This article was published on September 23rd, 2015
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.
Thank you for posting this article. It is a huge importance to the gay, bi, queer, MSM (Men Who Have Sex With Men) and trans communities.
I personally think the more we talk about it will increase our ability to understand it well. Also to maintain an active and healthy sex life we must keep up to date about all known STI’s and treatments as prevention.
Thanks for the feedback Thomas. The HomoCulture contributors are dedicated to providing great content, information, tips, advice, and fun things for our readers. We do it because we love gay culture and we want to open up lines of conversation and get people talking about important issues the gay community faces. Thanks for being a loyal reader!
What a great article. Great job advocating for a rational, science-based approach to our response to PrEP and undetectable viral load. And your exploration of how the history of HIV/AIDS has affected gay men’s relationship to sex shows rare insight into how history, culture, and intergenerational trauma are an essential – if not *the* essential – factor impacting our sexual health. I would agree that in many ways (including for me personally) PrEP is a far better option for prevention HIV. I don’t have to use it during sex, it doesn’t affect the physical sensations I feel during sex, and if you miss a dose here or there there’s little chance anything will happen – very different from condoms, which make it painful to bottom and a sensationless bore to top.
I wanted to respond to the question of STIs. While I agree that yes, other STIs *can* be transmitted through things like oral sex or skin-to-skin contact, condoms do provide a high level of protection – not perfect, sure, but pretty darn good. Yes, chlam and gonno can get to the back of the throat, and syphilis *can* be transmitted through rubbing skin – but that’s far less common than transmission through anal sex. Condoms do make a significant difference. But for many guys on PrEP, I would posit that it’s not gay men’s lack of trust in the effectiveness of condoms that leads them to not use them – it’s the way they negatively impact sex. Sure, condoms are going to make me less likely to get a particular STI…that doesn’t change the fact that they also render sex altogether unpleasant for some of us.
As lot of STIs really aren’t a big deal at all; there is a cure or treatment for pretty much every STI out there. Swimming in the lake can give you a bacterial infection in your ear. Riding the subway or TTC exposes you to all sorts of cold and flu germs. Heck, lots of kids get oral herpes way before being sexually active – from their parents! We could avoid all of these things if we never swam, never took public transit, and didn’t allow parents to kiss their children on the cheek. But we do them anyway – because the risk is worth it. I don’t *want* to get STIs, but would I give up having and fully enjoying the sex I want, just so I never have to *maybe* take antibiotic pills for chlamydia? I’m sure you can guess my answer. Truth of the matter is STIs are a fact of life, and even if condoms *do* reduce the risk you’ll get one, STIs won’t be going anywhere any time soon.
The vast majority of gay men are completely underserved when it comes to STIs – a combination of not being out to homophobic/uptight/sex-negative doctors (a significant proportion of gay guys are not out to their doctors) and doctors not knowing how to do their jobs. *Most* gay men don’t get rectal or throat swabs for chlamydia or gonorrhea when they ask their family doctor for STI testing – and you can’t treat an STI if you don’t know it’s there. A medical system that is literally incompetent when it comes to providing basic sexual health testing and treatment for gay guys should make those anti-PrEP STI fearmongers way more concerned about STIs than an informed, thoughtful gay man on PrEP who is taking control of his sexual health, engaging with the healthcare system, and regularly testing for STIs (which is part of PrEP prescribing guidelines).
Health and absence of illness are not the same thing. Someone who is totally sexually frustrated and unhappy with their sex life, but doesn’t have any STIs (and is terrified of ever getting one), doesn’t sound like the picture of sexual health to me. And while I might be slightly more likely to get a treatable or curable infection, I’m having a fearless, fun, and active sex life full of joy and compassion and tenderness – and that sounds a lot healthier to me.
Thanks for the feedback LT. Kevin did a great job on this article, articulating people’s irrational fears of risky sex and STI’s. Each person needs to take responsibility for their own sexual health, which includes employing a variety of tools to keep him or herself safe and healthy. This goes beyond just using condoms and/or anti-retroviral drugs. Getting tested, knowing your status, and talking to your partner is incredibly important. Far too many people engage in risky behaviour but aren’t necessarily responsible for it, or quick to get upset over a simple STI that can easily be remedied. That’s the point Kevin is trying to make. STI’s don’t have to be a big deal, they are easily treatable, plus they can be transmitted without even having unprotected anal intercourse. Have fun out there!