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Has PrEP Launched Round Three of the Sex-Wars?

Tags: PrEP, Prevention

There is a battle of billboards going on in Los Angeles as we recognize World AIDS Day this Tuesday.

On one side of a debate about preventing HIV and other sexually transmitted infections, AIDS Healthcare Foundation has erected messages equating hookup apps with STIs and casual sex with greater risk of contracting HIV.

On the other, the Los Angeles LGBT Center has launched a campaign dubbed “What R U Into?” showing men in various WeHo hot spots conveying “what they’re into” by using various emojis on smart phone apps. Scrawled under the images, the message from the Center: “Whatever you’re into, caring for your sexual health is our priority at the new Los Angeles LGBT Center-WeHo.”

Under the AHF billboards, the type reads: “Tindr, chlamydia, Grindr, gonorrhea” and “Do you trust him?”

What’s interesting is this: The sexual patterns of gay and bisexual men probably haven’t changed much over the long-term, minus a dip during a panic in the 1980s and 1990s after the onset of AIDS. There still is an often contentious debate going on within the community itself over whether having lots of sex is irresponsible.

What’s lost, many experts agree, are facts about HIV prevention such as the efficacy of the once daily HIV prevention pill known as PrEP. Because of all the shaming, we still live in an environment where those who openly admit having a hearty sexual appetite are shamed into not being open and honest about their sexual habits. In the end, that means that everyone from the person they may be sleeping with to their primary care physician doesn’t have true picture of how best to encourage or negotiate sex that is as safe as possible.

Nobody wins.

How ‘Barebacking’ gave way to ‘Sex Panic’

In 1997, just as protease inhibitors began to quell fears that arose in the 1980s that AIDS was going to decimate the gay community, a phenomenon began to emerge among HIV-positive men known as “barebacking.” At the time, the term invoked much fear, judgment, and even shock. Among many, it still does.

About that time, gay writer and historian Michelangelo Signorile catapulted to notoriety with his book “Life Outside,” which talked about the gym culture, drug use at circuit parties (which often led to unsafe sex), and its long-term effects on a person’s psyche and view of self. Signorile was dubbed a “neocon” by a group that emerged in backlash called “Sex Panic.”

At the 1997 National Gay and Lesbian Task Force conference “Creating Change,” Sex Panic advocates spoke out during panel discussions that stressed the importance of safe sex. Talk of “barebacking,” at that time, caused prevention specialists to cringe: There was no PrEP back then, and discussions about the pleasures of condomless sex instilled fear and judgment.

Tony Valenzuela, an HIV-positive porn star and self-described hustler at that time, was quoted in The Advocate as saying, “I’m a sex gourmet in a community serving sexual TV dinners.”

Gay author Gabriel Rotello, who some believe ignited the debate in his book “Sexual Ecology,” wrote in a column for The Advocate how “Sex Panic” was a repeat of the so-called “Sex Wars” of the 1970s and early 1980s, before AIDS.

“I see the new sex wars as a tremendously positive development,” Rotello said in the piece published Sept. 30, 1997, “a sign that we are struggling to come to terms with the reality of sexually transmitted diseases and the imperative of sex and trying to make sense of both.”

He asked where it will lead, surmising ”maybe nowhere.”

Los Angeles LGBT Center ‘Stigma-free Zone’

So today, in Los Angeles, who many may consider an icon of gay sexual liberation, a sort of “sex wars” continues.

Jim Key, a spokesman for the Los Angeles LGBT Center, explained to HIV Equal why The Center took a “sex-positive” approach.

“Most of us grew up believing that gay sex was bad or wrong and it’s common for that internalized stigma to persist at some level, which is unhealthy in so many ways. Our campaign is designed to promote the fact that at the Center, you can feel comfortable talking to our medical providers about whatever ‘you’re into,’” he said.

He noted that LGBT people not wanting to talk about behaviors that put their health at risk, especially with a doctor, results in a dangerous reality: They don’t seek care to protect and/or treat their health. In the end, it’s a public health hazard. “You won’t feel uncomfortable here, this is a stigma-free zone,” he said. “Our campaign also reflects that today, many people connect for dates or sex via phone apps and there shouldn’t be any stigma associated with that either.”

Michael Weinstein, the head of AHF, and Ged Kenslea, AHF spokesman, could not be reached for comment. But AHF defended their billboards in a statement in a story published in The Advocate, saying, "Mobile dating apps are rapidly altering the sexual landscape by making casual sex as easily available as ordering a pizza. In many ways, location-based mobile dating apps are becoming a digital bathhouse for millennials wherein the next sexual encounter can literally be just a few feet away—as well as the next STD."

PrEP shifts fear focus from HIV to other STIs

So now, in the era of PrEP, fear-based sexual suppression techniques have shifted away from fear of contracting to HIV to fears about catching other STDs.

It’s true that STDs among gay and bisexual men are a real problem. AHF in recent arguments has quoted research actually performed at the Los Angeles LGBT Center. The study of almost 7,200 men who had been treated for STIs at The Center showed that those who met on geosocial networking apps were more at risk of contracting gonorrhea or chlamydia than those who met in person or on the Internet.

The study concluded that the apps are an important place for reaching gay and bisexual men for messages about testing, treatment and prevention. When AHF erected their billboards equating Grindr and Tindr which sexually transmitted infections, exactly the opposite happened. Grindr and Tindr removed AHF’s ads.

In a cease and desist letter to AHF, Fortune reported that Tindr wrote: “These unprovoked and wholly unsubstantiated accusations are made to irreparably damage Tinder’s reputation in an attempt to encourage others to take an HIV test offered by your organization.”

Meanwhile, in a statement to The Advocate, Grindr stated:

“Grindr conducts educational campaigns on disease prevention and testing, support health advocacy organizations, and run in-app PSAs regularly encouraging testing and supporting health causes.

-Globally, Grindr conducts research with users on issues as broad as access to proper healthcare and issues of mental health facing the gay community, and share the information with local advocacy groups to help their outreach.

-Grindr partnered most recently with the San Francisco AIDS Foundation (SFAF) and the U.S. Center for Disease Control and Prevention (CDC) on national studies regarding PrEP usage and attitudes. (results to be released in the near term)

-We also devote a section of our website to these topics.”

Shamed in Churches, Black MSM at top of HIV infection tier.

Value judgements and shaming has been almost universally accepted as one of the reasons young, black gay and bisexual men have the largest HIV infection rate in the U.S. Black culture leaders agree that the stigma associated with homosexuality, perpetuated in black churches, drives young, black men underground. They deny their sexual behaviors and avoid settings where HIV testing, prevention and treatment messages might reach them.

Also battered about via the shame game are sex workers, who also are driven underground and may not be accessing PrEP as needed.

In an interview with Healthline last year, Jose Zuniga, president of the International Association of Providers in AIDS Care (IAPAC), said, “We need to make sex a positive again and eliminate as much as possible these negative connotations. Interventions are available to allow for HIV-positive and HIV-negative people to enjoy sexuality without having to suffer through the value judgment that many are suffering through now, including in the U.S.”

In the same Healthline story, noted sex expert David Ley pined, “We’re bipolar as a society as it comes to sex. On the one hand we’re obsessed with it, manically obsessed with talking about it and using it in marketing. Yet we’re terrified of it and whipsaw people. We dangle the sex carrot in front of people and then we spank them. This is how you make people crazy.”