THOUGHTS ABOUT PrEP AND WHY IT ISN’T THE ANSWER (YET)
So, there’s this thing that everyone is really excited about called PrEP (Pre-Exposure Prophylaxis), which is an HIV prevention treatment that consists of taking Truvada, an HIV treatment med. It’s really exciting, right? You could just take a…
I read Morgan’s article with interest, for several reasons:
1) I am queer and live in New York City, where I have many friends who are HIV+, sex workers, or both; as well as having many friends who are at risk for contracting HIV
2) As an HIV activist who has volunteered at organizations like ACT-UP NYC, the Sylvia Rivera Law Project, Gay Men’s Health Crisis and SAGE (Services and Advocacy for Gay Elders), these issues are very much being discussed among our constituencies, and
3) I like Morgan, consider her a personal friend, and am very interested in her ideas.
However, I take a different view than some of the opinions expressed in her article. Namely.
The jury is still out as to whether the consequences of non-adherence to and long-term use of PrEP are quite as dire as Morgan has characterized them. Truvada is already a medication used for the long-term treatment and management of HIV. It keeps viral loads down, which reduces the over-excitation of the body’s immune response, which it is hoped will prevent many of the inflammation diseases (dementia, heart disease) endemic to people who have been living with HIV/AIDS for a very long time (including seniors.) Truvada is a very good drug. And, of all the HIV drugs on the market, it has the lowest measured side-effect profile.
Many people living with HIV take Truvada every day. The official literature says that it requires 99% adherence (meaning, you can only skip one dose about every three months), but in clinical practice — ask any doctor who has many HIV+ clients, and they will tell you that this drug is more forgiving than its labeling would indicate. It is my suspicion that the extreme adherence requirements expressed on the drug’s labeling are a way of covering Gilead (the maker of the drug in the US)’s ass.
Speaking of which, it’s true: the price of HIV drugs are outrageous. But, they don’t have to be. In India and Thailand, for example, the public health ministries of these countries refused to issue patents for certain HIV drugs, citing their high cost and inaccessibility for their citizens. It is our job as activists to demand fair access to these drugs. A wise activist once taught me this fundamental rule of social change: ain’t nobody gonna give you nothin’ if you don’t ask for it.
Also, Morgan’s point about sex workers’ clients expecting them to be on PrEP and thus being more adept to demand unprotected sex is a valid one, especially for street-based sex workers. However, in my experience, I am not so sure this bears out in practice? A casual glance at Backpages.com lists dozens (if not hundreds) of girls advertising BBBJs and “no condoms needed.”
Morgan makes another good point in her article, too: THE COMPARISON TO PrEP TO BIRTH CONTROL IS AN APT ONE, but I’d like to explore this analogy a little further…
Lots of people fuck up taking all kinds of meds. I, myself, was conceived while my mother forgot to take the pill for a few days. It should also be considered that combined oral contraceptive pills were only legalized in the United States in 1960, and during that time, they contained a much higher dose of hormones than they do today — it was a matter of (frankly, unethical) experimental titration for toxicity that left many women with reproductive health issues for the rest of their lives. I have suspected that the higher doses of hormones used in the early days of the pill may have contributed to my own mother’s reproductive health issues later in life; and yet, using the pill gave her control over her own reproductive choices, which allowed her to graduate from college (despite being married at age 15), greatly increasing her socioeconomic life chances. Many life choices require risk evaluation. Sometimes, it’s a trade-off.
(It should also be noted that prior to 1960, these experiments were conducted in Puerto Rico in inhumane conditions that left many women permanently sterilized.)
The march of progress for allopathic medicine has at times been a long and cruel one, and has claimed many bodies, lives, and spirits. And yet, today, birth control has given women control over their bodies and the ability to plan their families in a way never before imagined in human history. And sure, people still fuck up! My mom, of course, being a perfect example, but then, had she not, I probably would not be writing this article. (And hey, depending on what research you chose to believe, were she not all pumped up with these exogenous neonatal estrogens, I might not even be trans. And wouldn’t that be a shame!)
And — this is the point on which I feel most passionately — though perhaps the long-term health consequences of PrEP are unknown, you know what is quite well known? The long-term health consequences of living with HIV/AIDS. If these can be prevented in any way, I say, go for it.
When I was at the Lambda Literary Retreat this summer, I spoke with a brilliant young queer femme queen of color who was debating going on PrEP. In the city where he lived, it was free. Though I am excited about the possibilities of PrEP and encouraged him to explore its possibilities, there’s certainly no way I can say what the right choice for him is.
At the end of the day, though, I’m glad the choice is his to make.
This year PosterVirus struggled to find its footing. We looked critically at ourselves. We aim to understand our own limitations. How can we challenge the logic of the AIDS industry? What can art posters change? What do people care about in the AIDS response? In a movement divided by identity…
Read. Feel. Question. Read. Act. Action. Feel. Work. Love.
Ted Kerr and Chris Jones
This poster was inspired by the work and lived experience of Chaplain Jones, a black HIV-positive Baptist minister and activist, who is passionate about raising awareness around the lived experience of black and brown men who have sex with others men and their disproportionate rate of HIV infection in the West, which rivals infection rates in third world countries.
The burning condom, (and litany text), are shared by Jones, and collaborator Ted Kerr, with the intention of igniting public discourse around the condom. Since the Sisters of Perpetual Indulgence (Play Fair, 1982) and Richard Berkowitz and Michael Callen (How to Have Sex in an Epidemic, 1983) first popularized the use of condoms as an AIDS prevention strategy there has been little public discourse around the holistic impact of condoms on the lives the latex barrier is said to be saving. In an age where condoms are—for some—a loaded symbol of “AIDS Inc” and the systemic discrimination leveled against profiled and monitored bodies, and at a time pharmaceutical interventions such as PEP and PrEP are seemingly reducing the need for condoms, what is one to make of the rubber?
Key to this conversation are the various understandings and attachments people have to condoms, often related to age, life chances, race, orientation, faith, gender and class.
The burning condom is the fire around which we can gather, listen and discuss.
Litany for Burning Condoms
Chaplin Christopher Jones and Ted Kerr
It’s hard to stay silent when faced with burning condoms.
We burn condoms to say we are whole.
We burn condoms to say we matter.
We burn condoms to remember.
We burn condoms to say that public health does not have all the answers.
We burn condoms to exercise our voice and power of choice.
We burn condoms to merge the secular with the spiritual.
We burn condoms to influence thought and change.
We burn condoms because they are not enough.
We burn condoms because they are too much.
We burn condoms because the kids want more.
We burn condoms because sex is not just penetrative.
We burn condoms because they do not protect against stigma.
We burn condoms because they add to stigma.
We burn condoms because they are not they only answer.
We burn condoms because they are distributed in our name.
We burn condoms because we believe in harm reduction.
We burn condoms because we know it is complex.
We burn condoms because it’s a primordial act.
We burn condoms because we know they save lives but they also erase them.
We burn condoms because if you are going to give me something free make it health care education or a place to live.
We burn condoms because by 2015 approximately 27 billion condoms will be distributed across the globe bringing 6 billion dollars to the condoms industry.
We burn condoms because if you are going to pass me something pass mean end to racism sexism gender roles homo and heteronomativity transphobia profiling and policing.
We burn condoms for those unheard & populations underserved.
We burn condoms for the good & the bad and the light & the shade & the dark.
We burn condoms in the age of the Global AIDS Industrial Complex.
We burn condoms in our friend ’s backyard.
We burn condoms as two men living together on the HIV spectrum.
We burn condoms as a ritual which can be activism.
We burn condoms like a draft card for a war we didn‘t sign up for.
It’s hard to burn condoms. It takes time, partnership, and patience.
It’s dangerous, stinky, challenging, beautiful and shocking.
It’s life giving.
What ‘s your response when faced with burning condoms?
YOUR NOSTALGIA IS KILLING ME
Vincent Chevalier with Ian Bradley-Perrin
“Strictly speaking, nostalgia does not entail the exercise of memory at all, since the past it idealizes stands outside time, frozen in unchanging perfection. Memory too may idealize the past, but not in order to condemn the present. It draws hope and comfort from the past in order to enrich the present and to face what comes…”
In the slight of hand that weaves the short and long memories of our community with the artifacts that remain and the work we do to alter our near future into our present sense of the blurred lines of our “community,” let us not drop the adaptability that we have always used to keep up with the virus that adapts so well to us. It is not the remembering and it is neither the history, nor the material culture nor the valorization of the battles won and lost that impedes our movement forward, but rather the unpinning of our past from the circumstances from which the fights were born. It is this that makes light of the impetus to resist; the gentrification of our memories and our worshipping of idols whose miracles are forgotten.
Silence=Death but the white noise humming from your latest post is keeping me up at night. Flying in two dimensions, scrolling through virtual space, virtual time, random access memories referencing deep memory held in those you find inaccessible; beneath the porch light we’ve all been circling. Do not let the dregs of our history be your horse blinders as you move through today’s world because things are different now as they were different then. Allow the history to be real and tethered to a time and place and reason such that the output is responding to today and is ready for tomorrow. Let the past sleep some such that it can be more present the choices you make on reality, not the reality itself. “Nothing’s lost forever. In this world, there is a kind of painful progress. Longing for what we’ve left behind and dreaming ahead. At least I think that’s so.”
"You are lucky to live sad moments." - Louis C.K.
Ted Kerr delivering a speech at The New School for Public Engagement Graduation Ceremony 2013