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The Next Condom Conundrum

Why use a rubber when you can just pop a pill? That’s what HIV-negative guys across the country are asking themselves -- and their doctors.


When Adam, an HIV-negative Bostonian in his mid 20s, was dating an HIV-positive man last year, he made a conscious decision not to use a condom when they had sex. Instead, he popped a tenofovir, an antiretroviral drug that may help prevent HIV infection. “My partner didn’t insist on [barebacking],” says Adam, who asked that his last name not be used in this story. “I thought it would bring us closer together.” Now single, Adam says he regularly uses condoms again, although he hasn’t been tested for HIV since the relationship ended.

Like Adam, many gay men around the country are opting to forgo the standard defense against HIV -- a condom -- in favor of a highly controversial and thus far unproven method of protection known as pre-exposure prophylaxis, or PrEP. Whether in a serodiscordant relationship or just looking for a fun night (or weekend) out, guys are trading rubbers for HIV drugs like tenofovir, known commercially as Viread, in hopes of preventing infection. The idea is inspired by post-exposure prophylaxis drug regimens long given to people possibly exposed to HIV -- such as health care workers, rape victims, or those who’ve experienced condom mishaps -- and by the AZT and Nevirapine pills that HIV-positive pregnant and nursing women routinely take to prevent mother-to-infant transmission.

And while PrEP’s not new -- guys have been popping a T, or “disco dosing,” as the practice is sometimes called, for several years, acquiring the drugs from friends, partners, or drug dealers selling “party packs” including crystal meth and Viagra -- a host of studies are now under way seeking to determine if it actually works. If proved effective, PrEP could revolutionize what it means to have safe sex -- at a time when HIV infection rates are rising among gay men.

Doctors don’t condone this underground prevention method, even if some informally discuss it with their patients. The medical consensus is that guys who use PrEP are putting themselves at risk of contracting an incurable disease and that no one should abandon condoms. But health care professionals also acknowledge that the practice of PrEP will continue even without the approval of any medical group. “Gay men have traditionally been ahead of scientists in trying to lower their risk,” says Bill Stackhouse, director of the Institute for Gay Men’s Health at Gay Men’s Health Crisis in New York City. “Unfortunately, this [approach] comes with complications.”

“Clearly, sex is more exciting without a condom: They’re not very convenient, they’re not sexy, they don’t feel natural,” says Rob Garofalo, deputy director of the Howard Brown Health Center in Chicago. “People are clamoring for a strategy that works.”

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Reader Comments
  • Name: Dietrich Pajonk
    Date posted: 3/3/2009 7:57:00 PM
    Hometown: Vancouver, Canada

    Comment:

    Dear Lord! Gentlemen! Please use a condom! This is the BEST defense! I sure wouldn't bet on anything else. If sex workers can use them consistently and effectively, you can too. If sensation is the issue, try this: Add a few drops of your favourite condom compatible personal lubricant inside the condom (not too much though). Reinforce its position with an erection ring. This reduces friction, increases sensation and after a few strokes, you'll be hard pressed to be able to tell the difference. I use this technique all the time and it seems to work dandy for me. Cheers! Dietrich

  • Name: Angry Black Professor
    Date posted: 2/22/2009 5:36:00 PM
    Hometown: New York City

    Comment:

    This is a careless and really irresponsible article. It amazes me that The Advocate (which of course touts itself as a the "voice" of gay men across the country) would publish a misleading story like this. To suggest that there is this mass community of reckless gay men who rely on PEP over condoms is just outright insane. I'm sure that there are incidents where some guys willy "rely" on the medicine, but to suggest that this is actually some of kind of "movement" is ridiculous. It is articles like this one that help fuel the logic behind many homophobic, conservative funding cuts for crucial HIV prevention services (i.e. this erroneous idea that gay men "abuse" services like PEP). The Advocate should be ashamed of themselves!

  • Name: bill
    Date posted: 2/9/2009 5:11:00 PM
    Hometown: atlanta

    Comment:

    GET REAL. I"m a gay man that has been H.I.V. postive for 10 yrs.I have gone thought some really tough times. Both hips replaced, in the hopst. over 20 times,and countlless other problems.So many younger gay man dont get it. Just because there is a pill doesnt mean there is no sickens.Im very lucky ,many of my friends died yrs ago.Get it right- wrap it or dont use it.

  • Name: n
    Date posted: 2/2/2009 5:45:00 PM
    Hometown: homoha

    Comment:

    As the one who tells you that your test is positive, I appreciate any efforts made to "reduce risk". However, having said that, you may as well just get used to NEEDING that pill to stay (somewhat) healthy, not HIV-. Start taking it now, and you'll be accustomed to having to take it when it is legitimately prescribed to you to potentially save your life. I cant begin to explain how awful telling someone theyve just tested positive is, then hearing that person say that they "want to kill" whomever it was that "gave this to me". Get it together, find a condom that works, and work it!

  • Name: Jonathan
    Date posted: 1/24/2009 3:04:00 PM
    Hometown: Duluth, Minnesota

    Comment:

    So many gays don't care what happens to other gay mens' health. He was just some loser you slept with, who cares if he lives or dies? Why even get to know his first name? Just a throwaway. Then we demand marriage rights with relationship skills equal to 7th grade girls. If we hate each other this much (besides our own self-centeredness)...forget it! We won't respect gay men, why should the rest of society respect us? We're an anonymous community except at Pride then the money, alcohol or party is over with. Then pretend we don't even know the guy when passing him on the street. We need to grow up and fast. Marriage? Forget it. 95% divorce rate. Kids? Forget it. We'd have them on diets and teeth whitening kits by age 8. Why is it always image? We are human beings, not disposable products.

  • Name: stdgirl
    Date posted: 1/17/2009 10:08:00 AM
    Hometown: New York

    Comment:

    Bad news!!! Whatever CDC says STD is on the rise! I think that's why more and more people living with STD join the STD dating site stdslove.com

  • Name: Alan
    Date posted: 1/17/2009 7:03:00 AM
    Hometown: West Hollywood

    Comment:

    I think this just follows in to the general complacency that the gay community has succumb to over the last years since the improvements in HIV meds. I am 39 and 10 years ago I had no friends in my close circle that were positive. Today i have 5 friends that sero converted within the last few years, all are 40 and over. We all know to where condoms, we all lived through the late 80's and are very clear on how HIV is transmitted. But yet sometimes we slip, there is no excuse for it. Something is going wrong with the psyche of the gay man today, something has to be done to get people practice safe sex again given the alarming increase in new infections. It has been a very sad day to see my very best friend test positive in his 40's we need a reality check fast since there is no vaccine insight.....

  • Name: J. Wilkins
    Date posted: 1/16/2009 1:11:00 PM
    Hometown: Long Beach

    Comment:

    I hear what ever one is saying about the stupid doings of people having sex without condoms; but, I want to ask how many of these people are having sex with out a condom? Even in a relationship, shouldn't the standard be, use a condom, but instead we insist that in a monagmas relationship it is okay not to use a condom.... ummmm.

  • Name: Gaby
    Date posted: 1/13/2009 10:01:00 PM
    Hometown: San Pedro

    Comment:

    It's amazing how far science has come, but having a pill that may "prevent" HIV, is dangerous. Like everything their will be handful of people who would take advantage of this. Society doesn't need a pill, it needs people to take responsibility of their actions, and stop being so careless.

  • Name: Shawn
    Date posted: 1/13/2009 6:07:00 PM
    Hometown: Atlanta

    Comment:

    No more AIDS walks or donations? A personal choice for sure, but halting generosity for what a very few (less than 1 percent according to this article) seems a bit harsh. I agree that chancing you and others' safety on an unproven method is a VERY unwise choice. On the other hand, simply saying "we have condoms, why bother with any other research?" seems pretty naive about the world we live in. People do make mistakes (especially those with less experience) - why NOT research something that could be promising?

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