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31 Days of PrEP

Op-ed: It Is Time to End Bottom-Shaming

Op-ed: It Is Time to End Bottom-Shaming


Why shaming bottoms allows HIV to keep spreading.

"It's cool, man. I'm clean. I swear." Admittedly, this uncouth line worked on me more times than I care to recount. During my naive years, I trusted everyone, and no one could do any wrong. Then a friend contracted HIV.

This was also my first time encountering bottom-shaming -- it wasn't long until catty rumors swirled about my friend's status, and the comments I'd hear always tied back to him being a bottom.

"He should have known better. Bottoms are more likely to contract HIV."

"That's what happens when you're a slutty bottom."

There was never talk about the top who had HIV and passed it along unknowingly, as is so often the case in transmission. The judgment rested solely on the bottom. When I've talked to friends about "bottom shaming," many don't recognize it until I share a conversation like this one.

Bottom-shaming is nothing new and has always been partly about power. In fact, there is evidence of bottom-shaming as far back as ancient Greek and Roman societies in which to be "violated" could strip one of citizenship, according to Daniel Pullen, a professor of classics and chairman of the department at Florida State University. According to Pullen, the act of being penetrated was often hurled as an insult. "Aristophanes, the comic playwright, he often has a character that looks out into the audience and talks directly to them," Pullen says. "And one of his favorite things basically translates as 'Look at all the gaping assholes.'"

Some of the stigma associated with bottom-shaming is indicative of gender roles. How many times have you heard a straight person ask, "Which of you is the girl in the relationship?" The guy on the bottom is the one being penetrated, which they associate with femininity. In this society, which is more of a handicap -- being a woman or being a man who exhibits a trait associated with being a woman?

A close friend of mine who is a trans woman and still in the process of transitioning has been the target of this startling intersection of judgment, as he (he uses male pronouns for now) begins to dress and act more feminine to present better in alignment with how he really feels inside. The ridicule is driven by a bias that being male-identified and exhibiting so-called feminine traits is seen as some backward affront to maleness.

Yet despite the public manifestation of bottom-shaming there is an underground community of butch tops anonymously seeking fem bottoms. Craigslist, Grindr, Scruff, Adam4Adam, whichever site or app you use, is full of "masc seeking fem." Many of these same men won't look the fem partner in the eye in public.

So bottom-shaming has a long history, and no single cause, but it has a new effect. Men who should be among the first to ask their doctor about PrEP aren't doing it.

For most of my life, I was ashamed to be a bottom, and much of that shame was rooted in history and statistics. A study by the University of California, San Francisco's Alliance Health Project quantifies the risks of condomless sex associated with your sexual position: Tops have a 1 in 500 chance of contracting HIV from an HIV-positive bottom, while a bottom has a 1 in 50 chance of contracting HIV from an HIV-positive top.

That shouldn't negate the fact that both parties involved in a sexual relationship shoulder the responsibility equally. Simply because the bottom is more likely to contract a disease shouldn't mean it is the bottom's sole responsibility to provide the protection.

But is it smart for the bottom to provide the condom? Of course it is. I always make sure to bring my own protection if the situation arises.

Since bottoms are more at risk of contracting infections such as HIV, we should be the first to take advantage of preventive measures such as PrEP. I am all for a pill that, when taken as directed, reduces the risk of contracting HIV by 99 percent. That's according to a multinational Preexposure Prophylaxis Initiative (iPrEx) study published in September 2012 in the journal, Science Translational Medicine. Yet, according to experts, bottoms, the group at the highest risk, may be less likely to ask their doctor about the drug for fear of being judged for their preferred position in bed. Frank Spinelli, MD, an HIV specialist in New York, told The Advocate that the social stigma of HIV and gay sex lends itself to more secrecy about whether a person is a top or bottom, which is stunting needed conversation.

"The issue with PrEP, is for the most part I think, the person who is the receptive partner has to say, 'OK, I am the highest at risk for contracting HIV. I'm going to go in and ask my doctor about this,'" said Spinelli. "And then they feel shame about that. There's this shame of owning up to the fact that I have gay sex. [They] want to feel empowered by it, but they don't know how to do that."

Those of us who are bottoms must accept the reality that we're more at risk, and that when the time comes for sex, we aren't the one putting on the condom. We should of course talk to each other more often about empowering ourselves to insist on condoms whenever the top has excuses, but PrEP is a chance to protect ourselves.

Would we feel safe even talking to each other about PrEP? If not, in keeping quiet, we are failing each other and the public. San Francisco supervisor Scott Weiner recently came out as being on PrEP. In his coming out column, Weiner said the main thing lacking in the advancement of PrEP is political pressure to ensure the public is properly educated on preventive measures.

Like all other communities, it takes multiple experiences to create a full community. Ours is waging a lobbying campaign already on multiple fronts, versus different factions of people who do not agree with our "lifestyle," because of who we love. The last thing we need is bottom-shaming driving a wedge between us. It is important we stand together and speak up for the greater good.

We are also fighting a disease of epidemic levels that affects our community more than others. Meanwhile, we have the option to take medication to prevent the spread of HIV. This is one bottom who will be asking his doctor about starting on his own Truvada regimen.

JORGE RODRIGUEZ-JIMENEZ is a journalism student at Florida A&M University and a contributing writer for The Advocate.

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