Let’s Talk About PrEP: The Silence Of Gay Men On Truvada


In a lengthy piece at Out.com, Tim Murphy dives into the controversy and silence that pervades gay male culture about taking the HIV medication Truvada as a pre-exposure prophylaxis, or "PrEP." One of the people Tim interviewed, a doctor who is referred to anonymously as "Dr. John", said of the attitudes around the medication:

Gay men talking about not using condoms is really stigmatized. Most of us have never known sex without condoms or without threat of a ‘deadly disease.’ [But] I think it’s a lot to ask an entire generation of gay men to use condoms forever.

Despite being FDA-approved, 99% effective when taken as directed, and covered widely by health plans, comparatively few gay men are on the drug. Even though condoms are lauded as the ideal, studies have been taken since the 1980s that show that gay men as a whole consistently only use condoms about half the time, and the HIV transmission rates have increased by 22% in recent years. Jim Pickett of the AIDS Foundation of Chicago notes:

If condoms were so wonderful and a part of human nature, we wouldn’t have a problem with rising infections.

The biggest concerns seem to be that PrEP would provide a false sense of security and invite reckless barebacking, which is the stance of Los Angeles' AIDS Healthcare Foundation. A valid concern since though PrEP would dramatically reduce the likelihood of HIV transmission, it would do nothing against other forms of STDs such as Hep A-C, syphilis, and gonorrhea, the latter of which has started showing up in drug-resistant strains. 

What PrEP advocates and activists want men to understand is that the use of the drug is another tool in HIV prevention, not a panacea that will flawlessly protect people from everything. Said Darius Mooring, a 34-year-old bookkeeper in Pennsylvania:

If I go on PrEP, will I be condomless in all my sexual encounters? I don’t think so. But I’m not going to live in fairy tale where I tell myself I use condoms all the time. PrEP will be adding another strategy to my HIV prevention.

Previous Towleroad coverage of PrEP can be found here, here, here, and here