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Not Being on PrEP Is Making It Harder for Me to Get Laid

Thanks to PrEP, the pill that prevents HIV infection, guys like me who still use condoms are finding it a bit harder to bone.

by Brian Moylan
Nov 3 2016, 5:00pm

Illustration by Stephanie Santillan

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Last summer, I picked up a gentleman on Fire Island. We retired back to his place for a makeout sesh and found ourselves naked, with him straddling me, when out of the blue he sat right down on my dick without a condom. "Excuse me!" I said as I wriggled out of his orifice.

"Oh, it's OK," he said. "I'm on PrEP." Of course, my trick meant Pre-Exposure Prophilaxsys, a daily dose of the HIV medication Truvada that prevents the virus from taking hold inside someone who is not yet infected. It's like gay birth control, and though it's only been prescribed to around 80,000 people (and counting!) since coming on the market in 2012, the drug has become popular enough in certain gay circles to begin changing the culture of how men have and negotiate sex.

I am not, however, among those 80,000 men, so I told my summer lover that I don't have anal sex without condoms. That activity off the table, we returned to our regularly scheduled slap and tickle—minus going all the way. If it wasn't going to be bare, he wasn't interested.

I've had several similar experiences over the past couple years when talking to guys on hookup apps like Grindr or Scruff: I'll be on the verge of an invite to someone's house until they ask me my HIV status. "Neg and only play safe," I always reply. It's sometimes met with either stony silence or the abyss of being blocked by them on the app forever.

Of course, this doesn't happen every time I try to get laid; a good number of guys are still fine with using condoms. But it's something I've been seeing more lately—and I'm not the only one. My friend Tim* told me he was recently arranging an assignation with a guy who said, "I'll come over as long as you have condoms," quickly followed up with a "JK. LOL. [Three crying so hard he's laughing emoji]." In less than a generation, condoms have gone from an imperative, socially policed by the gay community at-large, to a punch line for some.

A study released by the Centers for Disease Control (CDC) this July found that condom use, particularly among young gay men, is on the wane. It found that in 2005, 28.7 percent of HIV-negative men who have sex with men (MSM) were having condomless sex, whereas in 2014 the number was 40.5 percent.

Anecdotal evidence backs this up. My friend Joe* was at a sex party in Provincetown last summer when he asked the host for a condom. His request was met with a look of surprise; he was told that the guys at the party were all on PrEP, and while he helped my friend look for rubbers, he couldn't find any. Joe eventually left when he realized that no one there was interested in keeping it wrapped even if he did find a condom. The experience was one of the main reasons he decided to get on the drug himself. "The irony is that now, a year later, I'm one of those guys who thinks it's quaint when boys are still using condoms," he said.

Curtis,* a 32-year-old gay guy in New Jersey, was chatting with a dude on Grindr who said he was on PrEP and preferred bareback sex. Curtis told the guy he's not on PrEP and preferred to use condoms. Not only did this potential suitor decline to meet up, he also gave him a stern lecture about how all gay men should be on PrEP, like some sort of Truvada proselytizer. "I'll take a lecture on curing the world of HIV when you use a condom 100 percent of the time—and you're on PrEP," he told me.

He was alluding to the fact that PrEP doesn't protect against any sexually transmitted infections aside from HIV. It's not surprising, then, that STIs are on the rise among gay men: On October 19, the CDC released its 2015 STD Surveillance Report, which found that total combined cases of chlamydia, gonorrhea, and syphilis reported last year reached their highest level in history; from 2014 to 2015, those STDs respectively saw a 5.9, 12.8, and 19 percent increase in reported cases. Gay and bi men, they said, accounted for the majority of new gonorrhea and syphilis cases. What's worse, antibiotic resistance means that untreatable strains of all three are a looming threat. (That said, correlation doesn't make causation; it's possible these STDs were lurking all along, and we've just got better testing for them now.)

Demetre Daskalakis, assistant commissioner for the bureau of HIV/AIDS prevention and control for the New York City Department of Health, echoed that point. He emphasized that when men are on PrEP, the CDC recommends they be screened for HIV and other STIs every three months, in order to obtain prescription refills. "We're making a method of STD control that we've never had before," he said. He and other health experts anticipate that catching STIs and treating them early should lead to fewer transmissions of and better sexual health for gay men across the board.

He also agreed that people who are on PrEP are more adamant about their desire not to use condoms when hooking up, but doesn't see it as a stigma against condoms so much as men just expressing their sexual preferences. He likened it to a guy stating in his online profile that he likes hairy guys and choosing not to have sex with someone if he's not hairy enough.

What's more, this July's CDC study on condom use noted that the decline can't be explained by the rise of HIV treatment, serosorting, or seropositioning (choosing sexual partners or activities based on HIV status), nor by PrEP use, which it noted is still relatively uncommon among MSM at large. PrEP isn't the reason people aren't using condoms—they weren't using them in the first place.

Daskalakis still advocates for PrEP and a condom as the gold standard of disease prevention, but recognizes that might not always be practical or realistic. That means it's a lot more complicated today for two men to negotiate sex with each other. Like everything about getting it on, the key is open communication and trying not to judge other people for their choices.

The bottom line is that there are more ways to define "safe" than ever before—but with some tolerance, respect, and a bit of communication that involves something other than well-placed grunts, we should all be able to get laid while staying both happy and healthy.

*Names have been changed.

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