The Grumpy Ghey: I'm Drinking the Koolaid

by / Nov. 18, 2015 12am EST

I remember seeing the screen name “Truvada Whore” go past me online. Initially I thought it referred to a new sugar substitute. It remained stuck in my head for a few days, so I typed the term into a search engine and discovered that Truvada is a medication for HIV which had recently been approved for preventative use and had even been successful when used as a sort of emergency morning-after pill. So-called Truvada whores were guys apparently using the drug to bareback like meth-addled rabbits. 

This was a couple years ago. My dad had just died. I was miserable in Austin and fixated on extricating myself from my circumstances there. Having sex was very low on my list of priorities, which is actually where it had been for years. Despite this, I found myself wondering why such an amazing AIDS-related breakthrough hadn’t been bigger news. Was it too good to be true? Was that why we weren’t screaming from the bathhouse balconies?

I ran it by an HIV positive friend, who agreed that it should be better publicized. He said that, to his knowledge, the statistics about Truvada as a preventative medication were excellent and that his guess was that people feared side effects or some associated stigma. Also, he said, it was expensive. Very expensive. 

Fast forward to 2014. I’d relocated to Buffalo. Governor Andrew Cuomo announced his campaign to end AIDS in New York State, which, not having thought about Truvada in a couple years, sounded ambitious to me.

But when I interviewed Evergreen Health Services president Ron Silverio late that fall, he reminded me about Truvada, saying that daily use of the drug as something called pre-exposure prophylaxis (a.k.a. PrEP) was a major component in the governor’s game plan. Silverio had been appointed to Cuomo’s Ending AIDS Task Force, and he explained that negotiations were underway to make the drug more affordable for HIV-negative individuals who were wlling to admit to engaging in high-risk behaviors. 

Cuomo’s strategy now seemed more promising to me. Offering a preventative medication, for which HIV screening is required  in order to gain access, would encourage folks to update their status. From there, they could go on a drug regimen either to prevent or to treat infection, depending on the outcome of the screening.  

Despite this, when I started seeing billboard-size ads strewn around town with the slogans “PrEP for Tonight” and “PrEP for Love” this past spring, I waxed cynical. It wasn’t my finest moment, but I won’t lie: My initial reaction to PrEP was lame. I even posted a snarky Facebook status: “Load after load, PrEP’s got you covered so you can bareback with confidence. #‎notconvinced,” it read. For shame, oh Grumpy One, for shame. 

What I didn’t understand at the time, which also goes far to explain why so many people are still in the dark about PrEP, is that the drug company that makes Truvada, Gilead Sciences, isn’t investing in a traditional marketing campaign. Gilead’s sales force is focused on HIV specialists who prescribe Truvada as a post-exposure treatment for HIV (always used in concert with other drugs, dating back to 2004), not primary care doctors who regularly see HIV-negative gay men who could benefit from using it as PrEP. Gilead spokeswoman Cara Miller is on record saying the company “does not view PrEP as a commercial opportunity and is not conducting marketing activities around Truvada as PrEP.” Instead, the California-based pharmaceutical entity puts money into various community organizations around the country, subsidizing related educational efforts.

The bottom line is that any PrEP marketing you may see in your travels is provided by local health organizations—in our case, Evergreen Health Services. There are no TV ads urging you to ”ask your doctor if PrEP is right for you.” On the one hand, it’s reassuring that Gilead isn’t looking to exploit the fear of HIV as a commercial opportunity. On the other, it smacks of something unsettling. Are they keeping something from us? It’s like they’re saying, “No, that’s all right, we’ll take a pass. If you want to market this drug as a preventative measure, you’re on your own. Here’s a little start-up dough as a token…”

Getting back to my snarky Facebook post, I’d mistakenly assumed the ads were the product of a pharmaceutical conglomerate attempting to profit from gay promiscuity. That they’re the work of a local health service changes the tone significantly, but acknowledging my knee-jerk negativity is still important since it illustrates how far I’d veered off course regarding my sexuality. 

The shocking reality was that my gay identity had become sexless. It’s strange to find oneself a card-carrying member of a culture defined by a sexual behavior that you barely engage in any longer. I certainly had an identity, and it had plenty of components that could be construed as gay. But sex wasn’t really one of them. 

Unraveling how this happened put me back in touch with growing up during AIDS, which I’ve covered here before. My sexual education was fraught with tones of danger, which I then spent most of my 20s trying to drown out with booze. That only worked in the moment: I could get wasted enough to have carefree sex, but the anxiety made up for its medicated lapse by coming on twice as strong in the harsh light of day. 

Here’s the real clincher. I discovered after I got sober that I still had a hard time enforcing condom use—on myself, on partners. It didn’t seem to matter which one of us should be wearing the thing, they weren’t getting used. I could no longer blame it on the booze: So-called safer sex was awkward and dissatisfying enough to me that it just became easier to stop pursuing sex altogether. That was never a conscious decision I made. It just happened. I forfeited. Cue sad horn.

Additionally, without drugs and alcohol, negotiating encounters had become an unpleasant ordeal—too much hassle, too much judgment, too much shallow posturing, and too many uptight guys. In hindsight, however, the irony is glaring: Fear of HIV had resulted in an uptight sexual culture which, in turn, had rendered me uptight about having sex at all. I went through several one- and two-year stretches without a single sexual encounter. In between, scattered hookups were so lousy and unfulfilling that they just reinforced my lack of interest. 

So, that’s the cynical frame of mind in which I initially greeted PrEP.

Six months later, I remained mighty skeptical about whether it worked. Despite reassurances from my friend in Texas (a skeptic in his own right) and knowing the governor was advocating its use in his campaign, I couldn’t seem to buy it. A drug that could prevent me from contracting HIV? Bitch, please. 

I realized that I’d never really felt like I could trust anyone when it came to sex. We’d been taught not to. Maybe 20 years ago, I used to daydream about a miracle that would halt the spread of AIDS. But time had broken my spirit. I’d given up hope. Now confronted with the possibility of a breakthrough, I couldn’t fathom it as truth. Plus, large pharmaceutical companies and politicians aren’t particularly trustworthy. I needed a doctor to explain it to me in scientific detail. 

I wrote an article about the science of PrEP for Loop Magazine, which afforded me the occasion to talk with an infectious disease specialist for an hour about how Truvada works (and how it doesn’t work when not taken as directed). We discussed the evolution of PrEP and the future of HIV treatments, both pre- and post-exposure. Around the same time, I began meeting people who were using Truvada for PrEP. I got to ask them for firsthand accounts of side effects and candid thoughts about whether they stood by their decision to try the drug and how it had impacted their sexual behavior. Additionally, I discovered that the funding Silverio had mentioned had been secured and that PrEP was actually an option for me rather than something that only wealthy gays could afford. 

I made the appointments and I filled the prescription. Suddenly, I felt like someone had thrown me a lifeline.

Never before had it been so clear: I’d made it. I’d always figured I’d end up with HIV. It wasn’t so much a matter of if as when. Now, at 45, for the first time ever, I could almost trace the path of a future without it. To say it was a liberating sensation barely scratches the surface. Someone else I know who started PrEP around the same time I did sent me a text that read “#drankthekoolaid.” It was a clever way of surmising the mix of hope and skepticism we both felt.

There are naysayers running around, saying that PrEP will destroy condom culture and ignite a new degree of carelessness within our community, leading to rampant sexually tranmitted infections and even resistant strains of HIV. I can understand those concerns: PrEP isn’t foolproof. But for me, it’s not about throwing caution to the wind or making up for lost time. To make the most of the opportunity, I can’t waste too much energy worrying about all the ways that other guys might ruin something I’ve essentially been waiting for my entire adult life. Truvada is not here to co-sign for hedonistic sexual binging, nor is it going to solve all of your longstanding intimacy issues. Taken as prescribed, however, it will probably keep you from contracting HIV. Isn’t that enough? It sure as hell is for those of us who came of age during the height of AIDS.

For myself and others like me, PrEP presents us with options we may not have considered before. I can now sometimes choose to have more intimate encounters without worrying that I’ve made a life-altering mistake. It’s reminded me that sex was never meant to be about illness and death. Fetishes notwithstanding, it was also never meant to be about fear. A long time ago, I remember thinking that sex was about intimacy and pleasure—maybe a little mischief. It’s a hazy memory that I’m just getting back in touch with. Maybe I get to finally enjoy a little of that. It’s about time.