Who Do You Trust?

"I can't believe he lied to me!"

Recently, even in the PrEP (Pre-Exposure Prophylaxis) Facts Forum, a participant remarked that one of his tricks lied to him about being on PrEP. "How can this happen?," he pondered -- it does all the time.

Two years ago on the online site Manhunt, I was contacted by an HIV- guy even though my profile said "HIV+ only." Dialogue ensued that he was really HIV+, and he explained why he lied: "You know how cruel people can be."

David Fawcett reports from a recent conference that: "Of all the many obstacles to prevention and treatment worldwide, stigma remains the most challenging."

In spite of this reality, the AIDS Health Foundation's (AHF) just launched a very stigmatizing and paranoia-based campaign: "Trust Him?"

It is a lot easier for gay men to have sex then talk about it. Online hookup sites make it very easy with stats, HIV-status and pictures to find your man in a few clicks.

Unfortunately for safer sex advocates, their message may come too late.

We still react when individuals show up that do not match their online profiles in appearance or HIV status, but yet we continue to trust the information presented.

Does this environment encourage a discussion about HIV?

Online I can read the HIV status of a potential hookup. Guys, we do this all the time to sero-sort for HIV- or HIV+ and even 'HIV- on-PrEP.' How does this fit into the Center for Disease Control (CDC) recent HIV prevention campaign: "START TALKING. STOP HIV"? I suggest this is yet another campaign dreamed up by individuals with good intentions, but isolated from the reality of today's gay life.

New poster campaigns continue and even billboards with gigantic condoms. In spite of the fact that these efforts are science-based on what is known to end this HIV epidemic -- getting tested, getting treated and having protected sex. They have not worked to reduce infections; the HIV epidemic, now in its 14th year, shows no sign of abating.

Even AHF's "Trust Him?" campaign, although stigmatizing, is based on the hard reality from a study from the CDC by Purcell et al. that up to 70 percent of new infections are between HIV negative guys in relationships. It is not uncommon for guys in open relationships to have loose rules of 'engagement' and a 'don't ask' don't tell' agreement. If you and your partner are HIV- and in an open relationship, at least have a discussion between each other and your doctor about getting on PrEP -- then you are both protecting the relationship and your perspective partners.

Gay men remain the driving force in the HIV epidemic. Men-who-have-sex-with men (MSM) are estimated to comprise 2 percent of the US population, but we continue to account for 68 percent of all new HIV infections year-after-year.

The scientific community has known for years how to prevent HIV. The challenge remains getting a message across to the gay community that resonates with reality, and acknowledges that gay men have sex.

The condom culture, as continously advocated by AHF, is dead if it ever existed. As Damon L. Jacobs recalls volunteering in 1992 for a campaign, handing out condoms, ... on street corners and in bars, that said "100 percent". ... we would eradicate this epidemic by the year 2000. ... It made perfect sense.

But what happened? People didn't use condoms consistently. Even back during the darkest day of this epidemic, when the consequences of not using condoms were potentially an excruciatingly painful death, people didn't use condoms consistently. Moreover, one by one, many of my colleagues, co-workers, lovers, roommates and friends became newly HIV-positive."

Today in a recent RFP, the Bill Gates' Foundation stated that only 5 percent of the men in the world use condoms. While gay men are almost 10 times more likely to use condoms, we are at over 40 times greater risk than women. But condom usage is decreasing, and condoms work effectively only if they are used 100 percent of the time. Recent studies show this rarely happens.

The hard truth: we need a new approach and relying on trust whether in online profiles or in personal dialogue is a proven failure.

So let's make it a goal of promoting what we know and engage in the benefits.

1. PrEP works. Its implementation is challening. Guys, who are at risk, need to understand they are at risk and to take preventative stets. We need to make access to doctors and medication easy and affordable.

2. Treatment as Prevention (TasP) is based on science and documented studies that conclusively show that HIV+ individuals on meds with an undetectable viral load have close to a 0 percent chance of transmitting HIV. The challenge here, as documented in a recent conference in an article by David Fawcett, is we have a very leaky cascade of care and only 28 percent of HIV+ individuals reach and maintain an undetectable viral load. We need to fix this.

3. And condoms work -- as long as one uses them 100 percent of the time.

The good news: all these work right now.

The bad news: in 2015, we still do not have a cure for HIV/AIDS.

My concluding message: Sex has always been and remains an integral part of gay men's life. Why not just embrace and enjoy this reality? But let's add in PrEP, TasP and/or condoms.
Purcell et al:

Incorporating Couples-Based Approaches into HIV Prevention for Gay and Bisexual Men: Opportunities and Challenges David W. Purcell • Yuko Mizuno • Dawn K. Smith • Kristina Grabbe • Cari Courtenay-Quirk •Hank Tomlinson • Jonathan Mermin Arch Sex Behav (2014) 43:35-46 DOI 10.1007/s10508-013-0205-y