‘New York’ Magazine looks at Prep, Sex and Fear


New York Magazine has published a lengthy exploration into the current conversation surrounding Truvada, pre-exposure prophylaxis (PrEP), and the gay male relationship to sex itself.

107091581truvadacropFor some, like Jacobs, the advent of this drug is nothing short of miraculous, freeing bodies and minds. For doctors, public-health officials, and politicians, it is a highly promising tool for stopping the spread of HIV. Other gay men worry that the very existence of such a drug is a kind of betrayal: of those who’ve died in the epidemic; of fealty to the condom, an object alternately evoking fear and resilience, hot sex and safe-sex fatigue; and of a mind-set of sexual prudence that has governed gay-male life since the early ’80s.

Tenofovir and emtricitabine, the two antiretrovirals that make up Truvada, are both featured on the World Health Organization’s List of Essential Medicines, a guide detailing drugs absolutely necessary for a fully functioning healthcare system. Earlier this week the WHO made public its support for the use of Truvada as PrEP, a decision met with equal amounts of support and vitriol. The divide, as Tim Murphy describes it in New York Magazine, is often generational in nature.

The idea of prep can be especially fraught for older gay men, particularly HIV-positive ones. Larry Kramer, now 79, in poor health and HIV-positive since the 1980s, has been the most prominent voice projecting contempt and bafflement: “Anybody who voluntarily takes an antiviral every day has got to have rocks in their heads. There’s something to me cowardly about taking Truvada instead of using a condom. You’re taking a drug that is poison to you, and it has lessened your energy to fight, to get involved, to do anything.”

Reasoning behind arguments against the use of Truvada as PrEP range from claims that the drug encourages high-risk behavior to worries that drug-resistant strains of HIV will flourish should users not take the drug properly. Many of the initial concerns about Truvada’s side effects have been proven false, but only time will provide a more well rounded picture of the drug’s effects on users in the long term.

Watch the New York Times’s Truvada explainer AFTER THE JUMP



  1. TampaZeke says

    Please don’t be so dismissive of the side effects. I hold a doctorate in pharmacology and I can assure you that in the next 10 years we will be hearing of horrible, irreversible and often deadly side effects. It’s the nature of anti-viral intervention drugs. Some of the people who take this drug long term will end up wishing that they had just contracted AIDS instead. The World Health Organization recommendation is extremely troubling to me. It REEKS of Big Pharma!

  2. MB says

    Parts of this article left me wanting to pull my hair out. I don’t have a problem with people using Truvada this way…if it works, great. I’m sure it could help. It’s wouldn’t be my personal choice but who cares about that. However, all of the “I deserve this” and “why should I have to worry about getting HIV” is infuriating. What’s with all the entitlement? I’m sorry you have to wear a condom but that’s just the way it is! That’s the reality we live with…everyone. What’s the complaint going to be next? “I shouldn’t have to worry about taking two pills at once so they should really package truvada and molly together. I have a lot on my plate.” Get a f**king grip!

  3. Qj201 says

    Well the pundits and talking heads can give spin all they want. Every hookup site and app has plenty of profiles of negative bottoms on PrEP looking for bareback.

  4. crispy says

    Oooh, someone pass the popcorn. It’s about to get good up in here.

    The truth is, like most controversial issues, everybody is a little bit right, from the millennials who want to give up condoms to doctors and health experts to oldsters like Larry Kramer. But no one ever wants to consider the middle ground.

  5. Jack M says

    Larry Kramer is absolutely right. Why put drugs into your system if you don’t have to? Big Pharma rules the nation, it seems. Prescription drugs are not the answer to everything.

  6. Marlon Manroe says

    To each their own, but I’m definitely in the camp that would rather wait and watch the newly discovered side effects emerge within the next decade instead of jumping to take a drug like this.

    Sadly, I know of several cases of people who started taking other medications (not related to this), then develop side effects and then start taking more medications to deal with the side effects from the previous ones. One family member is now taking about 15-20 meds due to this. Oy.

    I’ve heard several people talk about using this with condoms but the majority of people I know would NOT use this med in conjunction with condoms but INSTEAD of them.

  7. John says

    And there is no forgetting the cost. I know folks who are expected to shell out $650 for the co-pay for the drugs. That is if they have health insurance at all. And Medicare drug plans don’t cover AIDS meds at all.

  8. Rick says

    I am going to say this as a member of the older generation (I am 56) that was most devastated by AIDS.

    Sex with a condom sucks. It just does. Latex was not meant to be part of human sexual experience and having to use a rubber destroys the mood and spontaneity. I used them when there was no alternative, but I hated them.

    So you cannot really blame some people for seeking other options, even if there is risk attached to them….what is the point of life if you cannot enjoy it to the fullest?

    I don’t think it is ever a good idea to put too many drugs of any kind into your body, but there are trade-offs in every life decision and this is a good example of that…with there being no “right” answer.

  9. Tom Smith says

    Haven’t looked yet but my guess it will take 4 paragraphs before you see a quote by Kenneth Mayer – a man who loves to promote himself around this subject when he hasn’t really accomplished much of significance. It’s all smoke and mirrors.

  10. Michael Sawyer says

    I am seeing most enthusiasm from the youth who did not have to witness, first, the horror of people dying from AIDS and then, second, the horror of side effects of HIV medication.

    Till then, I will save my insurance premiums $12,000 a year, wear a condom, and not hook up when drunk and maintain my negative status thank you very much.

  11. Tyler says

    Wait wait wait: Rick, the person who constantly lectures (and shames) the other commenters on this site about the “inherent” promiscuity of gay men, and how gay men deserve HIV and AIDS because of it, is now suddenly sex-positive? Is it opposite day?

  12. Sam says

    I wouldn’t take Truvada just for the cost alone. A condom may be less pleasurable but it’s much safer and cheaper.

    Yes most of these guys will not read about the side-effects. Wouldn’t be surprised if they had to sign an affidavit to get the medication that won’t sue Big Pharma for the side effects.

  13. andy says

    Considering some of the biggest indicators of risk are education and poverty, just imagine what $1300 a month could do for them! No one would even consider allotting that amount for 30 years now. Now big pharma has a magic pill that you still have to use condoms with and for serodischordant couples where the poz is undetectable, is unnecessary and all of the sudden insurance and medicaid is covering it. Can I opt out and get my $1300 in cash please?

  14. ATLJason says

    I’m 40, have been HIV+ since I was 26, and have been taking medication since 2004. I don’t remmeber exactly when Truvada came out but I’ve been taking it since the very beginning. In fact, I was taking the two drugs that make it up separately before Truvada came along and made them available in one pill. I HAVE NO SIDE EFFECTS. None. Zero. Zip. I’m not saying that NO ONE will ever have any side effects, but I sure don’t and I think the side-effect hysteria is quite a bit overblown. Tylenol has potential side effects too but no one ever suggests you shouldn’t take it for a headache.

  15. Brandon H says

    Why is everyone jumping to the conclusion that everyone will take this for the rest of their life? There could be a new better alternative in a couple of years. And most people only have sexually active periods of their lives. You can go off the medication if you aren’t having sex (believe it or not, some gay men go without sex for extended periods by choice!) It’s why people who take PrEP are checked every 3 months, first sign of serious side effect they are pulled off the medication. I’m all for healthy skepticism about PrEP but ya’ll are just sewing FUD and moralizing.

  16. TampaZeke says

    “Tylenol has potential side effects”.

    If there is one sentence that was created and promoted by Big Pharma, THAT’S THE ONE. And it has succeeded beyond their wildest dreams in achieving exactly what they hoped it would.

  17. Pookie says

    If you believe PrEP is some sort of miracle drug, and find using it “liberating”, you’re an idiot that shouldn’t be having sex in the first place.

    If using a condom is too much of a hassle or effort for you, you likewise are an idiot that shouldn’t behaving sex.

    I’m all for open discussions about these issues. Let the morons that nobody should be having sex with reveal themselves.

    If you don’t respect yourself or the people you have sex with, why are you so shocked the only people who want to have sex with you are just like you ?

  18. Texan says

    This is NOT the friggin’ Pill that’s been around for decades. Pharma is more concerned with $ than your health. If no long-term side effects and taken EVERY day, great for both parties. However, say a large member of users get sick off this crap, there will be a class action and the pill-poppers will get some worthless money and STILL be sick. This is not without precedent in other illnesses where there’s a rush to a gold mine and no one gives a damn who gets hurt afterwards. Trust me, some portion of the profits are going into a legal reserve fund on the accounting books so the company can already consider a future payout as you suffer 20 years hence. All because folks don’t want to wear a rubber.