An American gay man who had been on PrEP (pre-exposure prophylaxis) has contracted HIV. For those not in the know, PrEP is a preventive mechanism that involves taking a tablet a day in order to reduce the possibility of HIV infection. It is generally advisable to use protection during sex even when one is on PrEP, but its efficacy so far had led some to believe that it might work even otherwise. That is no longer true.
It would seem that there really is something about gay life that the stars are against. Every time we see a ray of hope, this potent malaise known as HIV shoots us down.
The man in question told Poz, a magazine on HIV, that he had stopped using protection from the time he began taking Truvada, the drug of choice for PrEP in the US. “To be honest with you, I stopped using condoms after going on PrEP. I was such as big proponent of PrEP that if I was chatting with someone on a hookup site who wanted to use condoms, it was a deal-breaker for me. I was having sex to enjoy it. And if I was wearing a condom or the other person was wearing a condom, I wouldn’t enjoy it,” he told the magazine.
Since the dawn of the AIDS era, the question of sexual activity among gay men has been intimately mixed withthat of disease. Beginning in the mid-80s in America and then spreading around the world, AIDS sounded the death knell of a community already in the shadows. The pockets of pleasure it had created for itself were gloriously hidden from the straight world, but after AIDS,it was also haunted by the spectre of death.
As medicine advanced, better treatment options became available. In the ‘90s came antiretroviral therapy (ART).While not a cure, ART kept the viral load down in HIV-positive patients. Stories of people with HIV living long and relatively healthy lives began to be heard. With time, ART became better at keeping HIV in check, but the virus was no slacker. It mutated and continued to present a challenge to researchers.
And then came PrEP. With its promise of a single pill keeping the virus at bay, PrEP was soon adopted by a large number of gay men in the West as a means to reduce the distance between leading a normal, carefree life and always worrying about contracting HIV. Over the last few years, many stories have been written about how PrEP has helped many keep their AIDS anxiety in check — a not insubstantial boost to a beleaguered community.
The relief seems to be short-lived, now that we have news of PrEP’s failure. While the doctors have never advised going off protection with PrEP, the American’s is the first case of someone actually contracting the virus while on the medication.
Why not be cautious? Why take risks? There are those who argue that gays, too long victims of discrimination, are finally coming out of the woods. At least in the West, things are changing. In the US, you can marry a same sex partner in any state, just as you can in Canada and a slew of European countries.
The unspoken suggestion in these claims is that gays ought to start living ‘straight lives’ (as indeed many of them are doing). This should lead to lower risk-taking, more stable relationships. True and true, but before we jump on that respectability bandwagon, let me add a delicate caveat: the realities of being gay, of learning to be gay, are not amenable to such easy compartmentalisation.
Imagine a gay man, and for the sake of argument, the straightest possible gay man — one who is highly adjusted to the details of straight life. He has a neat job, a nice roof over his head, and enough dope in the bank. In other words, he has ticked all the markers of respectability.
When it comes to his personal life, however, he remains unsure. He has been dating men on and off, but is yet to find someone with whom he can settle down. Even so, the idea of starting a family excites him and gives him goosebumps about a future that he has imagined. When he does find someone, he will be the first to register for an elaborate wedding ceremony. He is that kinda guy, you see. One that all straights, not just the liberals, will be too happy to co-opt.
Meanwhile, till he finds that special someone, he hooks up with other men. Even if he is the most comfortable-in-his-skin gay man, the arc of accepting his gayness has (naturally)passed through many such secret encounters. These are torrid encounters, conducted with the thrill and ecstasy that skin-with-skin contact bestows. These are dreamy encounters, coalescing his hopes for his future around a tiny sliver of time, all the more wonderful for its brevity, compactness, perfection. Nothing grey about these meetings; only the red hot of desire mixing with the red hot of an imagined love.
Suppose this man now finds a partner, a lovely man with whom he wishes to spend his days. He is in love and feels the old anxiety dissipate. He is now no longer a pariah. He is part of the system, a system that will bring him stability and peace.
And yet, he misses those intense encounters. Not because he is loose or greedy. Hardly! He misses them because it was out of those occasions that he was able to make some concrete sense of this vague, painful thing that is his homosexuality. To him, those moments are outside of space and time. They are not of this life, it seems to him.
They have an existence separate from him, and are dappled with a confetti that, curiously, reminds him of the sort of insane happiness he felt as a child. The mere thought of them excites him. He watches, in his mind, reruns of the tape that his own flickering imagination has stored there. The heat of that memory rises to his cheeks and he wants to revisit.
He goes, of course. He continues meeting men on the sly. Not because he is unfaithful to his man but because, in his messy humanity, he is bigger than anything his mind can process. At first he waited for things too much and too long, and then he learnt to push himself into the thick of things, and this is how his brain now functions.
He is incapable of judging himself. He wants love and he wants intimacy and he wants them with different people. And he wants love and intimacy with one man. He is surprised by how easy it is for him to have both, not in the getting-away-from-it way but in how natural it feels, like retuning home.
Of course, nothing has changed outside his mind. There is still an entire world of disease and fear out there. There is AIDS. He knows all this only too well, having walked through the densest thickets of that forest in his mind. But what does it mean to know this when he also has access to a vision of beauty that is both fickle and tangible, like happiness itself?
He uses protection, of course, but he will be damned if he reduced that choice to a simple binary between momentary pleasure and a slow, agonising death. The true choice that he faces, and one that he accepts, is to feel real in the here and now, to feel the blood rush in his veins, to be human and alive.
Beyond the threat of disease — or maybe because of it — gays react to their homosexuality in surprising ways.