Why Aren’t Gay Men On The Pill? Ctd

Andrew Sullivan —  Apr 14 2014 @ 11:53am

In another video from Dave Cullen, Truvada user and bestselling author, he addresses the anticipated backlash from Fox News and Limbaugh when PrEP drugs are more widely used:

The idea that gay sex requires more justification than straight sex is deeply embedded in the culture – even within gay culture. Two other themes have emerged as well in talking about this with my fellow homos. The first is that taking a Truvada pill means, for some, the taking of an HIV pill. And being HIV-negative is sometimes defined as not having to take an HIV pill. So taking Truvada as a preventative means, for some, crossing the HIV divide, when they have spent an entire adult life-time keeping their distance from HIV culture. This makes no logical sense  – taking Truvada as well as using safer sex helps you stay free of HIV more effectively than any other method (think of it as combination therapy). But it does make psychological sense for the countless who remain traumatized by the memory of the plague.

I think there’s also a resistance to the good news in the same way that there was intense resistance to the good news of the cocktail therapy eighteen years ago. Perhaps the most controversial piece I’ve ever written was my “When Plagues Endtruvadacover-essay for the New York Times magazine. It was assailed as empirically wrong, dangerous and complacent. But every single factual claim in it has been borne out – and then some. The truth is: we become wedded to the status quo, even if that status quo is terrifying. Camus grasped this in his great novel, “The Plague.” He showed how no one wanted to believe the good news that the plague was ending – because they were too scared to hope, too terrified of getting their hopes up, too conditioned by terror to change quickly. That psychological insight is invaluable – even as the truth now is that no one with undetectable virus can infect anyone, and no one on Truvada can get infected. Instead of embracing that, we shy from it.

Meanwhile, readers are responding in droves via Facebook and the in-tray:

Thank you so much for your writing on Truvada and celebrating it for the godsend that it is. I’m in a serodiscordant couple and to hear it described as a “party drug” makes me feel ill. If eliminating fear at the heart of a relationship is a party, then, yeah, that’s a party I’ll go to. If wanting to fuck the person I love safely makes me a whore, well then I suppose I’m a whore. The names can’t hurt our community as much as HIV has. So if takes being called names to finally end this virus, then let them call us whatever they want.

Another:

I’m a married straight guy. I had known somewhat vaguely about Truvada before your posts – though I didn’t really know anything about the drug and had no idea about the reputation. That said, the backlash is absolutely mind-boggling. There is a drug that would prevent the transmission of a drug that has killed millions over the past three decades, and people are called whores for taking it? I mean it literally when I call it mind-boggling; I simply cannot wrap my mind around that logic.

Another:

I have to say, I almost physically attacked my computer screen when I read the quote from the AIDS Healthcare Foundation president, Michael Weinstein, who called Truvada a “party drug.”

I have sex. I’m human. Condoms come off. It happens. I’m a working professional, not a raver on molly who dabbles in the gay meth scene. But I am single, in my 20s, sexually active, gay, live in San Francisco and I am HIV-. Why isn’t this the simple litmus test for potentially being prescribed Truvada?

After an “HIV scare” last year when a partner of mine tested positive (he was the first person I’d been with since moving to San Francisco), I raced to the doctor to get an RNA HIV test. I was fortunate. Tests came back negative. So next week, I will be going into to consult an HIV/AIDs specialist at my HMO about Truvada. I’ve passed all the blood/urine pre-screens, so I think it’s mainly for me to understand the importance of taking it daily, sign an agreement to get my blood work done every three months, still use condoms, etc. If I don’t keep up with the blood work, I’d imagine they may remove me from their PrEP program, which is completely reasonable to me, considering the potential side effects and needing to know the HIV status of the patient.

My general practitioner is the reason why I haven’t done this sooner. He may share the same views of Mr. Weinstein. After my HIV scare, which he helped me through, he was reluctant to recommend the drug for me. When I brought it up, the conversation was just shot down with “it’s not like a contraceptive pill” with a shake of the head. Ironically, during in the same conversation he mentioned that many people don’t know or lie about their HIV status. His other concern seemed to be there’s only been one solid, long-term study on Truvada in regards to effectiveness and side effects. This may be a valid concern.

But I have one life to live. Spare me the lectures and finger wagging.

And another:

I was infected in 1985. Those were the days of no available treatments and the best you could hope for was eighteen months – if you were lucky. Anybody remember drinking aloe vera juice? How about melting down a pound of butter and mixing in lecithin powder and then freezing it in ice cube trays to be mixed into juice? I do.

How about going to a bar and no longer looking for the tell-tale KS lesions but the cheap digital watches that beeped every four hours screaming “take your AZT!” I do, and that is why I do not wish this illness on anybody.

I am open to any and all available treatments, and the hateful rhetoric and name-calling on both sides is not doing either side any good. All I can do is be honest and tell my story and try to explain my fears, but I get immediately shouted at as some old guy who does not know anything about modern treatments. If you want to sell me something, educate me and try to understand my fears; don’t lecture me. Truvada, as well as a whole host of drugs, exist because my friends died. Don’t belittle my loss.

My biggest fear is maintenance. All I can say is that I have been taking pills since 1987 when AZT came out. There have been many, I am sad to say, times in the almost 30 years that I skipped a dose. Sometimes even weeks would go by. I can’t tell you why. You just get tired. You have a headache, you take an aspirin and it goes away. You take a handful of drugs and you do not have that immediate payoff and it just gets hard to keep up. I am clean and sober, have great insurance, and a long-term and loving relationship for support and it is still hard.

We don’t know the long-term effects, especially for the post-HAART infected. Even though the virus may not be detectable in your bloodstream, it can be quite active in your brain fluid. I have just been diagnosed with AVN and will need to have both of my hips and shoulders replaced. Google AIDS and aging and see what is happening. Most of the time it is not the virus, but the medicine that is responsible.

So do whatever it takes. Life is far too short to be worried about what anybody thinks of you.