If gay guys start taking PrEP, they’ll start engaging in risky, unprotected sex! Or at least that’s what the PrEP naysayers are going to say about it.
In case you don’t know, there is a pill called Truvada that, when taken daily by an HIV-negative person, is highly effective at preventing the transmission of HIV. This method of prevention is known as pre-exposure prophylaxis, or PrEP.
When an HIV-positive guy take medication to bring his viral load down to a low level, so low that his viral load is considered undetectable, he is highly unlikely to transmit the virus to another person. This method of prevention is known as treatment as prevention or TasP.
These two types of treatment are changing the landscape of HIV prevention. However, as with all change, some guys just haven’t caught up to science and oppose this method of prevention, not just for themselves (that’s perfectly fine if they choose a different method of prevention), but even for others. Their usual way of opposing it is to shame gay guys who prefer PrEP over condoms and they often do it by saying these guys are having risky sex.
Well what do they mean by risky sex? Well, when it comes to HIV, PrEP or TasP are just as good as condoms, and in most cases an even better option. Even when they can admit to this, they then bring up all those other reasons, including STIs. However, their arguments are irrational.
The real risk of STI’s:
Hepatitis C virus (HCV). HCV is not transmitted by semen like HIV, but from blood to blood contact. In other words, the blood of someone with HCV has to get into your circulatory system. Sex is a very difficult way to transmit HCV. The most common way through gay sex is when a top has rough sex with one bottom, gets blood on his cock, then immediately fucks another bottom roughly, transferring the virus from one guy to another. The top in this situation is not at much risk. So your average one on one guy sex is a very difficult way to get HCV. In fact, sharing a toothbrush is actually more risky. If you do happen to get it, there is an 80% chance that treatment will get rid of it.
Hepatitis B virus. This can be transmitted from both semen and blood. Fortunately, there is a vaccine. So if you get vaccinated, you’re protected.
Human papilloma virus (HPV). This can be transmitted from sexual contact through intimate skin-to-skin contact. It can lead to various types of cancer. It can easily be contacted through oral sex, as Michael Douglas can attest. A condom doesn’t prevent the spread completely because it doesn’t cover all the areas of the skin around the genitals that might be infected.Fortunately, there is a vaccine that will protect you.
Herpes (HVS). Herpes is also transmitted through intimate skin to skin contact, including kissing. Condoms are only moderately effective at preventing it. Fortunately, it’s not a severe condition and is easily treatable. So if condoms aren’t very good at preventing it, it’s difficult to say you’re protected from the virus. Fortunately, HVS is easily treated with prescription drugs.
Gonorrhea and chlamydia. These are usually lumped together since they are similar. Condoms do provide protection against these two buggers; however, they are also easily transmitted through oral sex, which usually happens before anal sex anyway. Fortunately, they are easily treated and takes about a week to go away once you take antibiotics.
Syphilis. This one is more dangerous than gonorrhea and chlamydia if left untreated. Condoms do provide protection but, since skin to skin contact is a mode of transmission, you can still get it even if a condom is worn properly. It is also easily transmitted through oral sex. Fortunately, if caught early, it’s easily treated. If caught it later stages, it is treatable but it will take longer to go away. Treatment is as easy as two antibiotic needle treatments.
So basically, other than HCV which is very difficult to get through your typical sexual encounter, the above infections either have a vaccine to protect you, are easily transmitted through oral sex, and/or are easily treatable. And yet, a condom is still held up by many as the holy grail of protection, even in the age of TasP and PrEP.
Why is this? Gay men still carry around a lot of emotional baggage and fear when it comes to sex. We are instilled, even in liberal environments, that gay anal sex is icky, unnatural, dirty, or just plain sinful, and if you have unprotected sex that you undoubtably will get HIV. Religion and the fear of hell used to be what gave gay men anxiety when it came to anal sex. Just as religion was losing its grip, AIDS emerged and renewed our fear of anal sex. After millennia of indoctrination followed by a fear of death, some gay men are having trouble no longer needing to fear anal sex. They feel guilty if they are able to have pleasure, the way nature made us, without treating it like they are operating in a CDC laboratory about to release a new plague as in a horror movie. Of course it’s okay if someone’s preferred method of prevention is condoms. But to project the same fear of HIV onto every possible STI out there reflects a deeper anxiety around the sexual act itself, rather than a rational analysis of risk and harm. This is all the more apparent when someone doesn’t use condoms for oral sex.
If you want to use condoms, that’s great. But stop telling guys on PrEP who don’t use condoms or those with lovers with low viral loads that they’re not protected or being risky.