I have recently been confronting my personal issues with Truvada and in the process learning a lot about myself. But it got me wondering, what exactly will sex between men look like after HIV is effectively contained or eradicated? How will it affect gay male culture? And is that the goal of safe sex education and advocating for the use of PrEP?
I believe a lot of gay media outlets are being disingenuous in the extreme by pretending as if PrEP and Truvada aren't about barebacking. The response, the #TruvadaWhore online campaign, was useless posturing because it didn't spark the conversation that needs to happen, which is the question of whether barebacking is now part of the norm. The infectious disease specialist I talked to, as well as the counselors at the free clinic where I was recently tested, both agreed that if gay men were using condoms 100% of the time, we wouldn't need Truvada, because PrEP is actually less effective. We can have a conversation about educating people on proper use, but if a condom slips off or breaks, you just replace it. But when used correctly, condoms have an almost 100% effectiveness rate against HIV. So then the question remains whether barebacking in a world where HIV transmission is minimized is still 'unsafe' or whether we should accept it as no longer dirty or irresponsible.
The sexphobia and slut shaming I was raised with in my teen years persists, with barebacking still being a dirty word even among gay men who periodically participate in it. But what exactly are we fighting HIV for? Isn't the ultimate goal to allow people to have sex without the fear of transmission? Or is it a future where condoms are still always necessary? Once the chance of transmitting the virus becomes next to nothing, are people still supposed to use condoms? What is the future of our community once HIV no longer poses a health risk?
These are no longer hypothetical questions. With the advent of PrEP and the development of vaccines, we are looking at the real possibility of containing or eradicating the disease in wealthy countries. Eventually, those of us who lived through the worst years of the epidemic or who grew up in that environment will have to deal with the fact that our definitions about what is 'safe' or 'unsafe' will prove wrong. Even the old information about HIV transmission has become radically outdated as new studies show that partners with an undetectable viral load and who are on medication have an almost 0% chance of transmitting the virus. Forget the hypothetical risks associated with oral sex, or whether a top or bottom is more at risk during unsafe sex. If there is no chance of transmitting the virus than does sex with an undetectable partner become safe?
We can have a discussion about other diseases, particularly the HPV that can lead to anal cancers, but as a person over 25 years old, I don't qualify for the vaccines against HPV, even the new one that guards against 9 strains of the virus. Moreover, syphilis is treatable, herpes is treatable, gonorrhea and chlamydia are curable, and no one seemed to have been worried enough about these diseases in the 1970s to push condom use as the only way to have sex. If they had, perhaps the epidemic wouldn't have been so devastating.
If HIV does become contained or eradicated, I wonder whether gay men will revert to the sex practices of the 1970s? We already see large numbers of gay men who are at least periodically not using condoms during anal sex. So it seems from the current trends in condom use that we are becoming a community where the majority of men stop using condoms at least some of the time. If condomless sex becomes less and less risky, will we see a spike in other forms of sex that are considered more risky and extreme? Will that push more guys into the leather, S&M, B&D or fisting scenes? What then becomes the acceptable 'norm' by which bougie white gay men judge others? What other behaviors or groups will we single out for slut-shaming?
And what happens to those of us who have been taught restrictive definitions of 'safe' and 'unsafe' sex? When people who bareback can no longer be held morally culpable for spreading the death plague, what then? Do we blame barebacking for spreading some other disease? Do we still designate barebacking as the behavior of a niche and disgusting subculture, or of poor people uneducated in the ways of 'safe' -- and thus 'responsible' -- sex? Do we redefine the term 'clean' as someone who is free of syphilis? Slut shaming and sex phobias take a psychological toll. Considering how so many LGBT people struggle for their entire lives with self-acceptance and self-love, propagating these negative attitudes toward sex seems to do more harm than good. If HIV is no longer a real threat, than we have to reevaluate our judgments and reconsider shaming people for their sexual habits.
These are questions that trouble me and that I've been having to wrestle with for a long time as more and more of my friends forego condom use. I was raised to think condomless sex was 'unsafe' and to make judgments about those people 'stupid' enough to not use condoms and to think of them as 'irresponsible.' But within five or ten years that may be baseless judgments. So just like how we as a gay male culture need to come to grips with how we define commitment -- and deal with our intimacy issues -- in the face of gay marriage becoming a reality, we need to think about what a post-HIV future looks like. Especially since that future may not be all that far off.