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Sluts, Stigma, and PrEP

, by Alex Garner

Alex GarnerWhen we talk about stigma and PrEP, the question we should be asking is, “Just what is it we are ashamed of?” Is it the sex? The gay sex? Or is it the realization that gay men find pleasure and fulfillment in anal sex and fluid exchange?

Didn’t we have this conversation in the beginning of the epidemic, when the general public tried to make sense of what gay men do in bed? Jaws were agape and there was collective clutching of pearls when people realized that not only did we participate in acts seen as “deviant,” but we really, really enjoyed them.

Many of the negative attitudes attached to PrEP—the strategy of taking an antiretroviral pill every day to prevent HIV—arise from the presumed sexual behavior of the person taking it. Some people believe that it will promote reckless sexual behavior or promiscuity, insisting that PrEP is only for so-called sluts, and that those on PrEP are just “Truvada Whores.”

This moralizing only serves to undermine our efforts to promote the health and well-being of gay and bisexual men. “Promiscuity” is an arbitrary construct whose only purpose is to shame people for their sexual behavior. (One person’s whore is another person’s prude.) It’s time to do away with the word, as it is about as timely as corsets and powdered wigs. The best way to push back against this sort of slut-shaming is to reclaim “slut,” as we did with the word “queer.”

There is no evidence to suggest that PrEP will increase risky behavior or lead to sexual anarchy. We’ve heard this all before. Condoms do not promote promiscuity, watching Glee doesn’t turn kids gay, and listening to rap music doesn’t make you a thug.

In the beginning of the epidemic, safer sex education was about giving people as much information as possible so they could make informed decisions about preventing HIV. But prevention education was constantly under attack from government, churches, and PTAs. Back then the condom was the culprit. The Catholic Church was, and still is, a staunch opponent of condoms. Activists heroically stood up to the church, as documented in How To Survive A Plague, because it was understood that denying people access to information and stigmatizing their sexuality was unjust and only made the epidemic worse. (Our movement is a history of sluts and deviants. Gay sluts don’t just vote, we organize.)

In the ‘80s, HIV stigma and homophobia was much more obvious when coming from the church or people like Jesse Helms as he blamed the epidemic on our “unnatural acts.” But now it’s much more insidious—much of the stigma today comes from our own community. In a New York Times opinion piece, Dan Savage, when talking about gay men and PrEP, said, “The guys these sensible health care folks are trying to reach are not sensible. They are self-identified idiots who can only be saved by a vaccine.” Just what is the point of calling gay men “whores” or “stupid”? It’s about as useful as Rush Limbaugh hurling the term “slut” at advocates of contraception.

To stigmatize is to delegitimize. The diversity of gay male sexuality is valuable. Since before Stonewall, we have fought to demonstrate that our humanity and our sexuality matter. We should be focused on various ways to foster sexual health while reducing harm, not on codifying specific behaviors as morally taboo. Let’s support gay men as they explore the various and (thank goodness) growing number of HIV prevention options at their disposal, while encouraging the cultivation of fulfilling and healthy sex lives. And let’s call out members of our community, like Savage and Duran, when they stigmatize PrEP and the gay men who use it.

One of the best ways to combat stigma is by demonstrating our resilience. We can show people that HIV, PrEP, and gay sex are nothing to be ashamed of. We can educate negative gay men so they can be their own best advocates around PrEP. We can work with doctors and providers so that they are informed about PrEP and don’t allow ignorance or bias to prevent them from giving gay men the quality care we need and deserve. And we can urge gay men on PrEP to speak openly and honestly about taking PrEP—because there’s no shame in it.

We’ve all experienced some form of stigma in our lives. As an HIV-positive gay Latino, I have experienced my fair share. When I seroconverted I encountered stigma for being “stupid and slutty” enough to get HIV. Now negative men encounter stigma for being “stupid and slutty” enough to prevent HIV. Poz and neg men are comrades in the struggle against this epidemic, and the stigma that continues to surround it. We can choose to allow some people to tear down our community, or we can work together to build a stronger and healthier community where all gay men are healthy, find pleasure, and have improved quality of life.

Alex Garner is a writer, activist, and founding editor of Positive Frontiers.

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9 Responses to Sluts, Stigma, and PrEP

  1. Andy says:

    This entire article is a straw man arguement. I have NEVER heard “Truvada whore” except for in article of this type where PrEP proponents play the victim. The legitimate concerns about PrEP have absolutely nothing to do with moralizing. It’s because of it’s abysmal adherence and creating drug resistant strains of HIV and other STIs. The studies that you refer to saying behavior didn’t get riskier, were using people who already didn’t use condoms! It *COULDN’T* get risker!

    • Alex: Thank you for using empowering and positive language! Better mental/behavioral health outcomes are dependent on the proper use of language. Instead of victimizing men who are interested in adding another layer of protection to their toolkit, we should be empowering them to take initiative and make healthy changes in their lives. The re-appropriation of “Truvada Whore” is key to removing stigma.

      • Alex – the term “Truvada Whore” was featured in the Huffington Post when Truvada first became better known for use of PrEP. It was then thrown around on many boards that appropriated the terms against me, and others who have opened up about using Truvada for PrEP.

        Adherence is hardly abysmal. A recent study showed that 92% of people using PrEP in San Francisco had 90% are more protection, due to the use of Truvada on 4 or more days. In Miami, it was only 57% of PrEP users who adhered this closely, but more than 50% of users getting more than 90% protection is still pretty darn good. http://www.aidsmap.com/Very-different-levels-of-PrEP-uptake-and-adherence-in-three-US-cities-demonstration-project-finds/page/2835832/

        There is absolutely no instance of PrEP leading to drug resistant strains of HIV or STI’s. Not a single one in any research study, nor documented in the real world.

        I do agree with you about the studies that say that condom use did NOT decrease with PrEP, especially with groups that weren’t using condoms to begin with. However, as result of iPrex and Partners studies, we now know that PrEP has an efficacy rate above 90% (when taken 4 or more times a week) whereas condoms have been found to be about 70-75% effective. That alters the definition of “risky” sex.

  2. Dan R says:

    I’ve never heard anybody stigmatizing anyone taking PrEP. Ever. Seriously, like NEVER.

    I have, however, heard serious concerns expressed about other STIs, compliance, and the possibility of creating resistant strains of HIV. Those might be part of a serious discussion about PrEP should you choose to start one.

    When can I officially start whining about “condom stigma?” I’m serious.

  3. Gus Cairns says:

    The original “Truvada Whores” piece is here.
    The person who wrote it, David Duran, has now softened his views and acknowledges he wrote the piece in some ignorance – as you can see in his postscript.
    There have also been influential columns complaining that condom users are stigmatised. See this one.
    If a proportion of gay men don’t use condoms and aren’t going to, then clearly PrEP is safer than doing nothing. And yes, there is little evidence so far that gay men are switching en masse from condoms to pills.
    Dr Kevin Fenton, formerly HIV programming head at the CDC and now head of Public Health England, is no great fan of PrEP and feels the way forward lies more in generating a healthier gay culture for young gay men to fit into. But that will take time, and Kevin once told me “We have to try PrEP, because nothing else is working in gay men.”
    PrEP is moving out of the science trial and into the lives of real gay men. Here’s a recent report I wrote on it.
    Yes, the possibility for HIV drug resistance is there, but mathematical modelling studies show that drug resistance will continue overwhelmingly to be created by the suboptimal adherence of people on treatment and very little by PrEP, because taking intermittent PrEP while coming down with HIV will continue to be a rare event.
    I share concerns about the generally poor state of sexual health in the gay community and about the potential impact of other STIs.
    But HIV still possesses a unique combination of lifelong infection, 100% lethality if not treated, and huge social stigma, and I think any initiative that aims to cut HIV infections is to be welcomed.

    • Andy says:

      Gus there is also this new article about stigmatizing condom users.


      I’m not sure the whole, “we’ve got to do something, something is better than nothing” approach is wise. We’ve added several “tools” to the “toolkit” since the condoms-only message. There hasn’t been a condoms-only message with any teeth for well over 10 years (and that’s being generous). Not only have new prevention strategies failed to produce results, new infections have GONE UP! I find it Orwellian to blame the new methods failure the result of condoms-only.
      Plus it is a HUGE leap to think that PrEP will be primarily taken, and adhered to, only by men with use no other protection. I’ve only heard of men already using other prevention techniques (oral, non-penetrative sex and condoms with anal) going on PrEP with the specific intention of not using condoms anymore.

  4. Dave says:

    Where I live, there is very little communication and a lot of ignorance when it comes to safe sex. This is before PrEP has become an option and I think most people have never heard of it. I find it difficult to understand. People seem to think kissing and oral sex are risky. There seems to be a vague awareness that HIV+ people are out there but people don’t think about it when they find someone attractive. My perspective is as a HIV+ person who is very open about his status in a city where no one talks about it. No one asks and no one offers the information so when I do, people act shocked, angry, fearful, awkward. Countless times this has been a new experience for the person I reveal my status to, they have never encountered the conversation. I am so stigmatized that I’m making plans to leave, I gave up on dating a long time ago, it’s become too much. I used to live on the West Coast and it was much more tolerable there.

    I’m not in a little town, it’s about a million people and it reflects the environment in most small and mid-sized cities in the US. I think a lot of these article come from people living in places like NY and SF where the issues are very different.

    I don’t know what the solutions are, the criminalization of HIV is on the rise and very few people in our community seem to care. I think most HIV- people agree with the laws.

    People need more clarity, the government would prefer that we not have sex at all so there’s a lot of misinformation out there, they make it sound like kissing and receiving oral sex is a ‘slight risk’ when there’s no evidence of any risk. They’ve been pushing the ‘super virus’ stuff for years, discouraging HIV+ people from having sex with each other. I’ve yet to see evidence. Just more evidence of how safe it is when both participants are undetectable. It’s like a taboo to even mention it to a negative person but most HIV+ people have been having unprotected sex with other positive people for years, we only talk about it amongst ourselves. We’ve felt safe doing it since the cocktail has made us undetectable and now studies are validating our beliefs. I would never mention it to a doctor, the judgment and condemnation is very predictable. This is a completely different issue when having sex with a negative person of course. I feel I need to clarify that even though it should be obvious.

    We need a dialog and we need to not allow the government to suppress these studies that should be seen as good news. We’re not communicating anymore but we are judging one another and pointing fingers.

  5. Michael says:

    Ugh! The prep hating has nothing to do with slut shaming, so the first line in this “article” is false. It’s that even if Truvata, an expensive, organ taxing anti-viral is as effective as one study found it doesn’t do SHIT about any other STI’s, especially bacterial ones that are already becoming methicillin resistant. My psychopharmacology professor always said “follow the money” when it came to research and people in the media taking any side. So, I wonder who paid for the Truvada research study that said it was so great.

    Speaking of money, Truvada is made by Gilead, the same company that is charging $1,000 a pill for the new Hep C drug Sovaldi. Probably because they are trying to get back the billions of dollars they paid for the company that discovered it. I wonder what kind of windfall they are looking at if every gay man were on Truvada?

  6. @imstilljosh says:

    Alex G is one of my favorite people in the world. Thanks for this!