Finally Freedom for HIV Men to Have Sex without Passing on HIV, For Men to Love without fear
The sex lives of gay men were once overshadowed by the fear of possible transmission of HIV. They no longer need to be. A mistake made in the heat of the moment, or even an intentional choice not to use condoms, no longer means worrying the next day about a life forever changed by an incurable disease. Thanks to medical progress, we are free to love and be loved without a constant sense of dread. Yet few know the good news.
Truvada changed everything. Used as an antiviral for over ten years, the Food and Drug Administration approved its use as an HIV prevention pill in 2012. Truvada, used as pre-exposure prophylaxis (Prep), is not considered a vaccine – just as the contraception pill used by millions of women is not considered a vaccine against pregnancy. But both, when used as prescribed, are highly effective preventatives; both are only used during periods of a person’s life when they consider themselves at risk; both have limited and well-defined side effects that few ever experience.
The protection offered by Truvada and other antivirals has impacted us both deeply. One of us – Peter – came of age during the early years of the pandemic, and is now in his fifties; I am white, and like hundreds of thousands of other American gay men, became infected by HIV before the virus had a name. I have been on antiretrovirals most of my adult life; they work so well that I now have to plan for my retirement years, like everyone else.
The other one of us – Matthew – is in his twenties, and has never known a time where HIV was not a threat. As a young black gay man, I represent one of the most affected communities in today’s epidemic and only recently started taking antiretrovirals; in my case, I take them to prevent becoming infected. Even though rates of HIV infection are rising again in gay men, especially young gay men of color, I remain virus-free.
Yet sadly, we both encounter people every day that have not heard about the scientific breakthrough in the fight against Aids that Truvada represents.
But that’s not the only important news that isn’t getting spoken about enough. A large study showed that those of us who are positive can have sex without infecting our HIV-free partners, as long as we take effective antiviral therapy that keeps our virus suppressed.
In the study, which followed hundreds of gay and straight couples where one person was HIV-positive and the other was not, there were zero infections after an estimated 45,000 acts of condomless sexual intercourse. This stunning result basically means that a person with HIV who takes effective antivirals cannot transmit the virus to others. That can give gay men a remarkable peace of mind that we could only dream of having during the early years of the crisis.
From a public health standpoint, these breakthroughs have become game-changers in the fight against Aids. Increased HIV testing and better access to healthcare not only help people living with HIV keep the virus suppressed, it prevents additional infections. The lives of 14mn people have been saved through international programs like Pepfar and The Global Fund that distribute antivirals, while annual infections worldwide have dropped by one-third since those programs began.
Here in the US, localities that have increased the percentage of those on treatment using testing and linkage to care programs have seen dramatic drops in annual HIV infections. Washington, DC, San Francisco, Massachusetts, and New York State have all seen drops of over 40% in annual infections over the last decade. With access to health care made easier after Obamacare, additional progress is expected.
But these stats mask a mixed record overall. Nationally, rates of infection among young gay men and transgender women have been rising, especially among African Americans. Gay men of color have faced the duel hurdles of homophobia and racism, including racism from other gay men, and an historical indifference from the gay establishment. As Aids activists, we know that the movement’s strength has always derived from the self-empowerment of the most affected. A new generation of activists have emerged, and they will now drive the pace of our progress. It is past time for younger gay men – especially men of color – to be heard and valued.
The discussion around Prep has offered hope in this regard. Its introduction has raised many questions, around access, its comparative effectiveness to condoms, and how gay men take care of themselves, and each other. That conversation, more than the pill itself, will prove crucial as we ramp up the final push to lower HIV infections. Silence once equaled death, and still perpetuates an epidemic. As our voices rise again, we can begin to imagine future generations free from HIV.
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