New federal guidelines urge gay men and others who have unprotected sex to take a daily dose of the drug Truvada, a regimen called pre-exposure prophylaxis (PrEP), to curb HIV infections and AIDS.
Is promoting the use of the antiviral drug a good public health strategy, or will it encourage more to have unprotected sex?
In the adult film industry, we have safeguards in place that have done a good job of protecting performers from HIV on set. In order to work, a performer must have tested negative for HIV and other STI’s within the last 14 days. While some performers choose to use condoms, most, for reasons of comfort, prefer not to.
Due to the efficacy of these protocols, the adult industry has not had a single documented case of on-set HIV transmission since 2004. During that same ten year span, however, a handful of performers have tested positive at their biweekly tests. Through viral genealogy, doctors were able to trace each of these transmission to their personal lives, where the people they encounter may not be tested. But just because it didn’t happen on set, doesn’t mean it shouldn’t concern us. After all, these are our co-workers, our friends, our family. For those of us who truly care about performers, Truvada offers a way to protect them both on set and off.
Oddly, the current debate about condoms in adult film has been entirely limited to performers’ on-set safety. Michael Weinstein at AIDS Healthcare Foundation (the same person who enraged the gay community by referring to Truvada as a “party drug”) and Assemblymember Isadore Hall have made mandatory condoms their rallying cry for performer health. The reality is their legislation, AB 1576, wouldn’t have stopped the performers I mentioned from contracting HIV.
Had these performers been taking Truvada, on the other hand, they still could be HIV. negative. We owe it to performers and other sex workers to move beyond old models of prevention and educate them about all the safeguards at their disposal — including PrEP — and let them decide for themselves whether they are taking risks that might be mitigated by use of PrEP. Morality and politics shouldn’t cloud prevention, on-set or off.
Whether you are seeing more and more gay bareback porn, reading ads for men looking for condomless hook-ups, or looking at stats from the C.D.C., there is little doubt that unprotected sex among gay men is on the rise. There are too many different explanations to cover them all here. However, what we do know is that this generation didn’t live through the holocaust of the ’80s and ’90s. And listening to their elders talk about the “bad old days” resonates about as well as our parents talking about how poor they were during the Great Depression.
We know that young people think they are invincible and that self-esteem plays a huge role in sexual risk-taking. It is not a surprise that gay men, as most men, prefer intercourse without condoms. Knowing what we know, what should we do about it?
There is a line of argument that promoting condom use is a lost cause. According to some, even if we talk ourselves blue in the face, no one is listening. We are supposed to come up with a whole new strategy – Pre-Exposure Prophylaxis, or PrEP. It all sounds so sensible. The problem is that it won’t work.
PrEP has failed to protect the majority of men in every clinical trial (study). Relying on negative men to take this medication every day just doesn’t happen most of the time. If you have multiple partners over a long period of time and you are not using condoms, there is a very high likelihood that you will turn H.I.V. positive or contract other S.T.D.’s. Sorry to deliver the bad news.
So, despite the rise in unsafe sex, condom promotion remains the best strategy we have to protect our community. Today, when the fear of H.I.V. has receded because of the improvements in H.I.V. treatment, it is more important than ever to promote safer sex. We won’t reach everyone (although the majority of gay men still do use condoms), but if we let our guard down and give up on safer sex, it is guaranteed that many more men will become infected.
It may not be fashionable to tell gay men that they need to use condoms, but it is the only strategy that has proven effective over the long term.