Monday, November 9, 2009

On the Biomedical Question - Are We Set for PrEP?

Charles Stephens wonders what oral prevention and rectal microbicides might mean for prevention and pleasure, risk and taboo.

Condom-centric HIV prevention created the “cum pig.” No one back then in the 80s, could have known that, but here we are. 

There has been a considerable amount of discussion, debate, and exploration around the scientific and ethical implications of biomedical HIV prevention. This I believe has been useful. However, moving forward, it’s imperative that we consider the implications such advances might have for our community and sexual practices for gay men.

So far, especially as it relates to PrEP (pre-exposure prophylaxis, or oral prevention), I’ve mostly heard things like “it will just mean more gay men will have sex without condoms.” And usually, I’m the one in the room that says, “maybe that’s not a bad thing.”

These discussions are important, even if they are limited and frustrating, because we have to think ahead. We have to imagine how these shifts in prevention technologies and strategies today, will influence our sexual practices, inform our identities, and shape our communities tomorrow.

Essentially, we have to question what these advances will mean for the future of gay men. How rectal microbicides, for example, might influence how we as gay men experience anal sex. How we think about anal sex. And how the potential meanings we attach to both anal sex and our anuses will evolve, along with our sexual landscapes and fantasies. The strategies we develop around prevention, can’t only be for the present, but also for the future.

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The condom-centric approach to gay men’s HIV prevention, influenced the rise of barebacking, if not created it. Condom-centric HIV prevention created the “cum pig.” No one back then in the 80s, could have known that, but here we are.

Certainly “raw” sex has always existed, and the exchange of bodily fluids, and so forth. There can be books and books on top of books written about gay men and their relationship to semen. The meanings they attach to it. Hell, classic gay porn is as much historical documentation as entertainment.

But as our semen started to be seen as lethal and deadly, in the HIV prevention discourse, and the centralization of the condom, the taboo was created. A taboo that created heightened awareness and eroticization of cum. Essex Hemphill’s poem “Now We Think,” comes to mind.

These days individual identities and tribal affinities seem to be increasingly informed by one’s desire to bareback or not. A proliferation of new identities and personas have emerged around the decision to go it raw or not. More consequences of early and arguably current prevention strategies. Of course no one imagined that telling people to use condoms in the 80s would later mean J.C. Carter giving his brilliantly raunchy performance in Nasty Men in the 2000s.

And we certainly cannot look into a crystal ball and see what the introduction of biomedical prevention strategies will mean for gay men’s sexuality 50 years from now. But that does not mean we should not try. And not only in the context of more virus or less virus. But also the types of communities and affinity groups that might be created, the kinds of identities that might be formed, the new sexual practices and categories that might arise. All through biomedical prevention.

I make this point, not to suggest we should build some time machine and go back to the past to prevent the eroticization of semen and the development around condom-less sex as a taboo. Nor do I raise these points as a cautionary tale. What I hope that our reading of the past will do is show that our communities are dynamic, that pleasure is complex, and that there are always unintended results of our efforts.

With our best intentions, and our best efforts to control behavior, we have opened up a Pandora’s Box of pleasures, desires and practices we did not imagine. And as we inject biomedical science deeper into prevention, we have to be prepared for the litany of meanings and practices that will be opened up. This is not to condemn or encourage barebacking or any other kind of sex, nor prevent it. Rather to understand and better grasp the slippery terrain of desire, the complexities of sex, and the resilience of pleasure, to ensure that gay men’s health strategies can keep up with our ever evolving sexual cultures.


  1. God, I hope PrEP doesn't become widespread. The concept that gay men need to be on powerful, dangerous medication even if they're not sick is the ultimate "sex is bad" message. I truly hope the efforts to popularize PrEP fall on completely deaf ears.

    I'd rather see gay guys infected with harmless forms of HIV like they're doing with people with Lorenzo's Oil Disease which can fight off other forms of HIV.

  2. Last night, I re-watched an old American Experience episode entitled "The Pill." I highly recommend it as food for thought.

  3. There is room for discussion about these potential new HIV prevention methods and their impact. The question is what impact are we talking about? Are we talking about their impact on how gay men think about their anuses? Or are we talking about how these interventions will impact on an epidemic for which there is still no treatment, for which there is still people who don’t know they are infected and still people who don’t have access to treatment?

  4. AMEN to what perpheries has commented. Those of us who are sceptical about PrEP or other biomedical prevention interventions seem to get labeled automatically as "sex negative" or crotchedly luddites or something. It's not unreasonable to question the benefits of these new technologies (which aren't even a reality yet) given the stark situation of haves and have-nots in this epidemic. If PrEP works and is a viable reality, are the people who need it most going to be given access to it or will it become a tool for the more well-off?


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