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. 

Terrence Higgins Trust, generally considered the UK's leading HIV and AIDS organization, and the largest in Europe, is promoting treatment as prevention, including for gay men, on its new “It Starts With Me” campaign.

"England", it says, “can halt HIV within a generation”.  The campaign is the largest scale by THT to date, running until Spring 2015. Read their press release here. 

Cary James, Head of Health Improvement Programmes at Terrence Higgins Trust says “While a cure or vaccine for HIV remains stubbornly out of reach, what many gay men don’t realise is that medical advances mean it is now within our community’s grasp to stop the virus in its tracks. By getting as many people with HIV as possible tested and on effective treatment, we should see new infection rates fall rapidly

Says the campaign website “We are at the start of a new era in stopping the spread of HIV. We know that the combination of regular testing, HIV treatment and condom use is the key to success.

You can be part of something that changes HIV history. You are the key to stopping HIV in your own life and in the community.”

This kind of strategy marks a transition from what was commonly called poz prevention  - a concept that essentially suggested that HIVers maintaining good sexual and emotional health were better placed to make sound decisions and in doing so, help reduce new infections – to a more direct approach which stresses the benefits of treating HIV to both improve health and reduce viral load, and thus make transmission much less likely.

The campaign makes no specific mention of when to start treatment, although treatment as prevention advocates routinely suggest the earlier the better, not only as a prevention technique, but primarily because the weight of evidence now suggests it produces better health outcomes for the HIVer.

Current UK guidelines recommend treatment for all individuals with CD4 counts below 350, but if a patient with a CD4 cell count above 350 wishes to start treatment, this decision should be respected and treatment be started.

On the issue of infectivity, gay mens' sexual health sites, in the absence of hard data relating to MSM, are currently all over the map. THT says what most experts believe, that “Someone on treatment has an extremely low risk of passing on HIV if their viral load has been undetectable for six month and they are free from sexually transmitted infections. Unlike other sites, there is thankfully no talk here about that perennial red herring, virus in the semen, which tends to be found only in “trivial” amounts according to leading researcher Myron Cohen.

Using the slogan “We Can Stop HIV” the THT campaign is also interesting for drawing on issues of community solidarity and GIPA. Not that this hasn’t been employed before, but more traditional poz prevention campaigns like HIV Stops With Me worried some critics with the perception that they sent mixed messages about personal and shared responsibility. The THT campaign seems to avoid that trap.

One "off" note: the THT website includes the “official” recommendation that all gay and bisexual men test at least once a year. It's arguable that for sexually active men with multiple partners that isn’t nearly enough. Vancouver’s Health Initiative for Men (HIM) for instance says “guys who are more at risk should test every three months.”  We concur with the latter recommendations.

In Canada, only B.C. has adopted treatment as prevention strategies  in the form of test and treat and is enjoying some success in reducing new infections as are other jurisdictions such as New York, San Francisco and Washington, D.C. The issue of the efficacy of TasP for MSM is a controversial area, though, as it has been difficult to reduce incidence in that population.  Dr Julio Montaner, the leading proponent of TasP maintains the issue is not whether TasP works in MSM but how much.

“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.

Recently I was invited to my friend Mike’s birthday celebration. He decided that he wanted to relive his childhood. For him that meant renting a soccer field at the local sports complex. For Soccer? No, for dodge ball. That’s right, dodge ball. 

Imagine, if you will, a soccer field filled with roughly fifteen gay men reliving their junior high gym class nightmares. We rocked out to Taylor Dayne, Michael Jackson, and Madonna and to top it off, some of us took the 80s reference to the max by wearing sweatbands and florescent tights. If you haven’t yet, do yourself a favor and just sit with that image for a minute. Now imagine us being gawked at by group of hard-core South American soccer players who just finished their game. 

As much as I would love to joke about the actual event, because it is kind of ridiculous, I can’t remember the last time I had that much fun! The fun increased doubly when halfway through our game, two new players arrived: Brad and Mark. Both were incredibly handsome, built, and just plain hot. I assumed that they were a couple and did what any adolescent minded person would do: I made them my constant dodge ball targets. What was it that our parent’s always told us? “Those who pick on you, like you the most.”  Soon it seemed that Brad felt the same way. Did they want me to be their Lucky Pierre? Well, either that or he was hired as some sort of dodge ball hit man and I was his only target.  I was so confused. 

After the last balls were thrown we decided to head to a local sports bar to boast about our day, like any good jocks would do. From across the table I heard Mark talking about his boyfriend. So maybe no Lucky Pierre, but there was still the possibility of Brad! Two beers down and as we were falling off our chairs reminiscing about the day, Mike looked at me with wide eyes and mouthed, “Look at your phone!” It felt like I was in study hall all over again when I picked up my phone and there was a text from Mike: “Brad is crushing on you. Hard.” I felt like writing on my napkin, ‘Do you like me? Circle yes or no.’ 

I didn’t even speak to Brad for the duration of our time at bar. Around 5pm and we all decided to disperse and meet up again later at another friend’s birthday party at Bamboo 52 in Hell’s Kitchen.  After much deliberation on what to wear, Mike and I arrived to the second birthday party. Brad finally showed up about an hour later and as if we were back in Junior High Mike said, “Brad, why don’t you sit next to me?” Which landed him right next to me. Unfortunately, the Junior High quality of our interactions did not end there.  All of a sudden, with no more than three words spoken to each other, we were a couple. There was no in-depth conversation.  There was no courtship. There was no copulation. Hell, we hadn’t even played MASH.  But there we were and he would be draped over me for the entire evening.  

At first I didn’t mind it: I actually enjoyed having all this attention being paid to me. Very soon it became quite annoying. I couldn’t go anywhere. I couldn’t talk to anyone else. Before too long I was trying to make eye contact with my other friends hoping they would rescue me. I assume they were trying to be polite and not looking at us afraid they might interrupt. 

As that party ended and we all left for another bar, I decided to make a break for it and head home. I thought at least this way I could finally find some peace. Alas, Brad said, “I have to get up early and I will go with you.” Mike patted me on the back and walked away without seeing the obvious look of distress on my face. 

We hopped on the train home and I made it obvious that I really was exhausted and had an early day, so I was going straight home. The one thing that kept on going through my mind was something that my father said to me when I was a teenager. I didn’t have the best relationship with my father, but god was he right…

‘Be careful what you ask for’.