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So, while PEP is now standard practice, rapid oral HIV home-testing is scheduled to be available in October of this year, and condoms remain the centerpiece of HIV prevention programs for gay men, it is absolutely no surprise that the approval of Truvada for pre-exposure prophylaxis (PrEP) would cause an uproar in the prevention community.
To cut to the chase, I’m all for it. An expensive pharmaceutical isn’t going to replace frontline prevention efforts, especially when our government can’t even adequately fund AIDS Drug Assistance Programs (ADAPs) for people with HIV. But it should be welcomed as the first step on a new prevention path, not a miracle pill to solve all prevention problems.
More importantly, I want the availability of PrEP to force gay men to have more honest discussions about sex and HIV and condoms. We know that it’s the rare man indeed who uses a condom every time for a lifetime, from first sex act to the last — I know I haven’t. We know that many gay men, single or partnered, actively choose not to use condoms — we just don’t like to talk about it, aside from shaming or tsk-tsking.
No matter how important or effective condoms are to prevention — and so many gay men, myself included, are alive today because of them — we can’t pretend that we have just one path. We’re at a point in the history of HIV where we can’t avoid these conversations about the complex and independent choices gay men make when they have sex. It’s time to start talking.