent that whole summer positive I was dying, and in ways large and small, stayed that terrified until sometime around my mid 30s. In my impressionable years, sex and love were woven in with guilt, shame, and terror in ways it would take me years to recognize and decades to unravel. Anyone my age knows the feeling. When you're learning who you want to have sex with at the same time you're learning that sex can be lethal, that shit stays with you.
When you're learning who you want to have sex with at the same time you're learning that sex can be lethal, that shit stays with you.
Well, now there's a pill for that.
Truvada, a combination of two antiretroviral drugs, is now being prescribed as pre-exposure prophylaxis (or PrEP), and when taken every day, can reduce the risk of HIV transmission by up to 99 percent. With more HIV-positive people having access to medical care that makes their viral load undetectable (and whose chances of transmitting the virus are thereby greatly diminished) and a large enough percentage of the population on Truvada, we can stop HIV/AIDS in its tracks. There is also post-exposure prophylaxis (or PEP), which if taken for 28 days starting no more than 72 hours after exposure, can prevent HIV transmission. Side effects of both appear to be both manageable and temporary.
The link between sex and death has effectively been severed. The 13-year-olds of 2016 don't have to deal with mortal terror on a daily basis. So why am I not happier?
PrEP does not prevent the transmission of other sexually transmitted diseases. Recent outbreaks of syphilis, gonorrhea, and chlamydia seem to indicate that younger people are feeling freer to engage in higher-risk activity without condoms. In an era where a simple message like "You still need to practice safe sex" can be shrugged off with accusations of slut-shaming, it's hard to get the point across effectively, but: You still need to practice safe sex. (These STD outbreaks have led to an epidemic of truly atrocious billboards and subway ads like this one, which make syphilis look like a Scientology textbook or a Master P album cover. Only you can stop their spread.)
What really kills me is the thought of the gay men in the 1970s, immediately post-Stonewall, living as openly as they'd ever been able to. They were free to mix and mingle and have sex as often as they wanted to. (And boy, did they get after it; watch the documentary Gay Sex in the '70s for a look at what you missed.) These had to have been thrilling years. But consider that the gestation period of HIV is around 10 years. All throughout that exhilarating, innocent, decadent decade, people were exposing themselves and each other to HIV without a clue.
What might any of us-gay, straight, or anywhere in between-be carrying and spreading right now without knowing it? What if we're already doing it? An AIDS-type epidemic can happen again, in any population. And as much of a breakthrough as Truvada is, we can't go back to a time before condoms. We can't pretend we don't know what we know.
Make no mistake: I am pro-PrEP. If you're sexually active, I absolutely recommend going on Truvada. We have the power to end a worldwide epidemic, and it would be reckless not to use every tool at our disposal.
But take a tip from my generation and throw on a condom. You might not remember every time, but you owe it to yourself and your partner to try. It will make you both that much less likely to contract HIV-remember: 99 percent is not 100 percent-and it might protect you from the next thing besides.
And maybe there never will be a next thing. I truly hope there isn't. But I worry. I can't help it. I was 13 years old in 1984.
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