Given that tape loop playing in the collective gay-male head, it’s hard to tell whether the argument the gay community is having with itself about Truvada is with the medical facts on the ground or with the very real demons of history: What are gay men scared of?
Many of my HIV-negative friends are on Truvada, but I didn’t know until I asked, and they’d speak to me only if I withheld names. The number of prescriptions is growing: “Last summer was crickets,” says Dr. Demetre C. Daskalakis, the head of HIV services at Mount Sinai Hospital, who played a leading advisory role in getting Truvada FDA-approved for PrEP (short for “pre-exposure prophylaxis,” the medical term for the function Truvada is performing, often used interchangeably with the drug’s name).
Nathan, a 24-year-old hairdresser friend of Gabriel’s who had initially told him the dance-floor slipup probably wasn’t a big deal, sought out Truvada around the time Gabriel did. The man who is now Nathan’s boyfriend—an older, wealthy guy with a Chelsea penthouse—told him to go on it after Nathan had condom-free sex with someone who had said “I’m fine.” Later, the guy divulged that he’d meant HIV-positive but undetectable. (HIV-positive people on regular medication suppress HIV in their blood to levels that don’t even show up on tests, rendering them nearly uninfectious.)
“It’s taken away the taboo of barebacking being a naughty thing,” says Nathan. But, he adds, “now that I’m on it, I’m buying condoms. I don’t want to be one of the guys who’s like, ‘I’m on PrEP, so come over and find me blindfolded and fuck me bareback.’ ”
Some are taking Truvada to do just that—behave without inhibitions. These are people who claim for themselves the epithet, found on T-shirts and in Instagram captions these days, “Truvada whore.” But for others it’s a simpler question, leading them to have the same (mostly) condom-protected sex they’ve always had, only for once in their lives without dread. For the generation of gay men who came of age post-AIDS, anxiety has essentially preceded lust as a first response to thoughts of sex. Sarit Golub, a Hunter College psychology professor, is leading a study at Callen-Lorde that indicates that half of gay men think of HIV all or most of the time during sex. “That, to me, is a psychological tragedy,” she says.
Over coffee and pie at the Blue Stove in Williamsburg not long ago, Adam, 33, a writer and filmmaker I know, mentions that he is exactly the same age as the pandemic.
“The terror was at its height when I was coming of age, postpuberty,” he says. “The message from TV shows that was drummed into us as gay boys was that we could get this disease and die and make our parents very sad. I developed this intense fear when I was having sex with someone and not even doing anything risky. I’d still freak out the next day. What if I gave a blow job to someone and his pre-cum had HIV in it?”
When Adam and I met up, he’d taken his first dose of Truvada the day before. He felt fatigued, but he’d also underslept, so he wasn’t sure it was the drug. The night before, he’d invited over a regular hookup who has told him he’s HIV-negative. “I had wanted him to cum in my mouth,” Adam says, “but I knew that the PrEP doesn’t take full effect for seven days.”
Matthew, another friend of Nathan’s, who works in tech, went on PrEP for extra protection, too. Twice he’s had a condom break. He’s a little older—48—and says he’s watched close friends who’ve been HIV-positive for years struggle with the disease and the meds.
Gabriel, Nathan, and Matthew all say they’ve had no side effects so far. They get labs done every three months to make sure they are still HIV- and STD-free, and twice a year doctors check that their kidneys are okay. (Truvada has been linked to mild kidney damage in a small percentage of people who take it as part of their HIV-treatment regimen.) But that fear of the unknown has kept their friend Lorenzo, a 23-year-old M.B.A. student and go-go dancer, from seeking a Truvada prescription. “I’d rather let them be the lab rats and wait a few years,” he says. “I’m very sex-positive, but … a condom is a wall. It keeps me away from you.”
That, to him, is a good thing.
Researchers suspected HIV drugs could work preventively well before Truvada went to market a decade ago for its original purpose. (Truvada, like all HIV medication, works by disabling the steps the virus takes to hijack human cells.) When the FDA approved Truvada’s use as a prophylactic, the drug company that produces it showed surprising restraint, given the potential size of the new market. Gilead, for which the drug has been a multibillion-dollar blockbuster in treating HIV-positive patients, instead gives money to various nonprofits in support of education and to raise awareness about PrEP. The company says, through a spokesperson, that Truvada is “an important public-health intervention and not a commercial opportunity.” Gilead also has a program to make Truvada available to eligible patients with no health insurance or with unaffordable co-pays.