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.

By Steve Weinstein

From The Advocate February 2009

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

These comments are reproduced as written by visitors to this Web site. They have not been edited for content, grammar, or spelling. The viewpoints appearing here are those of the writer, and do not necessarily reflect the opinion or views of advocate.com, The Advocate, or its affiliates.

Name: Angry Black Professor
Date posted: 2009-02-22 5:36 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: Jonathan
Date posted: 2009-01-24 3:04 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: Alan
Date posted: 2009-01-17 7:03 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: Rav
Date posted: 2009-01-12 12:08 PM
Hometown: NYC

Comment:

"Better living through chemicals", didn't work in the 50's (and gave many women cancer) and it sure won't work today. The idea that pills will make the world better is nothing more than ignorance by people who do not understand medical science. I went to school in the biomedical field and can say the horrible fallacies people see in this is from ignorance. Most important fact of all medication is it takes time to circulate through the body. If you take a pill orally and then have sex anywhere but in your stomach the medicine could easily not be at the site of infection. Now the antiretrovirus is useless since you have infected cells and this is not a CURE for AIDS. Your life is not a video game; drinking the potion or eating the fruit will not instantly give you the effects you desired through out your body in a perfectly uniform manner. This sort of ignorance will only spread HIV/AIDS and increase the epidemic.

Name: Fendie
Date posted: 2009-01-10 12:10 AM
Hometown: Kuala Lumpur

Comment:

I find it offensive as a member of the gay community to read what our own people would risk themselves for, in the name of having great sex. We'd risk lives, coz barebacking feels better. No wonder straight people cant help but look at us and judge us sexually, because this HIV fight we've endured all these years have simply been boiled down to us being stubborn idiots. So what if straight people dont care for condoms, is it the name of Equality do we call for stupidity on our parts. Girls, pick the right fights please. I hope HIV cure will be found so that I dont lose anymore friends, but I will not tolerate friends who would risk all this, just to bareback and be a stupid cum dump for half an hour.

Name: Scooter
Date posted: 2009-01-09 9:20 PM
Hometown: DTW

Comment:

I have many straight friends (female) that engage in unsafe sex.... they take a pill that doesn't allow pregnancy. All other issues seem to be ignored (std's primarily). I"ve talked about this with many of them, and they seem surprised at my concern. gay men are not exclusive from the major population twhen it comes to sex. the discussion should probably be more about personal identity and sexual habits. HIV &pregnancy today are linked together: meaning that neither are wanted, but something a pill might cure. Wear a condom? Tell that to all the straight people out there who are more concerned about becoming pregnant and they will laugh at you. Why are gay men treated so differently? Why not do what the greater population has been doing for 30 years? We live life with a certain degree of risk-those persons alive today have been able to factor out the really bad risks... a pill... a mis-shapen hanger? whats the difference for them? Think about it!

Name: Ricardo
Date posted: 2009-01-09 11:25 AM
Hometown: Quito, Ecuador

Comment:

"And we need new methods of HIV prevention. Current approaches work for some people, but over a quarter of a century into the HIV epidemic we’ve just got to admit that they have only limited effectiveness." Actually, condoms, when used right, have been proven to be effective over 90% of the time. Combined with limiting your sex partners down to a reasonable amount, this approach has proven to be an extremely healthy. There is a difference between something that MIGHT be effective, and something that actually IS. Encouraging the new generation of gay men to forgot about traditional safe sex methods and use PrEP instead because it MIGHT be effective is damned irresponsible, and certainly not "pragmatic." I love this line: "Leave the moralising and scare-mongering about other infections to one side." Sounds like classic gay AIDS-denial circa 1983.

Name: Roger Burr
Date posted: 2009-01-09 11:20 AM
Hometown: Marble Hill, MO

Comment:

What we NEED more than anything, is a government and national health system committed to finding a cure for HIV/Aids. Ever since the 1980's, when Ronald Reagan made it politically fashionable to marginalize gays, we have suffered the neglect of one political administration after another as tens of thousands of LGBT people have lost their lives. We can't even muster enought political strength to bring an end to DADT, which would cost the government absolutely nothing! If HIV/Aids only affected white, middle class heterosexual men, you can be sure a cure would have been found, years ago. Until we find a cure, the only avenue available is strict adhesion to safer-sex practices which primarily means using a condom. For years I enjoyed barebacking as much as anyone else. But for years now, I have put on the 'rubber', no matter how tempting the desire to do otherwise may be. Lives are still being lost to HIV/Aids. We need to continue using the only proven means of safer-sex yet devised.

Name: Pragmatic
Date posted: 2009-01-09 8:07 AM
Hometown: NYC

Comment:

It’s interesting how negative all these comments are. This is a promising area of HIV prevention that could well prevent HIV infections. And we need new methods of HIV prevention. Current approaches work for some people, but over a quarter of a century into the HIV epidemic we’ve just got to admit that they have only limited effectiveness. We urgently need effective chemical methods of preventing HIV – and PrEP and PEP (and treating people with diagnosed HIV to lower their viral load) at the moment look a darn sight more promising than vaccine research and even microbicides. Leave the moralising and scare-mongering about other infections to one side. It’s time for a new prevention agenda using all the tools at our disposal.

Name: Ricardo
Date posted: 2009-01-09 4:57 AM
Hometown: Quito, Ecuador

Comment:

There is no way I would want to sleep with a guy who is eager to pop PrEP pills. As the article states, exactly how effective they are is not a known, quantifiable fact, and that a guy is so willing to put his health at such an extreme risk for the sake of an orgasm means to me that such an individual is more than likely addicted to sex, makes out with lots of guys of whom he doesn't ask too many questions, and thus is not only at a much higher risk to be carrying HIV, but god knows what else. It reminds me of the early days of the epidemic, when guys invented all sorts of bullshit reasons as to why it would never happen to them.

Name: Laurent
Date posted: 2009-01-09 12:43 AM
Hometown: Ottawa, Canada

Comment:

I guess I am an old fashioned type guy and so is my husband, that is one of the benefits of the institution of marriage. Having the recognition of our relationship, for us means that risky sex is no longer an attraction, we can enjoy a sexual relationship with each other without condoms because anonymous sex is no longer an attraction. I sincerely hope that PrEP does work for these individuals in the prevention of HIV, but it will not prevent other STDs and these are becoming drug resistant due to the medical community overprescribing antibiotics.The incidence of HIV is rising due to fatigue of the message and drug companies advertising campaigns detailing the success of their regimens so HIV is no longer a death sentence. Just read the Advocate and Out magazine for examples of this. I recently met a young man of 28 who was lamenting the fact that he has never had sex without a condom, he also doesn't enjoy it and was considering taking his chances. Sad really.

Name: Jen
Date posted: 2009-01-08 7:05 PM
Hometown: Tacoma, WA

Comment:

It's truly amazing that people would be willing to subject themselves to such great risk simply for some momentary pleasure. As both the article and Alexander suggested, while PrEP may be able to prevent HIV exposure, it certainly is not a shield for other sexually-transmitted diseases, and therefore a condom should be used as protection. As for the PnP mix, I am further baffled that gay men would want to mix hard drugs like crystal meth with PrEP, without knowing what that mix could do. Meth all by itself is a pretty potent drug, and it seems like an unnecessary risk to be under the influence, on PrEP, and having promiscuous sex with other men who have an unknown HIV/AIDS status. Gay men already have a reputation for being promiscuous and prone to risk-taking, and I would hate for that to continue. I wish gay men would think more about the consequences of their actions, especially considering the decimation the gay community experienced when AIDS first became prevalent.

Name: Alexander S. Bauhart
Date posted: 2009-01-08 3:52 PM
Hometown: Pointe-Calumet, QC, CANADA

Comment:

My only comment is this: we have to be more patient, wait for all the necessary scientific evidence that Prep is really safe for one's health and a foolproof shield. However, let us not forget the other 'gang' of diseases one exposes oneself to: syphillis (harder to cure lately), ghonorrea, chlamydia, hepatitis C and of course, now a raging epidemic of tuberculosis. Humans like taking risks, that is an inescapable fact, but is it really worth the candle here, for just avoiding including such a simple sex-toy as a condom in one's panoply of pleasures? The unknown and the dangerous are seemingly always appealing to those who have not yet experienced the real danger, and most of the time, then, it is too late. Be prudent, save your life and that of others, all the time. That is worth the candle! Alexander S. Bauhart Montréal, QC, Canada Gay Rights Activist (GRIS Montréal) and AIDS Research Advocate (CanFAR)

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