Login

Switch On Your HIV Smarts.

The Changing Landscape of Gay Sex: A Q&A

, by Reilly O'Neal

Everett Holden

Everett Holden

Everett Holden wants you to talk about sex.

“The more honest we get about sex, the more likely we are to protect ourselves and ask important questions,” he says. Since January, Everett has been meeting gay and bi guys in San Francisco for coffee and conversation about their sex lives, their sexual health goals, and what new HIV prevention tools mean to them.

“I’ve met with 16 guys in just the past two months. The conversations we’ve had are amazing,” Everett enthuses. As a testing and linkage to care coordinator for Bridgemen, San Francisco AIDS Foundation’s community service group for gay and bi men, Everett helps connect newly HIV-diagnosed guys to the medical care and services they need, and works with both HIV-positive and HIV-negative men to understand their evolving HIV prevention options and advocate for their own sexual health and choices.

Our upcoming Real Talk public forum, “Undetectable—the New Negative?” on May 20 in San Francisco will explore how daily oral PrEP and undetectable viral load (that is, having so few copies of the virus that HIV transmission risk is dramatically reduced) are changing our understandings of HIV status, HIV prevention, and sexual wellness and intimacy. Everett will be on hand to answer your questions about these new prevention tools and what they mean for gay and bi men in our community; he will also host a group orientation on PrEP with Bridgemen on May 27.

In advance of these events, we sat down with Everett to hear his personal and professional take on PrEP, how he sees gay sex changing in our city, and why it’s high time to redefine “safer sex.”

Given your work with both HIV-negative and HIV-positive guys having sex in San Francisco, you’ve got your finger on the pulse of gay men’s sexual health in our community. What’s happening right now?

The sexual landscape is really changing for gay men, because of two things: PrEP, which lowers HIV risk by up to 99%, depending on how adherent you are to the daily medication, and the PARTNER study, which found that within couples where the positive partner had a viral load below 200 copies, there were zero new HIV transmissions. Put those together, and you have a whole new landscape.

So today, what does it mean to be “negative”? What does it mean to be “undetectable”? Guys are really wrapping their heads around these new conversations.

What do those conversations look like?

A major one is about what “undetectable” really means. Say I’m an HIV-negative man and I’m about to hook up with an HIV-positive guy, and he says, “I’m undetectable,” or he has “undetectable” in his profile. What does that mean to me? What questions do I need to ask?

Negative guys are learning how to understand what “undetectable” means for reducing their own risk of acquiring the virus from an HIV-positive partner, and newly diagnosed positive guys are learning why it’s so important to get on medication as soon as possible—not just for themselves, but for their sex partners and their community.

So, is “undetectable” the new negative?

I think it is the new negative, and this is why: Being “undetectable” is as good as your last viral load test, just as being “negative” is as good as your last test for HIV.

Negative guys often come to me because they don’t know what a viral load test is or what “undetectable” means, and they’ll say, “What am I supposed to ask when a guy tells me he’s undetectable?” And my response is, “Ask him when his last viral load test was.”

As we start navigating this new landscape, just like HIV testing became the norm for gay men, being undetectable will become the norm. Unless someone is newly diagnosed, it’s very rare that I meet a guy whose viral load is not down to undetectable levels. The only instances in which guys I’ve talked with have had detectable viral load are when they are living chaotic lives because of housing issues or substance use—because being undetectable isn’t their main concern at that moment. On their hierarchy of needs, housing is their most important concern, or food or substances might be their biggest concern.

But it really seems that in San Francisco, undetectable is becoming the norm, because of interventions like test and treat—and because of interventions like Positive Force—getting people connected to a doctor. And now we have Covered California making it easier for more people to have access to medical care.

Are PrEP and undetectable viral load changing how—and whether—guys talk about their HIV status before having sex?

That’s still working itself out. It’s so new: You have the negative guys asking “What is this undetectable thing?” and you have the positive guys asking “What is this PrEP thing?” You have these two segments of the community that have historically seen it as a big issue if they want to hook up, and now they’re discovering each other.

And there are some poz guys who don’t trust PrEP and aren’t going to have condomless sex with a negative guy who is on it. That’s absolutely their choice—people make decisions about using condoms just like they make informed choices about using PrEP. But making an informed choice is different from choosing condoms because of internalized stigma.

For so long, all we had were condoms, and the message was “Condoms good, barebacking bad. Condoms are wonderful and responsible and sexy, barebacking bad! Sickness! Death!” Now the message is beginning to change, but we still have that perception. I think it may be especially hard for some long-term survivors, who have seen whole groups of friends die, to embrace PrEP. But the more we talk openly and honestly about PrEP and sex and intimacy, the better equipped we are to take care of ourselves and our partners.

Do the guys who talk with you about PrEP say they experience stigma?

Yes. I recently had one person tell me, “My doctor said PrEP is only for intravenous drug users and people who are promiscuous.” A doctor. In San Francisco. So there is misinformation and stigma even among providers.

It’s a brand-new conversation in the community, and there is a lot of judgment—about oneself and about others, and a lot of slut shaming and bareback shaming. Especially among men who don’t really understand what PrEP involves, there’s this notion that guys are taking it to go out and have as much “promiscuous” sex as they can. But taking PrEP is being responsible; it is HIV prevention. In that context, what do words like “promiscuous” really mean anymore?

In my opinion, that kind of language is coming up more as we as a community assimilate more into “heteronormative” society. We’ve been told that, as gay men, we’re dirty, we’re promiscuous, and I think in some ways we’ve been trying to counter that image while we’re winning the right to get married in states across the country. It’s interesting to see PrEP, with the accompanying conversations around sex without condoms, taking hold at the same time the fight for marriage equality.

When you talk to guys about these different aspects of the new “sexual landscape,” what are your take-home messages?

It’s all about education and advocacy. All the negative guys I meet with, I give them a little 101 on advocating for yourself when you talk to your doctor about PrEP. It’s so important to have a really honest conversation with your doctor about your sexual practices. If you ask your doctor for PrEP but you downplay your HIV risk, he or she is not likely to prescribe PrEP for you.

But guys are really ashamed to talk about their sexual practices. We’ve been shamed. For how long have gay men been told, “Barebacking is bad, it equals sickness and death”? So it’s really hard for guys to unpack that now that PrEP is an option. And words like “bareback” are loaded and shaming. Just calling it “natural sex” instead of “bareback sex” could go a long way to reducing stigmatizing language.

I think that’s especially true for positive guys, who have been conditioned to believe that preventing HIV is mainly their responsibility. How do we look at that message and help people shift their perspective on what it means to be “safe”?

When people I’m hooking up with ask me, “Are you safe?” I say “Yes—but I don’t always use condoms.” And the response is always, “Huh? What do you mean?” It starts the conversation about me being on PrEP to protect myself against HIV. And when you look at it, 99% protection is pretty darn “safe.”

Do we also need to have more honest conversations about what kind of sex people really want, without judgment?

Absolutely. I think it’s our responsibility to create a safe place for people to have open and honest conversations. Whether that’s one on one or in a forum or a group, it’s our responsibility to create that safe space for guys to talk openly and honestly about the sex they want.

For guys who want to talk frankly and openly with me about PrEP and what it means for them, they have options: They can contact me and we’ll go out for coffee and talk about PrEP, or they can come to the group orientation and talk about PrEP with Bridgemen on May 27. We’ll discuss the financial implications of using PrEP, the social implications, stigma—it will be an open conversation about PrEP and sexual health.

. . .

For tailored information on PrEP and how to access it, or for details on the Bridgemen group orientation on PrEP, contact Everett Holden at eholden@sfaf.org.

Be part of the conversation about HIV prevention, the new “sexual landscape,” and the sex you really want: Join us at our May 20 forum! Click here for details and to register.

Reilly O’Neal is a freelance writer and former editor of BETA.

Related

Comments

Comments are closed.