Sounds Like…Abstinence Only; The Gay Community and the Truvada Conversation

ABC News via the Associated Press is reporting on the gay communities divide over the use of Truvada, which has been shown to help reduce new HIV infections:

Truvada, produced by California-based Gilead Sciences, has been around for a decade, serving as one of the key drugs used in combination with others as the basic treatment for people who have the AIDS-causing virus HIV. However, the drug took on a more contentious aspect in 2012 when the Food and Drug Administration approved it for pre-exposure prophylaxis, or PrEP — in other words, for use to prevent people from getting sexually transmitted HIV in the first place.

Since then, critics have warned that many gay men won’t heed Truvada’s once-a-day regimen and complained of its high cost — roughly $13,000 a year. Truvada’s proponents say most insurance plans — including Medicaid programs — now cover prescriptions for it, and they cite studies showing that the blue pill, if taken diligently, can reduce the risk of getting HIV by more than 90 percent.

While this may seem like the closest that we can get to prevention of HIV infections without a vaccine, the gay community doesn’t hail this development universally. There is a mindset in the community that the use of Truvada will lead to reckless, condomless sex.

…groups like the Los Angeles-based AIDS Healthcare Foundation — one of the country’s leading HIV/AIDS service providers — which suggest that prescribing Truvada for prevention means condoning condomless sex.

[snip]

[Michael] Weinstein, the AIDS Healthcare Foundation leader…says he’s undeterred by criticism of his insistence that condomless sex — even in the Truvada era — should be discouraged among gay men with multiple partners.

“There’s an element in the gay community that espouses ‘anything goes,’ that is for sexual freedom and not giving an inch,” he said. “But demonizing me or AHF isn’t going to shut us up.”

Another Truvada skeptic is Richard Weinmeyer, a research associate with the American Medical Association’s Ethics Group. In an article in February in Bioethics Forum, Weinmeyer — expressing his personal views — argued that preventive use of Truvada could encourage sexual irresponsibility.

“Personal responsibility for one’s actions has simply been thrown out the window in a community in which we are too often concerned about stigma and moral judgment,” he wrote. “We dare not speak against the reckless behavior of others because we wring our hands over the omnipresent worry that we will shame one another.”

These conversations sound an awful lot like the abstinence only conversations and programs that we fight against. The mentality is the same. In abstinence only education the fear is that if you give people access to sex education and contraceptives, they’ll have more sex. In the Truvada conversation, the fear is if you give access to Truvada, people will have more condomless sex. The latter statement can’t make sense if the former statement doesn’t make sense. If we know that having access to sex education and contraceptives doesn’t really lead to more sex, then why can’t we understand that access to Truvada and education about Truvada won’t lead to more sex without condoms. Our great oracle of sexual knowledge, Dan Savage, frequently notes that abstinence education doesn’t make teens sexual inactive, it just makes them sexually ignorant. This ignorance leads to poor decision making. If we can be a disciple of that teaching, why can’t we also be a disciple of the same line of thought when it comes to Truvada and condomless sex?

If we really want to prevent new HIV infections, keeping things like Truvada out of people’s hands isn’t going to do it. Nor is slut-shaming, which seems to be another tactic the community uses to get people to engage in safe-sex. We tisk-tisk and brand guys with a scarlet B around barebacking; the act of having sex with another guy without a condom. But the reality is people are doing it. And engaging in our own abstinence only education; ‘never have sex without a condom’, is as one-sided and incomprehensive a message as abstinence only.

If we really want to stop the spread of HIV, we need to start having honest conversations about barebacking. We need to have that conversation without judgement and without shame. We need to make it part of our whole sex education within the gay community. Leaving it out and acting like everyone is having safe-sex all the time isn’t leading to prevention, it’s only leading to ignorance. And that is the biggest barrier to HIV prevention. Saying don’t do it, doesn’t mean it doesn’t happen. It just means when it does, like abstinence only sex education, we give people fewer tools and information to make better and safer decisions.

Read the full AP article

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