Modern HIV-infection-prevention medications remain controversial

Recently (around World AIDS Day Dec. 1) Justin Ayars, the publisher of Q Virginia Magazine, a glossy publication for the LGBT community with a lot of commercial material especially for gay married couples, wrote a very succinct statement on Facebook about HIV-infection detection and prevention, with regard to how PrEP and PEP (pre-exposure and post-exposure prophylaxis) work.  Here is the best link.

Then I noticed that the mainstream men’s magazines, most of all GQ, published ads for Truvalda, showing glossy photos of attractive young gay men (all races).

I shared this with a friend on Facebook and got this comment:

“My only issue with Prep and Pep is it has completely changed the “safe sex” mindset that came after the AIDS crisis. Guys now demand to bareback as par for the course. The pills have to be taken on schedule, and I sincerely doubt a lot of men stick to the schedule precisely. It would be interesting to find research that shows any uptick in HIV infections as a result of this mindset change that is fueled by Truvada. marketing. It’s my understanding the infection rate has gone down in the last few years, but I don’t have any precise study I can point to.

“In other words, barebacking has become the norm again. And the expectation of anyone who grew up post-AIDS crisis.”

At age 74, I can hardly expect to be the center of “action” or attention in any such events.  But I do have social contact or online with younger gay men, especially in film or music as well as academia.  I do not get the impression that the practice is as widespread or reckless as my friend claims.

I can remember what it was like in the mid 1980s.  I was living in Dallas at the time.  Most of my own friends were getting infected or diagnosed by late 85.  I also recall the political scare in early 1983, when the religious right tried to push through very draconian legislation through the Texas legislature based on a hypothetical spread of AIDS to the general population after mutation, your sci-fi horror movie scenario.

I also remember my eventful last year in New York City, 1978 (yup, Bucky Dent’s home run), where there was an incident of sorts that possibly previewed and warned me of what could come and contributed to my decision to make a job change and leave for Dallas at the beginning of 1979.

I had my “first experience” in a Club Baths in early 1975  (age 31), after a lot of attention to myself on the issue, as a “fallen male”, to borrow from George Gilder.  From New Years Day 1976 until the spring of 1983, I was in the practice of “going home” with “tricks” or vice versa.  Maybe there were 50 or so “numbers” (as with the book in the Pententuch).  I did not get infected.  But to a “normally married” person with “a family” at the time that would have seemed really excessive.  I survived partly out of perversely reverse Darwinism (as Larry Kramer of “The Normal Heart” has said); my relative unattractiveness by the time of come-out turned out to be a survival advantage (although not reproductive).  Maybe I am lucky with some genes that make me harder to infect, but I wouldn’t gamble on it.

The PrEP and PEP issues would naturally come up in any attempts to repeal and replace Obamacare. It’s all too easy to say, health insurance companies shouldn’t be forced to cover diseases related to “behavior choices”, and it will be hard to argue that down.  But we think about this argument with substance abuse (needles) and now opioids. Along these lines, this piece on Vox by German Lopez is worth a look.

(Posted: Saturday, December 23, 2017, at 2 PM EST)

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