Op-ed: PrEP, Shame and the Intentional Spread of HIV

I have a pretty strong stomach. It takes a lot to make me sick. But when I stumbled upon the story last week of a young man in San Diego named Thomas Guerra who is being charged with intentionally infecting his boyfriend and possibly dozens of others with HIV, I was ill.

Guerra's alleged actions were a form of premeditated assault and, in the worst possible scenario, even murder. What's different about this story is that he was allegedly bragging to friends about passing HIV on to his boyfriends -- even laughing about it. We call people who get off on harming others sociopaths, and while movies and the news would have you believing these people are everywhere, they in fact, are not.

But what is everywhere -- what I believe contributes to people lying about or not finding out about their HIV status -- is stigma. Shame; the belief that telling someone you have HIV will result in being shunned or cast aside. And so, people lie, either knowingly or by simply not having any factual information.

And yet here we are with PrEP, a medication available on the market that could very well protect our community from the spread of HIV. It's a combination of medications that the CDC reports has been shown to reduce the risk of HIV infection in people who are at high risk by up to 92 percent.

I'm HIV-negative. I'm lucky, and I know it. I'm also not on PrEP -- yet. To be honest, I haven't yet decided if it's right for me. But it's right for some people. Hell, I'll go out on a limb and say it's right for a lot of people. And there's a lot of support behind it, from the CDC to the World Health Organization to numerous HIV foundations around the world. But there are also a lot of people saying that it's a crutch and an excuse horny gay men wield to get out of using condoms. Some say it's a magic pill gay men will take so that they don't have to think about the consequences of their actions. And then there's the head of the AIDS Healthcare Foundation, who, going against millions of dollars of research including claims from the federal government, says he fears PrEP is ineffective in preventing HIV.

But it's all stigma; this is convincing gay men to not even consider a medication that could possibly keep them well through simple shame. Convincing them that they want the drug for all the wrong reasons and again keeping our community from having an open, honest dialogue about an undeniable fact -- that HIV infection rates are once again on the rise among young, gay men.

The latest numbers from the CDC show a a 132.5 percent increase in new infections between 2001 and 2011 among gay and bisexual men who are between the ages of 13 and 24.

Our community's history is deeply rooted in shame. First it's the shame of being gay and the fear that family and friends will reject you. Then it's the shame of wanting to be in a relationship -- as if we're somehow less deserving. The shame that coexists with HIV is no different, and the availability of a drug combo like PrEP offers something our community hasn't had a lot of in the past -- options. And if experts -- people supposedly devoted to the health and well being of and at risk population -- are going to take an option that research supports as an effective means of combatting HIV infection and shame-goat a community into avoiding it and staying the current recommended course of protection, then we're slipping back into that vicious cycle again. A cycle that guilts people into living a lie.

Shit happens -- to people of all sexual orientations. Condoms break. People have a few too many drinks, don't have a condom handy and the next thing you know... And sometimes, people just like to fuck without a rubber. Or maybe, in the worst circumstances -- much like the victim in this San Diego case -- you find yourself committed to a boyfriend who happens to be positive and has chosen not to share that information with you. Life happens -- to all of us.

I don't know what prompted Thomas Guerra to knowingly infect his boyfriend with HIV. The evidence isn't in yet -- as of now, he just stands accused. But I do know that for every Thomas Guerra out there, there are others. There are people who know they're HIV positive and don't want to talk about it. And there are people who have walked by a testing facility a dozen times, and for one reason or another, have never bothered to go inside.

We owe them the support of saying it's OK to know your status. The outcome may be scary, and you may have an uphill battle, but knowing the facts and being honest about them isn't only OK, it's the brave thing to do. It's the socially responsible thing to do.

We can encourage honesty when it comes to disclosing one's HIV status, and that coupled with the efforts of organizations like The Stigma Project will go a long way toward reducing the shame that accompanies living with HIV. But some will slip through the cracks. People will continue to lie. And a medication like PrEP is an opportunity for a community to protect itself against that form of abuse.

We shouldn't discourage people from using PrEP. We should be celebrating the fact that this medical advancement even exists, and encouraging anyone who'll listen to talk to their doctor, ask questions, and take their health into their own hands.

ROSS VON METZKE is the former editor of Advocate.com and his work has appeared in magazines including Playboy, Out magazine, and Entertainment Weekly. He currently consults for a number of clients including Dan Savage, The It Gets Better Project and Every Monday Matters.