Jill Neimark considers the barriers to widespread PrEP use:
The stigma around anal sex plays out in the doctor’s office, where acceptance and compassionate care are necessary to stem the epidemic. An anonymous college student told his story on a site called My PrEP Experience. After two boyfriends had cheated on him, and one had snuck a condom off during sex, the student wanted a pharmaceutical brand of protection. He wanted PrEP. ‘We don’t prescribe this to people like you,’ he was told by a physician. ‘I felt like she [the doctor] had already labelled me as whore and, as far as she was concerned, the appointment was over.’ Eventually, the prescription was written by the doctor’s boss and, after jumping through some administrative and insurance hoops for a few weeks, the student went to receive his pills. He was the first in his town of 130,000 to be given PrEP. It takes a confident young man to persist in spite of that kind of humiliation. …
There aren’t many primary care doctors who feel confident opening up a conversation with a gay man about barebacking, online apps, anal chlamydia, and a treatment plan for protection. And how many gay men walk into their primary physician’s office comfortably prepared to discuss all those concerns?
And so, in 2014, in the developed world, HIV infections continue unabated at crushing expense to society because of HIV of the mind. I do not mean to imply the existence of a scarlet H unique to gay male psychology. No, I mean the incredible complexity around being gay in 2014 – when HIV is treatable and preventable, but profound vulnerability to infection remains. I refer to the whole welter of confusing feelings and polarised messages that gay men still shoulder, often invisibly, and that the straight world still struggles with, too. Silence equals death. That was the brilliant mantra coined by the original AIDS activists, the ones who mobilised all of us to action. But there is still a penumbra of silence around gay life, even in the most ‘out’ gay man’s heart.
The recent Dish thread on Truvada is here.