A thought for my fellow gay men: It is 100% OK that so many of us want to have bareback sex.
Even when the risk of complications due to sex is not zero (and when can we really ever guarantee that the risks related to any activity are zero), it is completely, 100% OK that we have the desire to bareback. The decision to have bareback sex has never meant that we are stupid, irresponsible, or immoral — it did not mean that in the pre-PrEP [pre-exposure prophylaxis], pre-TasP [treatment as prevention] (undetectable) era, and it certainly does not mean that now. It means that we are human and that it is tremendously challenging (and sometimes impossible) to change our sexual desires and practices.
It is a bummer that the first case of PrEP failure has been found in someone who was being adherent to Truvada — and very sad for that individual that they have acquired HIV. For some HIV-negative gay men, this single case will be enough to dust off the condoms and try to adhere to them again — and that is totally fine. Condoms are easier for some of us, and/or some of us have a very low tolerance for risk when it comes to our sex lives. The decision to use condoms is 100% OK.
For other HIV-negative gay men, this will still seem like a very remote risk, and they will continue to rely on PrEP as their sole HIV prevention method — and that is also 100% OK. We are not designed to all be the same — we all have different perceptions and different backgrounds. For some of us it is easy to use condoms, and for some of us it is nearly impossible. It’s all OK, and I hope that we can accept our variations and our diverse approaches to having sex.
What is disheartening within the current HIV prevention movement is seeing just how much we still feel the need to police each others’ bodies and our sex lives. We have PrEP-nazis and condom-nazis — people both inside and outside of our communities who go well beyond offering information and advice and instead move into coercion and manipulation in an effort to get gay men to have the kind of sex that we deem appropriate for them. We frequently do not honor individual choice and empowerment, and it sets the stage for the often bitter, shaming, and defensive debates that we continue to have around PrEP, TasP, and condoms.
As we individually and communally weigh all of the information that we have received over the past five years about TasP and PrEP, I hope that we can accept, respect, and honor each others’ sexual decisions as we individually interpret what we’ve learned and conduct our own cost/benefit analyses of condomless sex.
Even more importantly, I hope that we can each learn to shamelessly and confidently own our decisions to use or not use condoms without feeling that we must defend our choices at every turn, without feeling gripped with fear and shame each time a report comes out saying that nothing in HIV prevention is perfect.
We are all doing the best we can with the information we have — we are not stupid, we are not immoral, and we are not irresponsible.