Editor's Note: Guest blogger Damon L. Jacobs is a licensed psychotherapist and author in New York City. You can find out more about his unique approaches to health and wellness by visiting www.DamonLJacobs.com.
The World Health Organization's recommendation that HIV-negative gay men consider using PrEP has set off another dramatic maelstrom of controversy in the HIV prevention world. Immediately, these new guidelines were distorted in media articles claiming all gay men "should" get on medications. My PrEP Facts Facebook Group immediately filled up with angry debates about who "should" take PrEP, who "should not," whether it's 92% or 99% effective, the evils of Big Pharma, upsets that PrEP doesn't solve global warming or world hunger, and a general tone of hostility and attack.
All I could do was hopelessly witness the shredding and think to myself, "All this arguing about butt sex? If only they knew what it meant to be HIV-negative and have sex without fear."
My own "spring awakening" popped wide open in the summer of 1985, much thanks to the incredible slew of hairy hunks on NBC's daytime lineup. From Bo Brady to Perry Hutchins to Ted Capwell, there was no shortage of troubled scruffy heroes who somehow found themselves in various states of unclothed mayhem. At age 14, I started becoming aware of my impulse to be underneath all that fur and muscle, and conscious of my urges to do something about it.
However, in the midst of being ensconced in these soap worlds, a real-life drama was playing out on the news. Rock Hudson, whom I was familiar with more for his work on Dynasty then from his rich movie career, was being talked about everywhere after coming out as having AIDS. Nearly every network seemed to find it necessary to contrast the images of a young, healthy, vibrant Hudson with the gaunt, ill, and frail man whose body was ravished by the cruel disease.
It became very clear to me at this vulnerable moment that sexual impulses led to illness and death, and if I acted on my desires, that would be me someday.
By the late 1980s, it was clear that consistent use of condoms could prevent HIV transmission. Continuing to take my life cues from fictional characters, I heeded Glenn Close's advice in Dangerous Liaisons:
"I'm saying, you stupid little girl, that provided you take a few elementary precautions you can do it or not as often as you like, with as many different men as you like, in as many different ways as you like."
With that sage wisdom, I grabbed my scores of condoms and went off to San Francisco for some experimenting. It wasn't long before I found some daytime-worthy hunks who wanted to share their bodies and skills with someone new, unpracticed, and curious. It was during this time that I learned the art and thrill of bottoming -- of taking another man inside me, sensing stimulation inside the butt and feeling the bliss of having sex.
However, no matter how good it felt, no matter how satisfying the experience, I couldn't subtract the terror of believing that pleasure would ultimately kill me like Rock Hudson. Although my partners -- both HIV-positive and identified-negative -- used condoms in every encounter back then, I still lived from HIV test to HIV test in complete and utter fear that something went wrong and I would be next.
Every cough, every sore throat, every fever and every night sweat was accompanied by the paralyzing thought, "This is it, I'm seroconverting." I lost sleep, I lost concentration and I lost time worrying.
Although the release of the new anti-retroviral medications in 1996 became a medical game-changer, the early years were not without complications and drawbacks. Many had severe physical and psychological side effects, and it was not unusual for those working at San Francisco General Hospital to see admissions for Sustiva-related psychoses.
We still did not fully understand in the 1990s how effective the new meds would be at expanding the quality and quantity of life for so many. My sex life remained filled with the troublesome juxtaposition of gratifying bottoming and wearisome dread. At the same time, my partners' willingness to use condoms, and my willingness to get fucked without condoms, were steadily in decline.
After twenty years of coping with the never-ending juggling of pleasure and panic, a news story caught my attention: on November 24, 2010, the initial results of the iPrex study were released, which revealed that a medication called Truvada could reduce risk of HIV transmission by 44%. Initially, that number was not impressive to me. I didn't think less than half would be enough to assuage my fears.
But six months later, GMHC held a forum in New York City where it was explained that people who took Truvada daily had a protection of 92% or greater. I took that information to my doctor, explained why I thought this could be an ideal way of reducing HIV risk, and began using this medication for PrEP on July 19, 2011.
To be completely honest, my fears were not immediately allayed. The FDA hadn't yet approved Truvada as PrEP, and I had my own disbeliefs that a pill could actually prevent me from becoming HIV-positive. I still carried the burdensome angst that PrEP was too good to be true and HIV was sure to be the result of enjoying bottoming without condoms.
I remember thinking, "How could HIV risk have shifted diametrically without it being on the front page of the New York Times? How could any of this be for real?"
Then toward the end of 2012, I was having sex with an HIV-positive friend who was going through his own transformation of living without fear of infecting others, due to the new understandings of Treatment as Prevention (TasP) and PrEP. As he climaxed, I felt not only his body collapse but also his spirit shudder with complete and total abandonment, as his voice shrieked with involuntary screams, and he pressed against me.
It was there and then I had the breakthrough: "I'm no longer afraid of this."
It was like something shifted in the time-space continuum, like a boulder of doubts and knots and chest-pressing weights were lifted. I enjoyed sex. I enjoyed pleasure. And there was not a single shred of fear inside me. Just my partners' love, sans condom.
So now, when I see people arguing about charts and data and graphs and percentages, it seems rather bizarre. PrEP prevents HIV. PrEP invites pleasure. PrEP promotes intimacy. PrEP provides freedom.
There will be arguments along the way. There will be those who want to go back to 1985 and to frail images of Rock Hudson, to sleepless nights and to panicked, middle-of-the-night phone calls to friends. But those of us on PrEP are stepping up, with pride and integrity, about our right and responsibility to enjoy sex and end HIV transmissions. And we are not backing down.
Originally published by HIV Equal. Reprinted with permission.