Enjoy your butt sex. And Truvada, too.

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READ MORE | Grindr wants to get you off (and maybe on PrEP)

If I was a top, I would never consider Truvada. But I’m not. So let’s talk about HIV and butt sex, Truvada and PrEP. But without any slut-shaming asshole telling you what you should do with your body.

First, though, a framing device about life with epilepsy.

Five or six years ago I was in the neurologist’s office over at Emory, and there was this big chart of 42 epilepsy medications. And for each one, there was a picture to show what it looked like, and what the major side effects were. The purpose of the chart was clear: You were picking the lesser of 42 evils.

Or really, the lesser of 43; you didn’t have to take drugs at all. I went that route for a long time, many years in fact. I didn’t mind not driving, avoiding open water, or the substantial risk that I might drop dead at any given moment. But then as things progressed, I lost the ability to read. That was the tipping point.

“FUCK IT!” I thought.

I still hated the pharmaceutical industry, I hated being medicated, I hated the side effects, I hated that big stupid fucking chart. I hated paying $7,000 a year.

But shit happens. I wanted to read again. I didn’t want to worry about dropping dead. I didn’t want to piss myself.

I wanted to drive. I wanted to be able to use bathtubs. Swim in lakes and rivers in West Virginia.

So fuck it.

I became married to the drugs. Twice a day, like clockwork. If I forgot them or lost them, I would suffer withdrawals (including seizures), so everywhere I went, I checked twice to make sure I had extra pills, or a pharmacy was nearby. And there were no guarantees. It would be two years before I could be confident using a bathtub without the fear that I would black out and drown (a fear that’s hard to just switch off, even when it’s no longer rational).

It was a tough decision, deciding to go on the drugs, and picking which ones, but it was mine to make. Only one of the neurologists got shitty with me about it; he pressured me about whether to take drugs and which one he liked the most, to which I said, “You’re not the one who has to deal with the side effects the rest of your life, asshole.”

Truvada: A decision not a debate

When I chewed on the question of anticonvulsants, I didn’t have a thousand chiming Facebook voices about the merits of the drugs, the side effects, whether I could afford it, whether I could be trusted to take something twice a day, whether the doctor would know to check my liver every six months, whether I would endanger others or myself, whether it would work.

It was just me, and the chart, and the doctor more or less waiting for me to decide what I wanted. Well except for that one doctor, who I fired.

Compare this to the PrEP/Truvada “debate.” Why do we tolerate such public scrutiny of a personal medical decision? Why do we even allow a debate?

Epilepsy drugs are just as expensive, don’t work as well, have way more side effects, and are way more annoying to take than Truvada. The penalty for forgetting them is severe. Getting off of them is hard, a months-long process.

But no one ever judged me for that decision. I don’t remember any stern looks about Depakote or Keppra.

Epileptics are, of course, very much closeted for this reason – there’s roughly as many epileptics as there are gay people, and we usually hide it, partly out of anxiety that we’ll be the next victims of a fickle public potentially willing to become experts in our condition and arbiters of our decisions.

Let’s get back to HIV and butt sex. I would probably qualify as your safer than average homosexual bottom. Of the boyfriends I had condom-free rampant butt sex with, we talked a lot about monogamy and got HIV tests together and we were all very kosher and open about it.

I’ve never gone bareback in the “heat of the moment,” as most of my friends have, but I’ve had several condoms break. I’ve had condoms break and not realized until after everything was over that the condom had broken. (Hopefully, I don’t need to spell out what that means).

I have never, not once, used a condom for oral sex. I don’t have any friends who do. Giving, receiving, never.

I would say, every few weeks someone I know tells me they’re positive. Much of my gay social circle is affluent and white and professional. (I’m a lawyer, surprise!)

The reasons for my friends’ and associates’ infections are all over the board. Broken condoms, oral sex, cheating boyfriends, broken promises about being negative, getting drunk and slipping up. If you put a gun to my head and said I had to estimate what percentage of the sexually active gay men in Atlanta had HIV, I’d guess 30 percent. This includes my friends. Boring friends. Friends whose Friday night includes board games. You know what I’d rather do than play board games? Shoot myself. In the forehead. With a bottle rocket. And then when I realized I wasn’t dead, I’d use a gun.

I would say if there was one group that actually had a lower than average rate, it would be the super slutty coke snorting six-pack sporting circuit queens. They’re also unembarrassed to discuss HIV, and treat it as a risk to be negotiated. Correlation or causation? Dunno. But either the cocaine is an undiscovered prophylactic, or they got the message that having protected sex with hundreds of people is statistically safer than barebacking the guy next door.

If 30 percent sounds like some shocking, pearl clutching number, it’s probably because you sound judgmental, and so of course nobody wants to tell you that they’re positive. But if you’re perceptive, you’d see the reality, which is that tons and tons and tons of people around you are seroconverting.

People reveal it to me in hushed tones, as they often do with epilepsy, and the (imminently reasonable and followed) expectation that I never repeat it, but I almost want to laugh, and say, “you do realize half the (gay) population is going to have it in 20 years, right?”

We’re in the middle of a forest fire, and the threshold of responsibility to avoid getting burned is getting higher as the infection rate grows. I’m convinced that people will look back on 2011-2014 as the period when suddenly… everyone had it. Or rather, the statistics finally caught up to my particular fishbowl, middle/upper class young white people, who had been skating along in the 5 to 10 percent range until the ice melted.

If I was a top, I would never consider Truvada

I approach it in a very banal way in dating. “Are you positive?” I ask. Maybe 20 percent say yes, and then another 10 percent refuse to answer until I answer first.

I don’t ask because I’m serosorting, but because I want to know if people are able to react to the question in a mature way. If they can’t, then I’m not going to trust them with anything, even handling fragile glassware.

I’ll be blunt: If I was a top, I would never consider Truvada for myself. I would have been like, “meh.” I mean, I know you can still get HIV as a top, but I wouldn’t have a panic attack if a condom broke and I blew a load in someone else’s ass. I wouldn’t be running some “one in a thousand” risk assessment every time I blew a load in someone else’s mouth. (“How many blowjobs have I given? What’s that times the infected rate? Times one in one thousand?”) That’s a lot of math to do with a cock in your mouth. And I wouldn’t be dwelling on the question of whether the top is going to know how to put the condom on right, whether they’re going to try to turn grinding into something more before putting a condom on, whether they’ll double check to make sure the condom is intact before they finish off. If I somehow through Jesus acquired a boyfriend, I wouldn’t be wondering if he’s like that previous boyfriend who seems to have a thing for getting shitfaced and barebacking really unattractive men.

You know what all of those concerns add up to?

FUCK IT.

That’s what they add up to. A whole lot of fuck it. I’ll take the blue pill. KTHXBYE.

I suppose I could retreat to the idea that a third of my friends are irresponsible reprobates. But it’s easier to reconcile the idea that I’m like them.

Because at the end of the day, the side effects include farting, and getting your kidneys checked in case you fall into the 5 percent of people whose kidneys get (reversibly) upset. That whole kidney/liver, thing, by the way, is fucking hilarious. I don’t know a drug that doesn’t come with a kidney/liver warning on it. I get my liver checked for my anticonvulsants. Even for my fucking Propecia. For over a decade. But in public criticism of Truvada, you’d think that was like, a serious thing.

I think I would make a good commercial for PrEP. Happy woman, swinging on a swingset. Man running on the beach. Voiceover: Do you have someone else’s cum in your mouth or ass more than once a year? Is the person who put it there in the same boat? Then consider: Truvada. It makes you fart. (Shot of man in flannel in diner, leaning to one side, smiling, busting one loose. Children wave their hands over their noses, in slow motion.)

But if you look in the comment threads, Truvada is a parade of horrors.

The internet, of course, is a world of false dichotomies. Debates of 1 person vs. 99 look like 50-50 debates. We see it with discussions of global warming (it’s happening), end of life care (pull the plug), smart guns (great idea), and people walking the earth with dinosaurs (nope). But on the internet message boards where the frothiest troll wins, and in news media where there’s exactly two sides to every issue (even if there should be three, or one), you’d think there were serious debates over all of these issues.

Don’t slut-shame Truvada as PrEP

Truvada as PrEP is the same: Of the people who are informed about it, few are opposed or have significant reservations. Of the organizations that weigh in, virtually all weigh in favor. As much as it may appear that there’s a debate, because two people out of a hundred want to froth at the mouth about personal responsibility, most people, when confronted with the reality that everyone around them is getting HIV, think it’s at least worth considering a once a day pill that wipes the risk by somewhere around 95 percent. Assuming you’re at risk.

If you fall into the category of people who like butt sex, giving head without a condom, barebacking with a boyfriend who could conceivably fuck around on you, or are otherwise at risk, you deserve the ability to consider PrEP without a bunch of slut-shaming assholes telling you what you should do with your body. It’s your body. Everyone seemed to think Rush Limbaugh was an asshole for complaining that women should have to pay for their own birth control, but Facebook and comment threads are full of mini-gay Rush Limbaughs, fuming about negative people driving up the cost of healthcare, as though we ever cared about that before.

We should stop tolerating this public examination. In much the same way women are subject to having their birth control decisions second-guessed, gay men tolerate public scrutiny of their own sexual choices. This is the damage of being a minority, which is why we must stop feeding into it.

Sex still exposes you to scabies, gonorrhea, and a severe head injury in a car crash on the drive over. That’s life. You’re all more than capable of your own cost/benefit analysis, whether you’re taking your risk from substantial to small, or small to improbable. We have the right to enjoy sex and to squeeze as much enjoyment out of this short string as we can before some errant thread wipes us into oblivion. To drive. To ride motorcycles. To be in bathtubs. Life is an unending exercise in cost/benefit analysis.

Every straight person I’ve asked about it has just shrugged and said it sounds like it’s probably a good idea if the side effects are minimal. The straight doctors all thought it was a great idea. The gay male doctors went into a conniption fit and demanded to know why I would take a drug when I could use condoms. You know why? For the same reason I don’t want to wear a seizure helmet, and for the same reason that I want to take baths in a bathtub in peace, and drive a car, and drink from glass instead of ceramic, and climb mountains. I want to have sex. And I want it to be less dangerous. And when my health insurance company sends me a refund for the ambulance trips they denied payment on, I might have one iota of sympathy about sticking them with the bill for PrEP, which they are willing to pay for anyway, since it’s cheaper than a continuing HIV epidemic.

So I think even among gay male doctors, they’re too overwhelmed by gay shame and stigma to see that this is nothing more than a personal health decision. That or they’re tops and they don’t know the anxiety of having someone blow a load in your ass when you didn’t intend for it to happen.

If you’re on the fence about PrEP, there’s not a whole lot I can do to make the decision easier. But what I can tell you, quite confidently, is that you are the one who makes and lives with the decision. No matter how many capital letters might appear in the comment threads below, whatever the level of vitriol, of judgment, of billowing refutations, spigots of already debunked hazards, reminders that it might “only” work 90 percent of the time, I can tell you, most confidently, one thing:

You’re the one who reaps the benefits and consequences of your decisions. Not the people telling you what to do on the internet. Hell, not even your doctor. I had to see a few neurologists before I found one willing to figure out a combination of modern seizure drugs that worked and wouldn’t slowly turn my organs to mush. If you recognize why it’s inappropriate to fall over yourself instructing women on whether they should use birth control, for which one could almost not imagine a better analog for the Truvada discussion, you should understand why you shouldn’t be making Truvada a debate. It’s not a debate. It’s a decision.

Also, the farting goes away after awhile. But it went on for like a solid month.

Alex Rowland is a general practice lawyer at Rowland Legal. He climbs stuff with queer people, too. He’s written for Project Q about why he hates Grindr, gay Atlanta’s mean girls and finding gay community in a world of alcoholics.

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