PrEP at 10, We Dare Texas To Rip It from Our Cold Dead Hands

Towleroad reported on the PSA:

“When straight guys have a lot of sex, they’re called studs; but when gay guys do, they’re called sluts,” says gay adult performer JD Phoenix, in a new campaign from Public Health Solutions to educate people about PrEP (Pre-exposure prophylaxis). “I like to party…and I like to be safe,” adds Phoenix in the spot, which shows him picking up a man at a club, cruising on Grindr, and taking the PrEP pill at home. Abadsidis told Towleroad: “J.D. is the embodiment of perceived young gay male sexual autonomy. He represents his generation’s unexpected, and for some vexing, response to the epidemic. And whether we like it not, there are plenty of young gay men using drugs and having barrier free sex, not at all unlike their heterosexual counterparts. But debasing gays for being human while in a higher risk group seemed at best like a double standard and at worst a highly unethical and ineffective means for keeping them healthy. J.D., a man who has and seemingly enjoys sex.”

The ensuing years have not been without controversy. Last year Brenden Shucart and I discussed the “controversy’ that pitted PrEP against TaSP:

The last decade has seen the emergence of two of the most promising efforts to end the epidemic: Treatment as Prevention and its subsequent public health campaign of Undetectable Equals Untransmittable (U=U) and Pre-Exposure Prophylactic (PrEP) originally in the form of Truvada and  now the more widely prescribed Descovy.

These two methods are ideally done in tandem for maximum effectiveness but more often than not are pitted against one another. The emergence of PrEP has among gay men essentially created two classes: on negative and one not.  While the lingering stigma surrounding HIV has mitigated how effective messaging around treatment as prevention is viewed (it’s an original sin argument i.e it’s better to not get infected at all).

HIV activist Tyler Curry wade into the debate with his essay over at HIVPlusMag.com:

For those living with HIV who are undetectable and insured, the future looks bright. We are on the precipice of change when it comes to new treatment options that will make less and less of an impact on our daily lives. But I can’t help but feel embarrassed by how little HIV has an impact on me when so many are being left behind by our health care system.

Whether it’s due to lack of access to insurance, the inability to prioritize health due to unlivable wages, or simply the fear of being “found out” that many in more rural, Southern areas face, the equity gap among HIV-positive people is growing by leaps and bounds. And I often wonder this: Is it because people like me (white, financially secure) occupy the space for visibility and we are so focused on PrEP that HIV advocacy has taken a back seat within our own communities?

I get it. Messaging around PrEP is sexy and fun. I follow LGBTQ+ influencers who are often paid by sexual wellness organizations or PrEP delivery companies to ask provocative questions and post flirty/dirty polls about whether their followers are on PrEP, would be on PrEP, or are opposed to PrEP. As you can imagine, this irked me quite a bit. So much so that I finally pushed back on one particular account with over 100K followers.

As I perused through all of the cute Instagram PrEP stories with Ken dolls perched in precarious positions, I urged him to include “undetectable equals untransmittable” messaging so as to not exclude any followers who may either test positive while seeking PrEP or already are positive. I pressed again on another post where he asked his followers whether they prefer being on PrEP or using condoms. I replied that I preferred being undetectable and once again urged him to incorporate some status-neutral messaging. Every message was “hearted,” but there has been nary a mention of U=U to this day.

This is, of course, a very trivial example of a much larger problem, but an example nonetheless. Whether it’s the fault of our health care organizations, our platforms for LGBTQ+ voices, or our desire to focus on PrEP as a much less complicated piece of sexual wellness, who are we leaving behind? Until we have truly normalized what it means to be U=U and grasp the importance of equitable outcomes for those living with HIV, there can be no moving forward. I am not interested in the progress of treatment until it is accessible to everyone.

I am not a representation of HIV; I am a representation of privilege in America. But I am willing to challenge the privilege of those ready to “move on” because we still need every voice in the fight against HIV.

Noble and lofty sentiments to be sure, but my problem with this argument is that it’s reductive and it sort of makes it sound like they’re two political parties.

They’re not.

It’s also unpersuasive.

Discussions around HIV and AIDS have always been fraught because conversations around sex in this country have been virtually non-existent. That coupled with the religious zeal in policing Black, brown, female, trans, and queer etc. bodies makes them difficult to start.

Effective public health campaigns are like advertising, they are effective for how they make or change how you feel rather than changing what you know.

And  if we’re going to make reductive arguments we could be even more reductive and simply look at the language that is there: Pre-Exposure Prophylactic may not mean much to many but PrEP evokes lots of sentiment: it sounds like prepared (boy scouts) and preppy (pop collars and polos, fresh and clean, Nantucket) while U=U sounds like  zero equals zero.  U=U is also mouthful and it involves a modicum of scientific knowledge. We live in a country where people still argue over whether the world is flat or not and COVID has demonstrated just how bad things have gotten.

The rhetoric surrounding the critiques of both hardly rise to eloquence. At their worst they suggest we’re sluts who want to have unprotected sex.

And they’re not wrong.

Where they are wrong is in demonizing being a slut.

We also live in an era where likes on Instagram are paramount so I’m not even surprised or angry at the ignorance of lingering stigma, so let’s stop with “we’re better than this” rhetoric.

We’re not.

If the last five years have taught us anything it’s that we’re actually worse than I could ever imagine.

Social media advances and promotes the worst in ourselves. It’s a super polarized and amplified popularity contest. And anyone who’s been to high school knows popularity is a zero sum game. And the loser can potentially lose everything.

“The promise of PrEP,” says actor/writer and former editor of The Fight Brenden Shucart, “was  we thought that it might erase the line between those of us living  with HIV and the uninfected and for a while that seemed to be the case — but somewhere along the way we lost the plot. The truth is PrEP alone will never end the epidemic.”

Word.

And to which I’ll add only: cute article, might delete later.

 

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I don’t know that it’s possible to articulate all the myriad ways this medical advancement has radically changed not only what HIV transmissions look like but how indelibly it has changed the gay psyche.

But we see you Texas. Let’s do this.

You about to fuck around and find out.