This month the World Health Organization recommended that all HIV-negative, sexually active "men who have sex with men" ("MSM") and trans women consider pre-exposure prophylaxis (PrEP), which is the daily use of Truvada, an antiretroviral drug combination, to prevent HIV infections. Like many others in the queer community, I felt conflicted.
While lacking exact numbers, I do know that HIV does not discriminate, affecting straight and gay people, trans and cis people, men and women alike. Yet, at the same time, we cannot deny that "men who have sex with men" and trans women are disproportionally affected.
So let us queer folk take antiretrovirals to prevent HIV, right?
Everybody should make their own health decisions: If PrEP keeps you healthy and you use it well-informed, more power to you.
However, while it is we "men who have sex with men" and trans women (save for lesbian trans women) who are having sex with men and therefore potentially exposing ourselves to risk, depending on our sexual behavior, I find it too easy to say that we are the problem and should solve it by taking drugs with potentially serious side effects at a considerable cost often not covered by insurance.
Anyone who engages in risky sexual behavior should take extra precautions, be it through PrEP or otherwise. While I'm certain that the WHO acknowledges this, their message nevertheless helps perpetuate the falsehood of HIV being a "gay disease."
There's a reason that the term "men who have sex with men" exists: It is used to identify a behavior regardless of how people see themselves. From a medical perspective I understand the need for this term, but I nevertheless loathe it. I am not a "man who has sex with men" even though I am a man who has sex with men: I am more than a behavior. I am a person who happens to be gay, proudly but also just that: I happen to be gay. While being gay is a part of my identity, my sex life is not. Don't make this the core of my being. The anti-gay zealots are doing a pretty good job of this already; we don't need our allies to do the same.
Call me "gay" (or "queer," as it is more inclusive) but not "MSM." Address gay men as "gay men" and trans women as "trans women." Yes, we are separate demographics, and we have our own specific needs and issues. Address us fairly and justly but without judgment, as we don't deserve it, and certainly not as a group at once.
Start to recognize that just as with straight and cis people, within our community you will find everything from asexual celibates to hypersexuals who have a permanent open house. You have those who share their bed with only one person, or with none at all, and those who share it with hundreds. Neither way can be defined as "gay" or "straight," "trans" or "cis," and neither way is, by definition, right or wrong.
What is wrong is to assume that we queer folk all show one sort of behavior (and that the straight cis community shows the exact opposite, which is just as untrue).
Organizations like the WHO know this and should phrase their messages accordingly: Say what has to be said, be certain that it cannot be misunderstood and is free of prejudice, and ensure that it addresses the demographic it concerns.
In the meantime, we should ask why we still need to define some men and occasionally trans women as "MSM." Being gay or bi, especially for men, is still a taboo if not illegal in many parts of the world. Trans people face similar issues. Everywhere vicious lies are told, and believed, about who we are and what we do. For many of us it is truly dangerous to be honest about our identities, and I dare you to find a single out queer person who has never experienced discrimination.
When I came out I took a great risk. And indeed, not much later, I was a homeless teen, had a gun against my head, and experienced a few other not-so-fun incidents over the years.
It would have been the safer option to not come out. However, not coming out would not have meant that I stopped being gay. Eventually I probably would have had anonymous sex with men, as I am a human being and therefore have sexual needs, yet I would not have taken the risk of being outed. Anonymous, dangerous sex pretty much would have been my only option, and it would have happened as I needed it. No, I would not have needed anonymous, dangerous sex, but I would have needed physical intimacy with someone I was attracted to instead of with the woman I would have had sitting at home, whom I would have been about to put at risk as well.
Luckily this is not my reality, but it is the reality of thousands of others.
Might that be a main reason that HIV is more prevalent in gay or bi men and trans women? Being shamed for who we are and at risk once we reveal our identities causes a considerable part of our community not to be visible, yet in the dark life still happens. It makes it difficult to blame people for seeking sexual relief anonymously, as otherwise they may just lose their families, houses, jobs, income, friends, freedom or even life should they come out. It's equally tough to blame people for not protecting themselves, as they came to believe themselves to be worth nothing and engaging in great sin, as that is what they've been told their entire lives.
If we truly want to prevent HIV/AIDS, we need to be honest. We need to address why "men who have sex with men" often engage in dangerous sexual behavior, and we need to acknowledge that the term is not, by definition, a synonym for "gay men" or "trans women."
An organization such as the WHO can't afford to get this wrong. Not only have they harmed gay and bi men as well as trans women with their recent statements, but they also potentially put straight people in a more dangerous position, as they may unjustly think they're safe from HIV. Most importantly, though, if we truly want to battle HIV and AIDS among everyone, including among us queer folk, we need to address the reasons that some of us engage in risky behavior and seek to eliminate those.
Sure, there will always be a small group that will keep to their ways, but this is not the majority of "men who have sex with men." These are people who've been made to be ashamed of who they are while nevertheless still having to address their basic human needs, of which sexuality is one.
PrEP is an important addition to the toolbox to prevent HIV and AIDS, but it is not something that should just be tossed over the counter, as the WHO almost seems to suggest. It is great to raise awareness about its existence and provide access for those to whom it may make an important and potentially lifesaving difference. Yet I struggle to see it as a proper way to permanently reduce HIV, and I hate to see that, once again, the root causes of why we are higher-risk populations largely go ignored.
With the crash of Malaysia Airlines Flight 17, we lost some of the leading names in HIV/AIDS research. Why won't we honor their legacy by truly addressing those elements in society that put people at risk of contracting HIV? If we really want to reduce and eventually eliminate HIV/AIDS among queer people and the wider population, I believe now is the time to truly start working on societies where there no longer is a need to hide who we are. It may just be one of the most important steps we can take.
(I recognize that there are more factors that may put queer people at risk of contracting HIV. However, for reasons of readability and space constraints, this blog post has a narrower focus.)