1990 was a scary time to come out. I gotta hand it to my younger self: Jimmy you had balls at 20 years of age. It was in the midst of time when people were still dying in droves, and you came out in a somewhat rural campus environment where people had hunting rifles in their dorm rooms. Now I understand a bit better why my mom and friends were freaking out so much after I came out.

I took a student study trip to Germany and Poland then, and went to the gay Pride festival in Cologne, Germany while I was there. I didn’t understand then why the gay Germans didn’t want to have anything to do with me, for it was predominantly an American plague at the time.

I’ve been catching parts of HBO’s “The Normal Heart” here and there and it’s been a good reminder of how scary things were back then. Today we know a lot more, with surviving gays of my age and older somewhat befuddled by the attitudes about HIV with younger gays. To them it seems like a manageable disease where you can just take some pills to deal with it. To us it was a death sentence at the time, and we have a hard time comprehending how some can be so relaxed about the disease.

That’s why it’s been so hard to get my head around the idea of PrEP and changing attitudes about prevention. This whole idea of discussing HIV status and whether or not one is on PrEP before you get down to business is a big change from the times when condom use was pounded into our heads from every angle for so long. I was a die-hard proponent of condom use no matter what, and even in my foggiest states I still stuck with that regimen.

Now they are recommending changed approaches to sexual encounters. It’s a new set of ideas and approaches, but I have reservations about the whole idea of being completely dependent on the pharmaceutical industry and my personal health. Open up any gay publication and you’ll see a four-page full-color advertisement for this or that drug, which essentially pays for that publication. Our lives are dependent on a set of drugs to maintain our lifestyles. Sponsorship from the pharmaceutical industry hovers around us like a pleasant specter. I don’t see a whole lot written on that angle so far.

I’m getting the feeling this huge push for PrEP is mainly targeted at 20somethings. The people pushing this program don’t seem to see that this is a big change for older gays and may require a little bit more than “you should take this drug now and change all your habits.”

Things change and our understanding of the disease is a lot better than it was then. But having experienced a string of un- and underemployment since 2012 I also have some perspective as a person without health insurance. Pharmaceuticals are available for low income patients, but I don’t and often can’t depend on regular doctor and pharmacy visits for a steady stream of drugs. And they are expensive. Condoms are still the cheaper and easier option for me for those I don’t know. I’ve hedged my bets with those I know and trust but that still seems like a big investment for me at this time. There seems to be a lot of hype and enthusiasm for PrEP but I suspect our discussions about it and the gay community’s growing dependence on prescription drug treatments isn’t and shouldn’t be over.

3 Comments

  1. Mike says:

    I came out in ’86, and Jim I think I have the same (not so distant) historical perspective as you. I agree with you 100%, especially about the attitudes of younger guys and the role of the pharma industry in this issue. The whole PrEP thing bears alot more study, consideration and discussion. In the meantime, if guys want to use it, and do in fact use it in the prescribed manner, at least they’re doing something. Everyone has to make their own choices, and sometimes I wonder “why not take the drug AND wrap it up too just be to double certain?”.

  2. John in Louisville says:

    PreP can cost upwards of $13,000…it can cause osteoporosis..it won’t prevent mainline STDs like syphilis…neither will it prevent any new viruses that might come along.
    Condoms are the way to go…or if you’re like me: mutual masturbation is fun with very low STD risks.

  3. Jesse says:

    It’s fine for a stop gap, I guess, as long as those prescribed it understand that the efficacy is immediately cut when missing even a single dose, but that seems unlikely. The studies which cite high numbers usually point out that PrEP is to be used in conjunction w/ condoms, not as a sole means of protection. Targeting younger people isn’t too strange, considering the stats concerning HIV infections among young people ( http://www.cdc.gov/nchhstp/newsroom/2012/Vital-Signs-PressRelease.html ), but I don’t understand at all the rise of unsafe behavior in the older population who lived while HIV/AIDS killed their friends and lovers.

    Being a cynic, I sometimes feel like a population dependent on such expensive medication suffers in some degree from pharmaceutical and financial slavery, and it is never acknowledged that the “livable condition” of HIV positivity is only livable while one can afford the medication, an increasingly precarious situation given the current health care crisis in this country.