Click here to read the first installment.  

On April 5, 2013 I took my first dose of Truvada as pre-exposure prophylaxis (PrEP). How did I end up in this situation where I feel like I need PrEP?

As I mentioned in my previous post, a look back at the phases of my sex life gave me some clues about why PrEP makes sense for me now. After more than 20 years of being sexually active, I only recently found myself veering away from perfect 100% condom use.

How did that happen?

Ironically, this is in part because I’ve been working in HIV for 20 years, including the last 10 years focussed on tracking biomedical HIV prevention research. I know what the research is telling us about HIV transmission. I know what proportion of new infections is driven by people who are undiagnosed. I know what undetectable viral load means for transmission risk.

I started serosorting, but not in the conventional sense. More and more, I’ve been dividing guys up into 3 categories.

1. The first category is small. With HIV-negative guys I know and completely trust, we arrive at a form of negotiated safety—if we have been tested for HIV and all STIs recently, and not yet had sex with others, we usually have condomless sex.

2. The second category has been steadily growing—positive guys. We have discussions about treatment, viral load, STIs and decide how to proceed from there. Sometimes without condoms.

3. The third category is basically everyone else—HIV unknown or undisclosed, and HIV-negative men I don’t know well. I consider guys from this third category as potentially being in the acute infection phase, whether they know it or not. This is the category of men with whom I am most adamant about condom use. All too often, their prevention strategy is dubious at best (e.g., “r u clean? how big r u? wanna bb?”). If I see another highly stigmatizing "disease free"/"no poz" message on an online profile, meant to be some kind of stand-alone, ill-informed HIV prevention strategy, I might reach through the screen and cyber-throttle someone.

So gradually, I’ve found myself feeling much less worried about having condomless sex with a positive guy after a conversation with him about treatment and viral load and STIs than about having condomless sex with a guy who says he is negative, but could be in the acute infection phase with sky-high viral load without even knowing it.

Paranoia? Rational, effective, evidence-based risk-reduction strategy? Both? You be the judge.

But let’s be honest. I also started “slipping up” more and more often because, well… sex feels better without condoms. *gasp* That’s right folks. Sex without condoms feels freaking amazing. You heard it here first.

So while I still maintained a relatively high rate of condom use, I found myself having condomless sex every once in a while. Of course, I also know how effective inconsistent condom use is over time (i.e., not very).

An illuminating peek inside the Little Black Book

Three years ago, I started to keep track of my sexual encounters in a proverbial little black book. (OK fine, it’s blue and has a Global Campaign for Microbicides logo and a Rectal Pride for Microbicides sticker on it. It’s super pretty and seemed appropriate). Every time I have sex, I write down what we did, what I know about my sex partner’s HIV status, and whether or not we use condoms. Yup, every time for 3 years. I do this partly so I have very accurate information at my fingertips to relay when I get tested for HIV and STIs. Partly so I have very accurate information at my fingertips when I start to worry. I can look at my list since my last tests and say: look, you had this many encounters, this is what you did with whom, this is how often you used condoms, and this is what you know about his HIV status. Sometimes that helps alleviate the occasional panic attack and insomnia. Sometimes.

I had never seen myself as being “high risk” for the first 20+ years of my sex life. But I’ve been working in HIV for 20 years. So I know the behavioural characteristics of “those people” at high risk. Armed with about 3 years of hard data about my own newly evolving behaviour (i.e., my stylish little blue book), I decided to look at it objectively.

• Multiple sex partners? Check

• History of STIs? Check

• Partners of unknown or HIV-positive status? Check

• Inconsistent condom use? Check

Well then. It’s hard to ignore what this spells.

I like to think I’m at least moderately intelligent. I know how HIV is transmitted. I know how effective condoms are.

I like to think I understand the consequences and the stakes. Yes, people living with HV are doing much better today. But I saw my dad die of AIDS in front of my eyes. I saw countless other friends, colleagues and clients become HIV-positive or die of AIDS. That leaves an impression, to say the least.

I like to think I’m a responsible person. I get tested frequently. I stay informed.

I like to think I have high self-efficacy. I have several years of experience using condoms consistently, and I am more often than not the one wearing the condom, so little to no negotiation is required.

I’m not depressed. I never drink. I don’t so drugs. My judgement is not clouded by any of those.

I’m not in denial. I know that the combination of inconsistent condom use, multiple partners, history of STIs and having partners of a different/unknown HIV status is a very strong predictor of seroconversion over the course of a few years.

If all of this doesn’t make me an ideal candidate for consistent condom use, I don’t know what more it would take, short of using Super Glue to permanently bond a condom to Mr. Happy.

Yet here I am.

So as a smart, responsible, well-informed, sexually active gay man with good self-efficacy and good access to healthcare and accurate information, I’ve come to the conclusion that PrEP makes sense for me at this point in my life. I don’t know how long this new “PrEP phase” will last. But I am glad it is available to me while I need it.

To be continued . .

About the author: Marc-André LeBlanc has worked in the community-based HIV/AIDS movement for 20 years.  He does community engagement, capacity-building and policy work related to biomedical HIV prevention research, both in Canada and globally. He is a co-founder of International Rectal Microbicide Advocates (IRMA), serves as secretary on their steering committee, has authored two reports on the global state of rectal microbicide efforts, and leads IRMA’s global efforts to ensure the safety of sexual lubricants. Marc-André loves movies. He got a film studies degree while working full-time, just for the sheer fun of it. He is now leading advocacy efforts to get ice cream and popcorn recognised as new basic food groups in Canada’s Food Guide

This article first appeared on My PrEP Experience here. 

A decade ago, Dr. Susan Cochran at UCLA’s School of Public Health published  findings from a comprehensive study conducted on the mental health of gays and lesbians. In the November 2002 issue of American Psychologist, Cochran’s conclusions on depression were depressing themselves: gay and lesbian youth suffer from higher rates of substance misuse than their heterosexual peers; LGBT folks need to utilize mental health professionals more than heterosexuals; and, gay men seem to experience recurrent, debilitating bouts of depression more than almost any other group in the overall LGBT community.

Confirming these findings, Michael Kerr writes on a study conducted in 2009 that reinforced Cochran’s findings, pointing out that “research shows that things are even worse for [LGBT] people. Depression affects LGBT people at much higher rates than the general population.”

In addition, Northwestern University’s IMPACT Program focusing on LGBT health asserts, based upon an even more comprehensive study last year, “Taken together, these results indicate health disparities for…LGBT youth are strong and pervasive. Due to the presence of these disparities at such a young age, they are likely to influence to health and well-being of LGBT [individuals] throughout their lifespans.” 

I can always tell when I’m letting my own depression get the better of me because of the responsive actions of my friends. Truly, my better angels prod me to be nicer. More specifically, there’s a small group of friends I’m lucky enough to have, people who are quizzically good-natured in spite of the arguably self-centered nature of mankind, who either directly say to me “Be nice” or who implicitly say this by responding to my gruffness and misanthropy with emailed pictures of llamas visiting elderly hospice patients for pet therapy. Based upon the amount of animals I’ve looked at lately, I must conclude that I am in a very bad place emotionally. And, admittedly, I am.

Yet, I do not feel utterly hopeless about my future nor do I not have a long list of blessings in my life: in fact, I have a better life than most of the billions of homo sapiens walking the planet. Instead, I am tired.

Now, perhaps some of my depression, this tiredness, is indicative of the ennui of our age, of our complete and total dissatisfaction with institutions of power that we are supposed to trust. Indeed, with growing frequency we expose these people and governmental bodies as clownish caricatures of the worst motivations of man rather than accurate reflections of the grotesque, and compassionate, nature of humanity. Instead of allowing for the unpleasantness that is requisite to be labeled human, too often we as gay folks have taken our social lead from the very discriminatory and ridiculous institutions once subjugating us, including institutions rooted in the necessary evil of politics, a field which, upon mention, should elicit nausea in the thoughtful, common man. We have become dismissive, sometimes, of anything that does not fit into our Facebook and online personas, personas who are apparently all very well coiffed, doing very well with that new small business thank-you-very-much, and who are madly in love without any semblance of negativity or strife whatsoever. And, one of the most grave sins as a public figure is, apparently, admitting flaws, contradictions in character, poverty, or sadness.

I need only point out the fact that when I was homeless (a fact most people still are unaware of) very few individuals had the time of day to actually consider for a moment what it meant to worry everyday about how to maintain proper hygiene without showering or how to remain warm and dry at night to demonstrate our society’s general hostility toward unpleasant facts surrounding human nature. Indeed, I myself am guilty of this intolerable sin of selective ignorance; I would much rather focus on my work than consider how to reallocate my own resources to help others out of those figurative holes in which they find themselves.

Then again, life is a consequence of action, so if bad things are happening to people, then these people behaved poorly, right? Unnervingly, this oversimplification is completely contrary to fact; sometimes, bad things happen to good people for no apparent reason whatsoever. And, “bad things” often include, at least in the case of a disproportionately high number of LGBT folks, anxiety and recurrent bouts of deep depression like I’m going through right now.

Most interestingly, I know a great many individuals whose lives are divorced significantly from the general public understanding of who they are as men and women; their collective loneliness weighs on me to a profound degree. Part of me thinks that if everyone was more candid, offered more details surrounding his need to move (from couch to couch, not apartment to house), explained her decline to my dinner invitation (she cannot afford the meal or the inevitable awkwardness when the check comes), provided context to his anxiety (his father has cancer), then we’d all get along better.

Unfortunately, because we live in society and, as such, must navigate society on its terms otherwise we’ll soon stop being mentioned in society pages, we cannot talk about the fact that we are sometimes sad or sometimes poor or sometimes sick or, inevitably as human beings, dying.

Yet, when we provide these details, people are embarrassed for us; they consider such unsolicited personal details as inappropriate or awkward. Rather, they find anything aside from their unsolicited braggadocio, personal “fabulousness,” or maudlin revision of history to fit into a sentimental simplified narrative as completely out-of-bounds. Even worse, they go one step further and, at least in the case of a critic of mine, begin to publicly call you “psychotic” for no other reason than their own apparent pathological discomfort with facts.

Of course, these same folks portray a fabulous image that is completely divorced from the modest reality in existence; but, naturally, this is unimportant to society. Indeed, it is a curious world we live in when facts are presented and those embarrassed by the facts find comfort in dismissing the presenter as psychotic. Then again, I cannot imagine that the King of England felt much affection for Jonathan Swift after “A Modest Proposal” or that Christopher Hitchens received a warm reception from the Vatican after “God is Not Great: How Religion Poisons Everything.”

Inconveniently, these unpleasant components of humanity are inherent to the experience of being alive. Without our downs, we cannot identify our ups. And, there are some human beings with a propensity toward depression; interestingly enough, there seems to be a strong overlap between those with a sincere desire for man to do the right thing and a profound sense of sadness when this does not occur.

The fact that we as LGBT folks suffer from depression higher than straights might just mean that we care a little too much about the world, in that case. And, while that’s a quaint thought, I nonetheless think the reality is much less noble and much more banal. After all, as some of the most talented members of society, we as LGBT folks are, by our very nature, different and more sensitive. 

So, it’s no wonder that we would rather portray an image as well put together, successful, well-decorated, and fabulous. Who’s got time for reality when we’ve got the theatre?

This article originally appeared on Josh’s own blog here. 

My editor asked me to write about the future of prevention. In taking up that challenge, I am discovering that I probably have more questions than answers, but I do have some ideas of the challenges we must meet if we are really going to stop HIV transmission. 

Motivation 

Scary "death" and "doom" messages will not motivate people to take measures to avoid contracting HIV. Fright messages sometimes have short-term effects, but these truly lack credibility in a context where a lot of people (particularly in the gay community) know someone living with HIV and living quite well with treatment. We need to be realistic talking about what it means to live with HIV today. I personally don't look like I'm about to die (not of HIV/AIDS anyway!) and I have a fairly active life, but I wouldn't wish my HIV infection on anyone else. We need to learn how to share our experiences of living with HIV in straightforward, honest ways if we want people to understand why they might not want this virus. 

Risk Assessment 

In all health issues, the quantification of risk is problematic. I have a friend who, in the course of his internship, was sometimes called upon to deliver a prognosis to an ailing patient. "How much time do I have left?" rivalled "What are the chances of the operation not working?" for tops of the unpopularity contest. He was reticent to tell the elderly patient that there was a 4% risk of death in an operation because it was so unlikely to occur and so likely to panic the patient to hear and try to interpret the words. 

How then do we explain that a single act of condomless anal sex with a person with a high viral load might have a transmission rate somewhat less than 1%, but that people still get infected with HIV? I know there has been some degree of reticence to share those percentages of risk because they are so very difficult to wrap our heads around, but that is an attitude that smacks of paternalism. If it is difficult to understand, then our challenge on this point is clear: learn to explain risk in a way that helps people to make informed decisions about their actions. 

A Full Toolbox 

There are many approaches to prevention these days, ranging from motivational counselling all the way to pharmaceutical intervention. We need to figure out which tools work best for which people in which situations. Then we need to be able to make sure that those people have access to the tools they need, understand the strengths and limits of those tools, and know how to use them.

With budgets for prevention stagnant and some new approaches taking up a lot of virtual space, those who make decisions about what to fund might be tempted to put all their eggs in one basket. We have to continue to recognize that there isn't a single approach that will work for all and fight to preserve the diversity of the available tools even as we work to understand them better and to improve them. 

The Pleasure Principle 

Most of the time – if we're lucky – sex is about pleasure. When our prevention messages are peppered with words like "safe" and "secure" or "protection" it shouldn't surprise us that not everyone wants to hear them, or even listen to them. We need to talk more about what to do, and not as much about what not to do. This goes beyond how our messages look (we've learned to make them sexy) right to the core of what they say. 

Since I am given to wild and sometimes inappropriate metaphors, let me just charge headlong into this one: Waterskiing is not all about the life jacket. That life jacket might be an essential tool in the end, depending on how you go about the sport, but the waterskiing is about hanging onto the rope, getting up on the skis (and staying there!), and it's even more about the sun on your face, the wind in your hair and the pure exhilaration of skimming across the water behind a powerboat. We need to focus on that approach when we talk about sex. 

Autonomy 

We need to trust people to make choices for themselves. That means sharing all of the information in the best way to ensure that it is truly understood and letting people determine how they will act on it in their own lives. I would hasten to add that one person's autonomy doesn't trump another's. I'm trying (and probably failing) to make this point not be about disclosure, but if we lived in a world where people wouldn't face unreasonable discrimination after disclosure I would be happy to include it. And when I talk about discrimination, I'm not talking about getting turned down by a potential partner, but about losing a job or not getting one, or about losing all semblance of privacy when the person trusted with the information decides it needs to be shared. 

Back to the autonomy part. People will not necessarily make logical or sensible decisions when it comes to sex and pleasure. We wouldn't be human if we always acted logically and based on the best available evidence. Humans have issues like self-esteem, desires, fears, urges…these all push logic out the nearest window from time to time. Sometimes we make bad choices for ourselves and sometimes we make good ones. Sometimes good and bad are a little difficult to sort out. That doesn't mean that someone else gets a licence to tell me what to do with a willing partner; it means that the prevention challenge is to try to ensure that I have all the information and tools I need to make the right decision for myself, and that my partner has those too. 

I don't know if we'll find the ideal approach to prevention or the means to make sure that the multiple approaches that work the best for now are fully available. I only know that we can't stop trying. One new infection is one too many.

My first concrete experience with HIV research took place in 2007. I had applied, interviewed and been selected to participate in a 2-month research and volunteer internship in the country of Namibia. The internship program that I joined had been established several years prior and had a reputation for being an incredible learning experience for those selected to participate. Undergraduate students from various faculties within the University of Toronto were selected to travel to Namibia to conduct research and volunteer within a local AIDS service organization (ASO). 

With very little applied training or education (in research methods, on HIV in a Namibian context, on community-based approaches to research), I flew overseas and landed first in Windhoek before driving eight hours north to a rural town called Ongwediva.

For the volunteer portion of my internship, I worked within an organization that provided microfinance loans and HIV education to women who were supporting orphans and/or other vulnerable children (OVC). OVC are defined as a child 18 years of age or under who has lost one or both of their parents or primary caregivers and  is in need of protection. In Namibia, more than 28% of those 18 years of age and under are classified as OVC with a shockingly high percentage of children orphaned because of HIV and AIDS. 

The first time I travelled to Namibia in 2007 (1), the national HIV prevalence rate was hovering around 15%, which is a high despite the fact that the population of the country was just under 2 million at the time. Although the country’s population isn’t large, dealing with thousands of people living with HIV in the context of a weak infrastructure is challenging. While the HIV prevalence in Namibia has shifted slightly since 2007 (the latest report shows a national prevalence rate of 13.1%), Namibia still ranks amongst the top ten worst countries globally in relation to adult HIV prevalence. I believe that the history of a consistently high HIV prevalence rate was the reason the internship program was established in Namibia. 

Outside of some readings completed prior to departure, we were not required to complete any courses or training to prepare us for the research projects we were about to undertake. On top of this, students traveling abroad were expected to create a research project that we would embark upon once we arrived in Namibia without consultation from our Namibian “partners”.

At the time, I remember feeling frustrated with these expectations; how could I be expected to develop a research project not only without the necessary training in methodologies but also without ever having been to Namibia or communicated with any of the potential organizations or ASOs that I might end up working with? 

Though I did not realize this at this time, I was operating within a colonial research structure which placed me, the undertrained, naïve, and eager (yet ignorant) undergrad, in a position of authority over the research including who would be involved and what and who would be studied. This structure positioned me as the research “expert” regardless of my inexperience both in research and in Namibia. Yet my overall academic immaturity and ignorance was irrelevant and became secondary to the incredible experience I was about to undertake. 

Critical considerations about how to ethically engage in an international research expedition were not a focal point and emphasis was placed on ensuring that the experiences of the University of Torontop (Western) students were monumental. Though I was aware that entire bodies of critical literature existed on research methodologies and approaches, HIV engagement and international work yet community-based research and ideas around the greater involvement of people living with HIV and AIDS (the GIPA Principle) failed to make an appearance in the internship program or research structure we were being churned through. 

(The Greater Involvement of People Living with HIV & AIDS (GIPA) Principle was introduced and formalized at the 1994 Paris AIDS Summit when more than 40 countries committed to “support a greater involvement of people living with HIV at all ... levels ... and to ... stimulate the creation of supportive, legal and social environments”. )

The GIPA Principle aims to ensure people living with HIV and AIDS are the backbone and key contributors to program development, policy-making and implementation and that this involvement is meaningful rather than tokenistic. This principle seeks to highlight the rights and responsibilities of those living with HIV and AIDS including the right to self-determination and the ability to play an active role in decision-making processes that impact their lives. Despite the widespread acceptance and global approval of the GIPA Principle, there is still much work to be done in order to more fully immerse this approach into various sectors including international student research on HIV and AIDS. 

While the benefits of applying the GIPA Principle are evident, there are often many challenges which stand in the way of successful implementation/involvement of people living with HIV including HIV-related stigma, inexperience with research, distrust of researchers, and that involvement in research may not be prioritized compared to other components in life (social, health, family, etc.) (2) Within the context of academic, social research, community-based (participatory) research (CBR) has emerged and solidified itself as a methodological process for conducting research in a way that positions itself in opposition to many of the more historically conventional approaches. CBR not only emphasizes the involvement and collaboration of community members at all stages of research (from project design and development to data collection and analysis to knowledge dissemination and translation) but rather understands meaningful community involvement as imperative and integral to the research process; in essence, meaningful community involvement is non-negotiable. 

Theoretically and depending on the goals and objectives of a research project, CBR represents an almost utopian approach to research which moves away from some of the more historically troubling aspects associated with some research practices. In practice however, CBR is far from perfect and – like the GIPA Principle – faces barriers in practice. The insider-outsider dilemma is often sited as a consistently challenging issue for CBR as is the general distrust that communities often/may have towards researchers. (3) 

My own university experiences with international research on HIV prevention serve as a case study to demonstrate not only the invisibility of the GIPA Principle and CBR in practice but the near complete absence of them. Many Western universities not only offer but promote student involvement in exchange or abroad programs which provide these students with infinite opportunities to expand their minds, experience different socio-cultural perspectives, increase their chances of accessing additional opportunities and importantly, aggrandize their CVs. This was my experience in both my undergraduate and graduate degrees at two academic institutions in Canada; this was also the experience of many of my university peers. 

While I felt I had learned many valuable lessons on my first excursion to Namibia during my undergraduate degree, in hindsight, it is evident that many more lessons remained unexamined. While I made the effort to think more critically about my social and global location in the work I was participating in, this critical thinking did not permeate my thought process in a way that drastically impacted my actions as I still actively chose to pursue a graduate degree which included traveling back to Namibia to conduct research. 

While I take full responsibility for my actions and choices within both my undergraduate and graduate degrees, I think it is also important to recognize that I was operating within a system which very much facilitated my goals of engaging in international work yet simultaneously did not provide adequate training in order to do this work critically, ethically or meaningfully.

As one would expect, my initial experience of travelling overseas to conduct “research” in Namibia created a slew of subsequent opportunities. Even though several years have passed since both my excursions to Namibia, I am still reaping the benefits of them via conference presentations and publications. Conversely, I doubt very much that the organizations and participants I worked with are fairing as well.

(1) I travelled to Namibia a second time in 2009-2010 to conduct my MA field research. This time, I travelled to Walvis Bay, an area in Namibia that experiences high levels of mobility via two transnational highways and the country’s only deep-water port where international boats can dock. In addition to high levels of mobility, Walvis Bay also experiences rates of HIV around 10-15% higher than the national prevalence rate (25-30%); it was for this reason that I chose to conduct my research in this town.

(2)Travers, R., Wilson, M.G., Flicker, S., Guta, A., Bereket, T., McKay, C., van der Meulen, A., Cleverly, S., Dickie, M., Globerman, J., & Rourke, S.B. (2008). The greater involvement of people living with AIDS principle: Theory versus practice in Ontario’s HIV/AIDS community-based research sector. AIDS Care. 20: 615-624. 

(3)Fockler, L.A. (2010). Community researchers’ experiences with community-based research. (Unpublished master’s thesis). McMaster University: Hamilton.

“That over one-third of LGBT people have been subjected to violence from an intimate partner is evidence of the brutality we can inflect upon one another, even those whom we claim to love.” 

David Phillips 

The quote above from David Phillips, was a comment on an earlier post of mine. At the time I thought, ‘Damn, he’s right. I should have mentioned that side of it in the article.’ Then a couple of days later it hit me that by saying that, he had inadvertently reopened a chapter of my life that I’d more or less successfully filed away. It shocked me that I hadn’t thought about it for years and that other events had overtaken it on my list of life changing moments.

It’s one of the last remaining taboos, along with men being abused by their wives. If you are a man you just don’t readily admit that you were in an abusive relationship …with another man and yet if the statistics are true and one in three LGBT people are being abused by their partners, shouldn’t we be talking about it? After all, we lay our sex lives bare and confess all about our relationships with HIV and yet revealing a past full of same-sex abuse somehow makes us losers, weaklings and unable to hold our heads up in society. 

An abiding memory I have is one which still gives me chills and one which David Phillips reawakened.

The pub would be its usual boisterous self on a Friday night. It was loud, full of smoke and both working and unemployed men from a tough industrial town in the North East of England. It was a straight bar and my partner’s brothers would be there, full of fighting talk and Newcastle Brown Ale (a lethal combination). I was sat on the edge of the group playing 5-card Stud, silently supporting my partner but not standing behind him, otherwise the others would accuse you of cheating. At any given moment but usually after Pat had had that elusive one beer too many, he’d turn his empty glass upside down on the table. At that moment my world would stop. The noise in the bar would be blocked out and my heart would start thumping in my chest. At that moment, mostly without warning, I’d know I was in trouble. 

I was 21 and he was my first real love, after a few years of fumblings, furtive adventures and infatuations here and there. He’d completely swept me off my feet. I was the deepest shade of green you could imagine and met someone who was street smart and a player and knew exactly how to manipulate my naivety; talk about putty in someone’s hands! I didn’t know he was psychotic, or had been behind bars, or was an ex-boxer, or was addicted to betting on the horses, or came from a family of five brothers living on and off in a small council house, with a mother desperately trying to cling on to the reins. I didn’t know that he had a sort of sugar daddy who worshipped him and funded his gambling and rent arrears out of his own meagre pension and hated me from the first moment he set eyes on me. I didn’t know any of that; all I knew was that he was the handsomest man I’d ever seen and after one night at one of his hook-up’s houses, after he had begged him to let us use a room, I was completely hooked. 

The timing was appalling. I’d just qualified as a teacher and had my first job in a town a few miles away. I had my own bedsit, my independence and loved the work I was doing. I was already set for promotion and my working future looked rosy. Pat ruined all that within six months. I should have taken the hint after a furious row during the morning after the first night before. I even walked away, horrified at the appalling arrogance of the man and the already evident aggression. The fact that I believed his apologies after he ran after me and swore undying love and unremitting attention, was a mistake that I lived to regret.

Funnily enough, looking back in many ways, I don’t regret it now. I grew up in those three years and I needed to and there’s no doubt that part of who I am now was forged through those harsh lessons. The road through life might have been easier and I would have avoided losing my job and my family and any other friends I used to have but in a perverse way, Pat taught me how to survive and read people in a way that I wonder if I could have done on my own. 

It was the beatings that I still carry the scars from, both mental and physical. I’m convinced that half of my current back problems come from his thumping me repeatedly on the back instead of the face, because I had to go to school and face a class the next morning. He would take out his rage on me and until that rage was spent, there wasn’t much I could do about it. In the beginning I fought back but I was out of my league and of course, the classic apologies and promises never to do it again always worked. Now I know I fit the profile of a classic abusee but I didn’t see it then. 

There came a point where it was too late and I couldn’t get out. The love changed to fear but I’d burned my boats with the schools, who got sick of my constant absences due to illness and I ended up on sickness benefit. I’d also turned my back on my family after a disastrous visit, during which Pat started an argument with them, as he loved to do with virtually anyone. My mother couldn’t take the swearing and the aggression and I ran out in sheer horror and shame. I learned later that Pat had added a few other choice home truths after I had gone and after that I couldn’t face them again. 

So there I was, living in his family home with battle-worn siblings and his mother who, in her own way, tried to take me under her wing. I had no job, I’d cut the ties with my family; I had nowhere to go. I had to adapt pretty damn quickly and learned what it was like to, shall we say, live on the other side of the tracks. I learned about honour amongst thieves and the fierce loyalty his family had towards each other. Luckily, his brothers were sympathetic. It was never mentioned that Pat and I were gay, although it must have been obvious. Pat was their brother and I was his partner and that’s all that was important to them; the rest of the world had better watch out with their comments.

We went down to London a couple of times to get jobs and I built up experience in different trades (supermarket manager, record shop manager etc). Again, I’m grateful for that. A teacher often goes from kindergarten to his pension without ever leaving a school situation and it’s frequently true when they say that a teacher is a man amongst children but a child amongst men. The problem was that Pat could never hold down a job and was repeatedly fired for starting rows and being aggressive. He’d take out his frustrations on me via alcohol and the beatings got worse. One day after turning up for work with a black eye and broken nose, the penny began to drop. 

To cut a long and painful story short, I eventually walked out on him; rang my parents and begged their forgiveness for two years of silence and asked if I could come home. To my astonishment, they later told me that they were convinced rough, tough, macho Pat was gay but didn’t ever suspect I was! Go figure! They protected me whilst I got myself together, got back into teaching, got my own place and got my life back on track.

What I didn’t know was that they had to put up with months of a drunken Pat ringing them, threatening them and abusing both them and me and once even turning up on the doorstep. Thank God they had the strength to put up with all that while making sure I never knew about it. It was only later when I came out to them and told them the whole story that they in turn told me about the aftermath of the break up. 

So why did I put up with all that crap for so long? Why would any sane and supposedly intelligent person allow his life to be dismantled and his body to be regularly battered in this way? Well, I could write a whole article about my theories as to why Pat was the way he was; a psychologist could have a field day but in the end you have to own your own mistakes and face up to the fact that it is nobody’s fault but your own. I was so naïve and my life experience had never prepared me for someone like Pat. I was in love, at least for the first year, after which I was in too deep and I was forever finding excuses for his behaviour.

From what I read now, these are classic avoidance techniques and classic abuser and abusee scenarios. My naivety also led me to romanticise the situation somewhat. His life and background was a sort of exotic ‘otherness’, with enough danger to make it exciting; it was almost seductive.

Only after the reality became apparent did all that nonsense disappear and it became a question of making the best of a very bad job. Perversely, although he was the beast personified in the outside world, he was passive sexually (more food for the psychologist). I’m sure that made him hate himself and by extension me even more but there you go, I just wasn’t aware what went on in the mind of a psychopath. 

There will be people reading this who make instant judgements. Yes I should have left him after the first fists were raised but nobody ever got away with threatening me in that way again – lesson learned! I’m not a masochist either; that was never a part of the equation. Yes, I should have been more responsible concerning my job and family; why would I put both in such a situation where they had to deal with my failure? I should have reported Pat to the police, or gone to a social worker. That’s possible today but in 1971, it was much more difficult. The police would laugh you out of the station and social services just weren’t equipped for same sex violence (they could barely protect people in heterosexual abusive relationships). Battered women’s shelters didn’t even exist and believe it or not, I still had enough pride to know that you didn’t go running to the authorities if you were being abused by your boyfriend.

One in three LGBT people are apparently still being abused by their partners. Believe me, it isn’t just physical abuse either. (One of Pat’s favourite tricks was to humiliate me in public by exposing my weaknesses in a sort of reverse snobbism.) Verbal abuse can be just as damaging although the scars are mainly on the inside and not visible to the outside world.

There’s clearly still a taboo round the subject. So, if it’s really true that a third of gay people are being abused by partners, why aren’t we hearing about it? Social workers will tell you that it’s a big problem which they do their best to deal with but society as a whole is far from sympathetic to the woes of the ‘sissy being slapped by his boy or girl friend’. Yet bullies can take all shapes and forms and same-sex bullies aren’t interested in having you as an equal partner, they search for conquests and possessions; people they can call their own property. It’s a mind- trip, a kick, a compensation tactic, call it what you will but if you’re on the receiving end, it can damage you for life.

Last week, I read a comment on an HIV forum that many young people wish older guys would stop giving in to the urge to tell their life stories…enough already! I get it, I really do. We come from a different generation, different circumstances and different truths and continually pushing the past into youngsters’ faces will of course turn them off big time. My point in writing this piece is that some things are universal and belong to every generation.

One in three LGBT people suffer abuse from their partners in 2013! Let that sink in for a minute. If it’s only half true, it’s shocking and proof that the stigmas and taboos are not confined to HIV. Surely, we as a community should be addressing this social cancer amongst us, or should we sweep it under the carpet like every generation before us?

Telling my own story has not been easy for me. I’m still ashamed that I let it happen (I’m blushing as I write) and with hindsight, which is a wonderful thing, I should have been strong enough to get out early but if one person reading this recognises the signs and makes the right decisions, then maybe it’s been worthwhile.

Remember, you can be outwardly the butchest creation on God’s earth and be regarded by society as a rock and someone who could deal with anything but behind closed doors, you could still be subject to someone else’s sadistic tendencies and living in your own private hell. It needs to be talked about and it needs exposing, so that people feel safe enough to get help if they need it. Unfortunately, breaking down society’s silence and disdain, is so much easier said than done. 

“You're only as sick as your secrets, but the truth shall set you free...” (via David Geffen).

“Some people are going to think, ‘Oh god, why did he not take steps to prevent HIV? Why did he act recklessly, and who the hell does he think he is, I saw people die from AIDS!’” A friend and colleague whose candor is always helpful said this to me over lunch recently, and his words have stuck with me over the past day

Most interestingly, I’ve noticed that those most receptive to my messages are under 30, those 30-50 are generally receptive but ask more poignant questions, and those over 50 are oftentimes, not always but often, openly hostile to my writing on bareback sex and HIV. In the next few months, I’m going to be speaking at several sexual health seminars and symposiums, and I’ve been assessing my own writing and essays on sex, barebacking, HIV, and personal responsibility, and I’ve reached the same conclusion that I originally had when I began writing on HIV and sex; that is, we are inadvertently sustaining HIV infections and continuing this epidemic because we are unable to confront our past honestly and without emotion.

I was born in 1984. Personally, I have no firsthand recollection of Ronald Reagan’s presidency, Ryan White, Arthur Ashe, the AIDS quilt’s beginnings, Rock Hudson, C. Everett Coop, or the obscene neglect the United States government took in relation to HIV/AIDS throughout the entire 1980s.  Rather, all of my knowledge of these things, people, and movements comes from oral histories from LGBT elders that are my friends, exhibits at places like the William Way LGBT Community Center’s stellar John J. Wilcox, Jr., Archival space, named after a man I am heartened to have called a friend, and from textbooks and documentaries. In addition, when I began to go through puberty and learn about the physical and sexual changes taking place in my body, it was the late 1990s, Bill Clinton was president, HIV/AIDS organizations and infrastructure had been in place for over a decade, and my teachers, parents, and mentors knew how HIV was transmitted, how HIV was not transmitted, and HIV’s timeline of progression in the human body.

When I was growing up, there was no plague where funerals were being attended every week. There were no candlelight vigils, there were no large scale protests interfering with traditional institutions of power and policy in the United States; rather, there was knowledge, there were early concepts of treatment that are still being used today, and there was a local, state, and federal government trying its best, guided and sometimes provoked by activists and advocacy organizations, to respond most effectively to HIV/AIDS.

Instead of learning about HIV through my own experiences or through seeing friends or loved ones suffer or die too early, I learned about HIV as an abstract concept far removed from my own life. Of course, this abstract viral boogeyman was as frightening as it was imaginary; after all, when our own innate fears are coupled with histories, real or not, of our elders and teachers, we manifest these fears in irrational terror and paradoxical behavior, like posting links on Facebook to condom campaign websites but barebacking someone we met on Adam4Adam because he said he was “clean.”

For years, I was terrified of this virus because it had seemingly no effect on me or my own circle of friends and family; rather, it was something that we knew existed, we knew how to prevent, and we knew how it attacked the human body, but this knowledge was predicated on the idea that I was born, luckily, at a time where I did not become a man or a sexual being until long after the early days of the virus spreading rapidly through the gay community. Of course, the only reason HIV/AIDS took off throughout the gay community is because gay men engage in anal sex which allows for easy access for the blood barrier to be crossed between sexual partners because of, often entirely unnoticeable, usually microscopic abrasions and tears around the skin on the penis or inside the anus.

Contrary to the belief of some misguided idiots who think HIV/AIDS was god’s divine judgment toward those of us who like to kiss men, HIV only seemingly “picked” the gay community because of this fact; if straight women were clamoring to engage in anal sex like gay men typically do, they would have been the ones who bore the brunt of HIV/AIDS. Instead, because gay men are the ones who engage in this, admittedly fun, activity, we were the ones who suffered the most during the early days of HIV/AIDS. And, to this day, the LGBT community overall, including transwomen and gay men, are dramatically disproportionately affected by HIV because of this fact.

So, like the Holocaust, the early days of the HIV/AIDS epidemic are a mere idea my generation and the generations after mine have to learn about from our elder peers, from our teachers, or from our books. We have no concept of the human tragedy endured by millions; we have no firsthand account of what things were like. And, this is why our experience as HIV+ people born post-AIDS outbreak is entirely different than that of those who lived during this time as sexual adults. Now, this is not to say that either experience is better or worse; rather, our experiences are equally as valuable and equally deserving of a seat at the table when it comes to outreach, prevention, and care.

Notwithstanding, if we are to successfully combat the tide of rising HIV infections brought on by what older folks like to call “recklessness” but what I like to call “natural human behavior,” we must be willing to honestly look at ourselves and admit that nobody has a monopoly on HIV/AIDS, and the fact that someone lived through something does not automatically give them deference on opinions just as the fact that I am HIV+ most definitely does not give me absolute authority on all things related to HIV. Rather, on the logical and science-based merits should we approach HIV/AIDS today without the baggage and trauma, both experiential on part of our elders and vicarious on part of my generation.

This is the current approach of the more misguided folks in our LGBT elder generation, generally, in relation to HIV: tossing out HIV stigmatic slurs like calling me, literally, a “murderer;” browbeating young men who bareback as “reckless;” advocating condom use over everything else; making people who bareback feel bad about themselves; shrilly obsessing over death when telling 20 year olds about the 1980s instead of honestly admitting that you were at the DCA club also getting topped on the truck bed at the bar; claiming falsely that dental dams are used widely to prevent hepatitis and so should condoms for anal sex; ignoring the fact that part of sexual liberation means engaging in natural human sexual activity like bareback sex; and, ignoring all scientific literature that refutes every single backward notion born out of 1990 and early treatment that effectively was more toxic than HIV itself.

If this approach worked, then we would not be seeing a steady rise in HIV infections.

 So, let’s stop damaging the lives and futures of young people today by taking a step back and stop forcing other people to obsess over our own memories, effectively refusing to allow these men and women to experience life on their own without the specter of a de facto Holocaust; the time of this period is over. We have antiretroviral treatment with no side effects that literally both gives us life expectancy into our 70s while simulanteously preventing us from being able to transmit HIV whatsoever (when we adhere to this medication); we are not dying, we are living. And, we are not frightened anymore because now that some of us have seen HIV for what it is. In particular, we know that HIV is a virus that will kill us if left untreated but that it is also a virus that is, today, incredibly manageable with the right governmental approach toward treatment availability like exists here in Philadelphia.

Human tragedy should never be swept under the rug or forgotten. And, we should strenuously remind folks that these things went on, that good men and women died needlessly and far too soon. But, we should not predicate our public health efforts and prevention efforts on the idea that we should force people to remember our dead friends or a tragic decade that future generations had nothing to do with. After all, if this fear-based approach was effective, nobody would get HIV anymore.

The fact that I’m writing this and HIV+ refutes that hypothesis.

This article originally appeared on Josh’s own blog here.