Comments on A New York Article on Gay Sex And Condom Use
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Thom McCann commented June 27
Thom McCann
New York
Larry Kramer, long-lasting gay sex proponent wrote a satirical novel "Faggots" which depicted a demimonde of men destroying themselves in wanton pleasure.
He said, "Gays really were dying like flies.”
According to the World Health Organization (WHO) the 2017 number in the U.S. is 35,000,000 million gay men dead and worldwide more than 70,000,000 gay men have died from AIDs.
There is no "end of safe gay sex."
He said, "Gays really were dying like flies.”
According to the World Health Organization (WHO) the 2017 number in the U.S. is 35,000,000 million gay men dead and worldwide more than 70,000,000 gay men have died from AIDs.
There is no "end of safe gay sex."
Jim Burroway commented June 27
So it would seem to me that this author is just one more of many who believe that gay men don't deserve the same options for sexual expression that straight men have enjoyed since time immemorial. That our love, unlike theirs, must always be sheathed. And, he has the gall to say that because we have rejected this kind of we-don't-deserve-real-sex mentality, we have lost our "radical sense of queer community."
I do have to hand it to him though. His argument is very queer -- in the early 20th century sense of the word.
I do have to hand it to him though. His argument is very queer -- in the early 20th century sense of the word.
Sabrina commented June 27
Condoms need an upgrade. There are a few promising companies, but I can only think of one (Lelo) that you can buy easily from the drugstore. Old style condoms just don't work for a lot of men which is one reason why they aren't used. Also, access to affordable female condoms (they can be used anally) would be beneficial. The only FDA approved one you need a prescription for to get it for a reasonable price or you have to pay around $50 for a box of 24.
Longue Carabine commented June 27
So important to discuss the specifics of gay sex in the NYTimes. Thanks for your contribution!
Bret commented June 27
If we want men to use condoms, then condoms have to improve. A few years ago, the Bill & Melinda Gates Foundation offerred money to anyone who could build a better condom, and for good reason. Come up with a condom that can be put on easily and worn comfortably for a long time and men will wear them. Until then, they won't. Then fact that gay men in the 1980s didn't start to use condoms until they were faced with the prospect of dying a horrific early death ought to tell us something about how awfully uncomfortale condoms feel in their present form. If we want to encourage safer sex, then building a better condom needs to be taken seriously.
Alex commented June 27
This is a very important article. I hope it is well read, and I hope it influences behavior, of people of all sexual orientations.
This AIDS epidemic of the 1970's and 1980's was a great tragedy, and these few words don't begin to describe its horrors, nor the lives lost. It occurred in large part because gay men practiced promiscuous unprotected sex, often in bath houses. This is not a moral statement, and it is not judgemental. It is simply a statement of fact. The biology of the AIDS virus is the biology of the AIDS virus. Microorganisms don't watch Fox News, and don't read the New York Times. They are what they are. We ignore biological reality at our great peril.
Condoms are the best enabler of safe sex, other than abstinence. Those who do not remember, and do not learn from, history will repeat it.
This AIDS epidemic of the 1970's and 1980's was a great tragedy, and these few words don't begin to describe its horrors, nor the lives lost. It occurred in large part because gay men practiced promiscuous unprotected sex, often in bath houses. This is not a moral statement, and it is not judgemental. It is simply a statement of fact. The biology of the AIDS virus is the biology of the AIDS virus. Microorganisms don't watch Fox News, and don't read the New York Times. They are what they are. We ignore biological reality at our great peril.
Condoms are the best enabler of safe sex, other than abstinence. Those who do not remember, and do not learn from, history will repeat it.
Domenic commented June 27
Mr. Kelly writes, "One answer is to recall the gay culture of the 1970s that gave rise to the AIDS crisis in the first place." This statement is dangerously misleading; what turned HIV/AIDS into a full-blown crisis was the genocidal politics of the actor Ronald Reagan, the Republican Party, and the fundamentalist Moral Majority. Don't blame a marginalized and stigmatized population and its culture for what a violently homophobic society has done to them.
Austin commented June 27
I have a few issues with this piece. First, the author seems to ignore the very much ongoing crisis of HIV in the US among black and latino men who have sex with men and trans women of color. If current incidence continues, 1 in 2 gay or bisexual black gay men will become HIV positive in his lifetime (1 in 4 for latino MSM). The crisis may be over for white queer folks, but systemic and institutional oppression as well as historical erasure of these communities, which Mr. Kelly may be guilty of, have resulted in a very real HIV crisis today. I would recommend reading Linda Villarosa's piece in the NYT Magazine about what the modern US epidemic looks like.
Second, the CDC's change of "safe" sex to condomless sex was done with clear biological and public health knowledge and intentions. No sex is safe sex. Let's repeat: no sex is safe sex.
Yes, condoms can greatly reduce risk of certain STIs, but they can be completely ineffective for infections like herpes, syphilis, and HPV which are transmitted through skin-to-skin contact and not through bodily fluids. Condoms can indeed make sex safer, but all sexual acts carry risk of disease. Sexual health education must be more comprehensive than condoms only, and language that centers them as the only safe sex is both biologically inaccurate and a hindrance to more in-depth sexual health education.
The reduction of condom use is alarming, but we should take about it in ways that are fully informed and don't perpetuate inequality.
Second, the CDC's change of "safe" sex to condomless sex was done with clear biological and public health knowledge and intentions. No sex is safe sex. Let's repeat: no sex is safe sex.
Yes, condoms can greatly reduce risk of certain STIs, but they can be completely ineffective for infections like herpes, syphilis, and HPV which are transmitted through skin-to-skin contact and not through bodily fluids. Condoms can indeed make sex safer, but all sexual acts carry risk of disease. Sexual health education must be more comprehensive than condoms only, and language that centers them as the only safe sex is both biologically inaccurate and a hindrance to more in-depth sexual health education.
The reduction of condom use is alarming, but we should take about it in ways that are fully informed and don't perpetuate inequality.
Tom Nevers commented June 27
Sadly, the upswing or soaring use of injecting drugs has certainly sent HIV and hep rates higher among both gays and straights.
Honeybee commented June 27
Safe sex never existed.
You risk pregnancy or an STD every time, even with a condom or other forms of birth control.
Biology is what it is.
You risk pregnancy or an STD every time, even with a condom or other forms of birth control.
Biology is what it is.
Erin B commented June 27
''...what are we to think about the millions ...of marginalized populations...without adequate access to costly and coveted drugs like PrEP? If they develop AIDS, they also struggle to acquire the triple drug therapies ... ''
NC Infectious Diseases provider here
-To all those who think HIV is only for gays and quit reading: 2 in 100 heterosexual black women will acquire HIV despite not having risk factors different from white women.
-Condoms only decrease HIV acquisition 70-80% and provide almost no protection against HSV. SO you are overselling it.
-I work in one of the Ryan White clinics. That means we have FEDERAL FUNDING to provide medications at ZERO COST TO PATIENTS. I treat tons of patients with no insurance. Ryan White clinics also have funding for transportation assistance.
EVERYONE at the time of diagnosis should now be on triple therapy with zero exceptions. Not just when you 'have AIDS'. Get tested and get treated.
-PReP is subject to the the same structural biases of the entire medical system (which we are trying hard to rectify) so this is disingenuous cherrypicking
-When PReP is prescribed, intensive counseling regarding the risk of other STIs like syphilis and encouragement of condoms still is a central part of the visit
-It is DANGEROUS to suggest to readers that both HIV diagnosis is pointless (you won't be able to afford the meds anyway!) and PReP is dangerous (youll have more condomless sex and unleash some future plague!)
NC Infectious Diseases provider here
-To all those who think HIV is only for gays and quit reading: 2 in 100 heterosexual black women will acquire HIV despite not having risk factors different from white women.
-Condoms only decrease HIV acquisition 70-80% and provide almost no protection against HSV. SO you are overselling it.
-I work in one of the Ryan White clinics. That means we have FEDERAL FUNDING to provide medications at ZERO COST TO PATIENTS. I treat tons of patients with no insurance. Ryan White clinics also have funding for transportation assistance.
EVERYONE at the time of diagnosis should now be on triple therapy with zero exceptions. Not just when you 'have AIDS'. Get tested and get treated.
-PReP is subject to the the same structural biases of the entire medical system (which we are trying hard to rectify) so this is disingenuous cherrypicking
-When PReP is prescribed, intensive counseling regarding the risk of other STIs like syphilis and encouragement of condoms still is a central part of the visit
-It is DANGEROUS to suggest to readers that both HIV diagnosis is pointless (you won't be able to afford the meds anyway!) and PReP is dangerous (youll have more condomless sex and unleash some future plague!)
Allen Shahid commented June 27
The larger part of this is that the common everyday guy (gay/bisexual or otherwise) does not feel liberated to talk about sex, what gets them off or why it does. Instead, we seek surface sexual interactions with folks while throwing caution and negotiation of sex to the wind for the sake of the climax.
Stating “Oh! I’m on PrEP” does shine a particular light on a person. And let’s be honest, it does! They become a beacon of sexual awareness, taking responsibility of their sexual lives. Inadvertently, it also says that “Oh! He got money” or has at least reached a level of stability or routine maintenance where he can afford PrEP, knows how to acquire it through Gilead’s Medication Assistance Program (if need be) and visits a doctor regularly. Acknowledging THEIR acknowledgement on how protect themselves in some way does deserve a nod. Let’s not PrEP shame.
But, all that glitters ain’t gold and whatever is done in the dark may not always come to the light; unless someone brings the sun.
Men need to talk sex and be more mindful of their partner selection, on PrEP or not. That guy that acquires PrEP may do so because he’s the frequent receptacle at the local bathhouse. He’s protecting himself in one way that he knows how, but how are YOU protecting yourself? That’s the larger question.
Not everything with three legs needs to be received or inserted into. Abstinence, foreplay and mindfulness are also hot.
Stating “Oh! I’m on PrEP” does shine a particular light on a person. And let’s be honest, it does! They become a beacon of sexual awareness, taking responsibility of their sexual lives. Inadvertently, it also says that “Oh! He got money” or has at least reached a level of stability or routine maintenance where he can afford PrEP, knows how to acquire it through Gilead’s Medication Assistance Program (if need be) and visits a doctor regularly. Acknowledging THEIR acknowledgement on how protect themselves in some way does deserve a nod. Let’s not PrEP shame.
But, all that glitters ain’t gold and whatever is done in the dark may not always come to the light; unless someone brings the sun.
Men need to talk sex and be more mindful of their partner selection, on PrEP or not. That guy that acquires PrEP may do so because he’s the frequent receptacle at the local bathhouse. He’s protecting himself in one way that he knows how, but how are YOU protecting yourself? That’s the larger question.
Not everything with three legs needs to be received or inserted into. Abstinence, foreplay and mindfulness are also hot.
Alex commented June 26
I'm a married gay man who has been monogamous for the entire ten year duration of my relationship with my husband. I remember, however, my single days when I enjoyed hook-ups and one night stands. I was vigilant about safe sex, and that meant not only using a condom, but also always being sober during sex. I met too many gay men who tried to cajole me to abandon the condom, claiming that "HIV is just like diabetes----a manageable chronic condition." I found their nonchalance appalling, and would quickly reply that even diabetes can be deadly.
Even if HIV remains a chronic manageable illness, it still poses longterm health risks, not too mention the inconvenience and cost of a daily RX regimen. I can appreciate gay men wanting to live freely without stigma and fear. To those gay men who embrace a carefree sex life without concern for STIs and safe sex, however, I share a message I saw on a safe sex poster in the 1990s: I want your body alive.
Even if HIV remains a chronic manageable illness, it still poses longterm health risks, not too mention the inconvenience and cost of a daily RX regimen. I can appreciate gay men wanting to live freely without stigma and fear. To those gay men who embrace a carefree sex life without concern for STIs and safe sex, however, I share a message I saw on a safe sex poster in the 1990s: I want your body alive.
kathy commented June 26
Prevention. A thousand times, prevention. It saves the labor of being sick, as Thomas Adams said. I was trained as a peer educator by the GMHC in 1987. Condoms are cheap, effective and have none of the side effects of medications. Manufacturers are offering many more options than before to address the legitimate complaint that there were not enough options to accommodate all men. Pills only prevent HIV, not all the other infections. The more infections one is fighting, the more difficult it is to be as healthy as we all want to be. Learn from history, don't repeat it!
Andrew K commented June 26
As a much older gay man, I am pleased that younger gay men today are being sparred the wrenching and dark days of the height of the HIV plague. As a retired hospital and healthcare insurance executive, I have mixed thoughts.
In many markets, the market price for health insurance for a man under 30 is in the range of $350 to $500 per month. In these same markets, the monthly cost to the insurance company -- just for the drug PrEP -- can run $1300 to $1600. PrEP is one of the many Rx drugs that is driving healthcare prices through the roof in many parts of the country, and Congress has forbidden the price fixing or control of Rx prices. The future is suggests that the price of drugs will continue to climb. Expanded use of PrEP is a small part of the growing cost of healthcare.
I try to appreciate of the $947 I pay per month now for health insurance (with a very BIG deductible) is going in a small way to offset the increased use of PrEP. As a younger gay friend of mine gleefully shared, PrEP allows him to go out and play and have lots of "fun". The marketing materials of the Drug companies that cater and focus to gay men send that message as well.
Without question, PrEP over the long term is cheaper than an HIV dx -- but condoms would be cheaper. I have to admit that at times I have trouble squaring this rationale when I look that increased global-spend that every one shares for unregulated Rx prices.
In many markets, the market price for health insurance for a man under 30 is in the range of $350 to $500 per month. In these same markets, the monthly cost to the insurance company -- just for the drug PrEP -- can run $1300 to $1600. PrEP is one of the many Rx drugs that is driving healthcare prices through the roof in many parts of the country, and Congress has forbidden the price fixing or control of Rx prices. The future is suggests that the price of drugs will continue to climb. Expanded use of PrEP is a small part of the growing cost of healthcare.
I try to appreciate of the $947 I pay per month now for health insurance (with a very BIG deductible) is going in a small way to offset the increased use of PrEP. As a younger gay friend of mine gleefully shared, PrEP allows him to go out and play and have lots of "fun". The marketing materials of the Drug companies that cater and focus to gay men send that message as well.
Without question, PrEP over the long term is cheaper than an HIV dx -- but condoms would be cheaper. I have to admit that at times I have trouble squaring this rationale when I look that increased global-spend that every one shares for unregulated Rx prices.
KG commented June 26
This interesting article could be summarized by the famous saying, "those who forget the past are doomed to repeat it." I was a medical student at the height of the AIDs epidemic. It was terrifying to anyone involved, whether gay or not. I watched people die from it. I listened to lectures by terrific infectious disease specialist who had projections that at the then rate of spread (and lack of treatment) HIV/AIDS could wipe out half or more of mankind. Science and fear (leading to safer behavior) intervened, fortunately. To read some of the replies, the next plague is a matter of when, not if. Anyone who ignores history deserves what they get. The gross injustice is the cost that will be born by those who are innocent, either in terms of their ill-health, deaths or financial burden.
1 REPLY
Roger commented June 26
I think it's important to point out that PrEP isn't 100% effective. It's possible to get HIV even while using the medications. That said, PrEP is an important tool to help prevent the spread of HIV, but it doesn't fully alleviate the need for condoms and safe sexual practices.
Tim Murphy commented June 26
"AIDS is no longer a crisis, at least in the United States." ??? And you're an AIDS scholar? As someone who has been reporting on HIVAIDS for more than 25 years, I urge you to do some research on black gay men and trans women, esp. in the Deep South who are still struggling with Africa-comparable rates of HIV and AIDS...amid the worst healthcare options in the country. And if you knew those rates and still made the above comment at least without a caveat, that's deliberately misleading scholarship. And also troubling that your NYT let that pass as well.
N. Fidel commented June 26
What exactly is the point of this commentary? Is it surprising to discover a linkage between declining condom and an increase in STDs? Why cry, if people (mostly gay men) want to ignore the risks associated with unprotected anal intercourse? Pitching personal responsibility to the wind, or rather to pharmacological option is more than absurd.
Joseph John Amato commented June 26
June 26, 2018
Title - the end of safe sex rampant and just stupid.
Surely we need this reminder that our love mean safety first.
How can we love and then be careless with the one - mainly one, we love sexually. Best we remind all that disease is what we must care to avoid and giving the gift of love and sex is very high civility and just not to ever fool oneself and another. Be true, be kind and have safe time to enjoy both brains firstly....
Title - the end of safe sex rampant and just stupid.
Surely we need this reminder that our love mean safety first.
How can we love and then be careless with the one - mainly one, we love sexually. Best we remind all that disease is what we must care to avoid and giving the gift of love and sex is very high civility and just not to ever fool oneself and another. Be true, be kind and have safe time to enjoy both brains firstly....
Mark S. King commented June 26
As someone carrying HIV antibodies older than Mr. Kelly, let me assure him that the decline in use of the once-obligatory condom does not spell the end of civilization, gay or otherwise. Instead, gay men are making, by and large, informed choices and adjusting behaviors as best they can in the current, non-crisis climate. And as an old AIDS activism warhorse, that is exactly why I fought in the streets decades ago. If the price of a greatly diminished AIDS crisis is some classic youthful apathy, then great. I'll take it.
Most offensive of all is Mr. Kelly equating passionate, risky choices to some kind of death wish or psychosis. Please. Can you imagine anyone writing this way about the hetersexxual STI's or unplanned pregnancies? ("Carnivorous sexual selves?" "Primordial?") Gay men are human, nothing more or less, and capable of the same urges, mistakes, and escapist behaviors of anyone else. Only when this kind of finger-pointing and double standards stop will be ever be able to approach gay sex -- and gay men -- as healthy and worthy of pleasure and self care.
Most offensive of all is Mr. Kelly equating passionate, risky choices to some kind of death wish or psychosis. Please. Can you imagine anyone writing this way about the hetersexxual STI's or unplanned pregnancies? ("Carnivorous sexual selves?" "Primordial?") Gay men are human, nothing more or less, and capable of the same urges, mistakes, and escapist behaviors of anyone else. Only when this kind of finger-pointing and double standards stop will be ever be able to approach gay sex -- and gay men -- as healthy and worthy of pleasure and self care.
Dan Stackhouse commented June 26
All good information, but I doubt the populations at risk will pay any attention to it. AIDS still exists, there is no vaccine, there is no cure, and yet condom use is plummeting. So, people are in denial, and they want to live hedonistic lives unafraid of the consequences. So they will suffer the consequences.
I'm a straight guy who doesn't have sex often (sadly), nor do I ever inject drugs, so AIDS really isn't a threat to me. But I still use a condom all the time. Maybe I'm just older and smarter than the people who are choosing to rely on blind luck rather than condoms to avoid AIDS and S.T.I.'s.
But since I'm doing the smart thing, I have no sympathy for people who choose not to do the smart thing, and wind up getting infected. There is plenty of information out there about how to avoid infection. If people make bad choices, that's really on them.
I'm a straight guy who doesn't have sex often (sadly), nor do I ever inject drugs, so AIDS really isn't a threat to me. But I still use a condom all the time. Maybe I'm just older and smarter than the people who are choosing to rely on blind luck rather than condoms to avoid AIDS and S.T.I.'s.
But since I'm doing the smart thing, I have no sympathy for people who choose not to do the smart thing, and wind up getting infected. There is plenty of information out there about how to avoid infection. If people make bad choices, that's really on them.
REJ commented June 26
At the risk of sounding like a terminal prude I'd like to point out a capital T Truth. Two virgins that remain in a monogamous relationship for life will never contract ANY STI. It certainly points to the wisdom of 'old-fashioned' sexual morality.
Ecce Homo commented June 26
I agree that gay men should use condoms. But I've been reading this kind of alarmist talk, literally for decades now, about how gay men have supposedly stopped being careful. I don't think the data bears out the alarm, and unnecessary alarm risks alienating the very people who need to be reached.
HIV-related mortality in the U.S. has dropped drastically since its peak - just 6,465 deaths in 2015, the most recent year for which the CDC has published final data. Diabetes killed 79,535 that year; heart disease took 633,842 lives.
The author neglects three matters that should reduce his level of alarm.
First, although the author acknowledges that many HIV-negative gay men are taking PrEP, he fails to consider the fact that many HIV-positive men are taking highly effective anti-HIV medications that reduce the infected person's viral load so low that it is undetectable in blood tests. These medications have dramatically reduced new infections.
Second, HIV-positive gay men may choose to engage in condomless sex with other HIV-positive men. There is no risk of new infection from sex between two HIV-positive partners.
And third, even when HIV-positive and HIV-negative partners engage in condomless sex, they may limit their sexual practices to those that pose little to no risk of infection to the uninfected partner.
It's not accurate to condemn all gay men who do not always use condoms as having "no memory or interest in the devastation" that AIDS once caused.
HIV-related mortality in the U.S. has dropped drastically since its peak - just 6,465 deaths in 2015, the most recent year for which the CDC has published final data. Diabetes killed 79,535 that year; heart disease took 633,842 lives.
The author neglects three matters that should reduce his level of alarm.
First, although the author acknowledges that many HIV-negative gay men are taking PrEP, he fails to consider the fact that many HIV-positive men are taking highly effective anti-HIV medications that reduce the infected person's viral load so low that it is undetectable in blood tests. These medications have dramatically reduced new infections.
Second, HIV-positive gay men may choose to engage in condomless sex with other HIV-positive men. There is no risk of new infection from sex between two HIV-positive partners.
And third, even when HIV-positive and HIV-negative partners engage in condomless sex, they may limit their sexual practices to those that pose little to no risk of infection to the uninfected partner.
It's not accurate to condemn all gay men who do not always use condoms as having "no memory or interest in the devastation" that AIDS once caused.
iain mackenzie commented June 26
"More troubling, condom use among non-gay men is also down significantly."
I was straight... now I am "non-gay"???
I was straight... now I am "non-gay"???
1 REPLY
io commented June 27
Yup, because until you specify, you could be bisexual. In the context of the article, especially, the unconventional paradigm makes sense.
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Thom McCann commented June 27
Larry Kramer, long-lasting gay sex proponent wrote a satirical novel "Faggots" which depicted a demimonde of men destroying themselves in wanton pleasure.
He said, "Gays really were dying like flies.”
According to the World Health Organization (WHO) the 2017 number in the U.S. is 35,000,000 million gay men dead and worldwide more than 70,000,000 gay men have died from AIDs.
There is no "end of safe gay sex."
He said, "Gays really were dying like flies.”
According to the World Health Organization (WHO) the 2017 number in the U.S. is 35,000,000 million gay men dead and worldwide more than 70,000,000 gay men have died from AIDs.
There is no "end of safe gay sex."
Jim Burroway commented June 27
So it would seem to me that this author is just one more of many who believe that gay men don't deserve the same options for sexual expression that straight men have enjoyed since time immemorial. That our love, unlike theirs, must always be sheathed. And, he has the gall to say that because we have rejected this kind of we-don't-deserve-real-sex mentality, we have lost our "radical sense of queer community."
I do have to hand it to him though. His argument is very queer -- in the early 20th century sense of the word.
I do have to hand it to him though. His argument is very queer -- in the early 20th century sense of the word.
Sabrina commented June 27
Condoms need an upgrade. There are a few promising companies, but I can only think of one (Lelo) that you can buy easily from the drugstore. Old style condoms just don't work for a lot of men which is one reason why they aren't used. Also, access to affordable female condoms (they can be used anally) would be beneficial. The only FDA approved one you need a prescription for to get it for a reasonable price or you have to pay around $50 for a box of 24.
Longue Carabine commented June 27
So important to discuss the specifics of gay sex in the NYTimes. Thanks for your contribution!
Bret commented June 27
If we want men to use condoms, then condoms have to improve. A few years ago, the Bill & Melinda Gates Foundation offerred money to anyone who could build a better condom, and for good reason. Come up with a condom that can be put on easily and worn comfortably for a long time and men will wear them. Until then, they won't. Then fact that gay men in the 1980s didn't start to use condoms until they were faced with the prospect of dying a horrific early death ought to tell us something about how awfully uncomfortale condoms feel in their present form. If we want to encourage safer sex, then building a better condom needs to be taken seriously.
Alex commented June 27
This is a very important article. I hope it is well read, and I hope it influences behavior, of people of all sexual orientations.
This AIDS epidemic of the 1970's and 1980's was a great tragedy, and these few words don't begin to describe its horrors, nor the lives lost. It occurred in large part because gay men practiced promiscuous unprotected sex, often in bath houses. This is not a moral statement, and it is not judgemental. It is simply a statement of fact. The biology of the AIDS virus is the biology of the AIDS virus. Microorganisms don't watch Fox News, and don't read the New York Times. They are what they are. We ignore biological reality at our great peril.
Condoms are the best enabler of safe sex, other than abstinence. Those who do not remember, and do not learn from, history will repeat it.
This AIDS epidemic of the 1970's and 1980's was a great tragedy, and these few words don't begin to describe its horrors, nor the lives lost. It occurred in large part because gay men practiced promiscuous unprotected sex, often in bath houses. This is not a moral statement, and it is not judgemental. It is simply a statement of fact. The biology of the AIDS virus is the biology of the AIDS virus. Microorganisms don't watch Fox News, and don't read the New York Times. They are what they are. We ignore biological reality at our great peril.
Condoms are the best enabler of safe sex, other than abstinence. Those who do not remember, and do not learn from, history will repeat it.
Domenic commented June 27
Mr. Kelly writes, "One answer is to recall the gay culture of the 1970s that gave rise to the AIDS crisis in the first place." This statement is dangerously misleading; what turned HIV/AIDS into a full-blown crisis was the genocidal politics of the actor Ronald Reagan, the Republican Party, and the fundamentalist Moral Majority. Don't blame a marginalized and stigmatized population and its culture for what a violently homophobic society has done to them.
Austin commented June 27
I have a few issues with this piece. First, the author seems to ignore the very much ongoing crisis of HIV in the US among black and latino men who have sex with men and trans women of color. If current incidence continues, 1 in 2 gay or bisexual black gay men will become HIV positive in his lifetime (1 in 4 for latino MSM). The crisis may be over for white queer folks, but systemic and institutional oppression as well as historical erasure of these communities, which Mr. Kelly may be guilty of, have resulted in a very real HIV crisis today. I would recommend reading Linda Villarosa's piece in the NYT Magazine about what the modern US epidemic looks like.
Second, the CDC's change of "safe" sex to condomless sex was done with clear biological and public health knowledge and intentions. No sex is safe sex. Let's repeat: no sex is safe sex.
Yes, condoms can greatly reduce risk of certain STIs, but they can be completely ineffective for infections like herpes, syphilis, and HPV which are transmitted through skin-to-skin contact and not through bodily fluids. Condoms can indeed make sex safer, but all sexual acts carry risk of disease. Sexual health education must be more comprehensive than condoms only, and language that centers them as the only safe sex is both biologically inaccurate and a hindrance to more in-depth sexual health education.
The reduction of condom use is alarming, but we should take about it in ways that are fully informed and don't perpetuate inequality.
Second, the CDC's change of "safe" sex to condomless sex was done with clear biological and public health knowledge and intentions. No sex is safe sex. Let's repeat: no sex is safe sex.
Yes, condoms can greatly reduce risk of certain STIs, but they can be completely ineffective for infections like herpes, syphilis, and HPV which are transmitted through skin-to-skin contact and not through bodily fluids. Condoms can indeed make sex safer, but all sexual acts carry risk of disease. Sexual health education must be more comprehensive than condoms only, and language that centers them as the only safe sex is both biologically inaccurate and a hindrance to more in-depth sexual health education.
The reduction of condom use is alarming, but we should take about it in ways that are fully informed and don't perpetuate inequality.
Tom Nevers commented June 27
Sadly, the upswing or soaring use of injecting drugs has certainly sent HIV and hep rates higher among both gays and straights.
Honeybee commented June 27
Safe sex never existed.
You risk pregnancy or an STD every time, even with a condom or other forms of birth control.
Biology is what it is.
You risk pregnancy or an STD every time, even with a condom or other forms of birth control.
Biology is what it is.
Erin B commented June 27
''...what are we to think about the millions ...of marginalized populations...without adequate access to costly and coveted drugs like PrEP? If they develop AIDS, they also struggle to acquire the triple drug therapies ... ''
NC Infectious Diseases provider here
-To all those who think HIV is only for gays and quit reading: 2 in 100 heterosexual black women will acquire HIV despite not having risk factors different from white women.
-Condoms only decrease HIV acquisition 70-80% and provide almost no protection against HSV. SO you are overselling it.
-I work in one of the Ryan White clinics. That means we have FEDERAL FUNDING to provide medications at ZERO COST TO PATIENTS. I treat tons of patients with no insurance. Ryan White clinics also have funding for transportation assistance.
EVERYONE at the time of diagnosis should now be on triple therapy with zero exceptions. Not just when you 'have AIDS'. Get tested and get treated.
-PReP is subject to the the same structural biases of the entire medical system (which we are trying hard to rectify) so this is disingenuous cherrypicking
-When PReP is prescribed, intensive counseling regarding the risk of other STIs like syphilis and encouragement of condoms still is a central part of the visit
-It is DANGEROUS to suggest to readers that both HIV diagnosis is pointless (you won't be able to afford the meds anyway!) and PReP is dangerous (youll have more condomless sex and unleash some future plague!)
NC Infectious Diseases provider here
-To all those who think HIV is only for gays and quit reading: 2 in 100 heterosexual black women will acquire HIV despite not having risk factors different from white women.
-Condoms only decrease HIV acquisition 70-80% and provide almost no protection against HSV. SO you are overselling it.
-I work in one of the Ryan White clinics. That means we have FEDERAL FUNDING to provide medications at ZERO COST TO PATIENTS. I treat tons of patients with no insurance. Ryan White clinics also have funding for transportation assistance.
EVERYONE at the time of diagnosis should now be on triple therapy with zero exceptions. Not just when you 'have AIDS'. Get tested and get treated.
-PReP is subject to the the same structural biases of the entire medical system (which we are trying hard to rectify) so this is disingenuous cherrypicking
-When PReP is prescribed, intensive counseling regarding the risk of other STIs like syphilis and encouragement of condoms still is a central part of the visit
-It is DANGEROUS to suggest to readers that both HIV diagnosis is pointless (you won't be able to afford the meds anyway!) and PReP is dangerous (youll have more condomless sex and unleash some future plague!)
Allen Shahid commented June 27
The larger part of this is that the common everyday guy (gay/bisexual or otherwise) does not feel liberated to talk about sex, what gets them off or why it does. Instead, we seek surface sexual interactions with folks while throwing caution and negotiation of sex to the wind for the sake of the climax.
Stating “Oh! I’m on PrEP” does shine a particular light on a person. And let’s be honest, it does! They become a beacon of sexual awareness, taking responsibility of their sexual lives. Inadvertently, it also says that “Oh! He got money” or has at least reached a level of stability or routine maintenance where he can afford PrEP, knows how to acquire it through Gilead’s Medication Assistance Program (if need be) and visits a doctor regularly. Acknowledging THEIR acknowledgement on how protect themselves in some way does deserve a nod. Let’s not PrEP shame.
But, all that glitters ain’t gold and whatever is done in the dark may not always come to the light; unless someone brings the sun.
Men need to talk sex and be more mindful of their partner selection, on PrEP or not. That guy that acquires PrEP may do so because he’s the frequent receptacle at the local bathhouse. He’s protecting himself in one way that he knows how, but how are YOU protecting yourself? That’s the larger question.
Not everything with three legs needs to be received or inserted into. Abstinence, foreplay and mindfulness are also hot.
Stating “Oh! I’m on PrEP” does shine a particular light on a person. And let’s be honest, it does! They become a beacon of sexual awareness, taking responsibility of their sexual lives. Inadvertently, it also says that “Oh! He got money” or has at least reached a level of stability or routine maintenance where he can afford PrEP, knows how to acquire it through Gilead’s Medication Assistance Program (if need be) and visits a doctor regularly. Acknowledging THEIR acknowledgement on how protect themselves in some way does deserve a nod. Let’s not PrEP shame.
But, all that glitters ain’t gold and whatever is done in the dark may not always come to the light; unless someone brings the sun.
Men need to talk sex and be more mindful of their partner selection, on PrEP or not. That guy that acquires PrEP may do so because he’s the frequent receptacle at the local bathhouse. He’s protecting himself in one way that he knows how, but how are YOU protecting yourself? That’s the larger question.
Not everything with three legs needs to be received or inserted into. Abstinence, foreplay and mindfulness are also hot.
Alex commented June 26
I'm a married gay man who has been monogamous for the entire ten year duration of my relationship with my husband. I remember, however, my single days when I enjoyed hook-ups and one night stands. I was vigilant about safe sex, and that meant not only using a condom, but also always being sober during sex. I met too many gay men who tried to cajole me to abandon the condom, claiming that "HIV is just like diabetes----a manageable chronic condition." I found their nonchalance appalling, and would quickly reply that even diabetes can be deadly.
Even if HIV remains a chronic manageable illness, it still poses longterm health risks, not too mention the inconvenience and cost of a daily RX regimen. I can appreciate gay men wanting to live freely without stigma and fear. To those gay men who embrace a carefree sex life without concern for STIs and safe sex, however, I share a message I saw on a safe sex poster in the 1990s: I want your body alive.
Even if HIV remains a chronic manageable illness, it still poses longterm health risks, not too mention the inconvenience and cost of a daily RX regimen. I can appreciate gay men wanting to live freely without stigma and fear. To those gay men who embrace a carefree sex life without concern for STIs and safe sex, however, I share a message I saw on a safe sex poster in the 1990s: I want your body alive.
kathy commented June 26
Prevention. A thousand times, prevention. It saves the labor of being sick, as Thomas Adams said. I was trained as a peer educator by the GMHC in 1987. Condoms are cheap, effective and have none of the side effects of medications. Manufacturers are offering many more options than before to address the legitimate complaint that there were not enough options to accommodate all men. Pills only prevent HIV, not all the other infections. The more infections one is fighting, the more difficult it is to be as healthy as we all want to be. Learn from history, don't repeat it!
Andrew K commented June 26
As a much older gay man, I am pleased that younger gay men today are being sparred the wrenching and dark days of the height of the HIV plague. As a retired hospital and healthcare insurance executive, I have mixed thoughts.
In many markets, the market price for health insurance for a man under 30 is in the range of $350 to $500 per month. In these same markets, the monthly cost to the insurance company -- just for the drug PrEP -- can run $1300 to $1600. PrEP is one of the many Rx drugs that is driving healthcare prices through the roof in many parts of the country, and Congress has forbidden the price fixing or control of Rx prices. The future is suggests that the price of drugs will continue to climb. Expanded use of PrEP is a small part of the growing cost of healthcare.
I try to appreciate of the $947 I pay per month now for health insurance (with a very BIG deductible) is going in a small way to offset the increased use of PrEP. As a younger gay friend of mine gleefully shared, PrEP allows him to go out and play and have lots of "fun". The marketing materials of the Drug companies that cater and focus to gay men send that message as well.
Without question, PrEP over the long term is cheaper than an HIV dx -- but condoms would be cheaper. I have to admit that at times I have trouble squaring this rationale when I look that increased global-spend that every one shares for unregulated Rx prices.
In many markets, the market price for health insurance for a man under 30 is in the range of $350 to $500 per month. In these same markets, the monthly cost to the insurance company -- just for the drug PrEP -- can run $1300 to $1600. PrEP is one of the many Rx drugs that is driving healthcare prices through the roof in many parts of the country, and Congress has forbidden the price fixing or control of Rx prices. The future is suggests that the price of drugs will continue to climb. Expanded use of PrEP is a small part of the growing cost of healthcare.
I try to appreciate of the $947 I pay per month now for health insurance (with a very BIG deductible) is going in a small way to offset the increased use of PrEP. As a younger gay friend of mine gleefully shared, PrEP allows him to go out and play and have lots of "fun". The marketing materials of the Drug companies that cater and focus to gay men send that message as well.
Without question, PrEP over the long term is cheaper than an HIV dx -- but condoms would be cheaper. I have to admit that at times I have trouble squaring this rationale when I look that increased global-spend that every one shares for unregulated Rx prices.
KG commented June 26
This interesting article could be summarized by the famous saying, "those who forget the past are doomed to repeat it." I was a medical student at the height of the AIDs epidemic. It was terrifying to anyone involved, whether gay or not. I watched people die from it. I listened to lectures by terrific infectious disease specialist who had projections that at the then rate of spread (and lack of treatment) HIV/AIDS could wipe out half or more of mankind. Science and fear (leading to safer behavior) intervened, fortunately. To read some of the replies, the next plague is a matter of when, not if. Anyone who ignores history deserves what they get. The gross injustice is the cost that will be born by those who are innocent, either in terms of their ill-health, deaths or financial burden.
1 REPLY
Roger commented June 26
I think it's important to point out that PrEP isn't 100% effective. It's possible to get HIV even while using the medications. That said, PrEP is an important tool to help prevent the spread of HIV, but it doesn't fully alleviate the need for condoms and safe sexual practices.
Tim Murphy commented June 26
"AIDS is no longer a crisis, at least in the United States." ??? And you're an AIDS scholar? As someone who has been reporting on HIVAIDS for more than 25 years, I urge you to do some research on black gay men and trans women, esp. in the Deep South who are still struggling with Africa-comparable rates of HIV and AIDS...amid the worst healthcare options in the country. And if you knew those rates and still made the above comment at least without a caveat, that's deliberately misleading scholarship. And also troubling that your NYT let that pass as well.
N. Fidel commented June 26
What exactly is the point of this commentary? Is it surprising to discover a linkage between declining condom and an increase in STDs? Why cry, if people (mostly gay men) want to ignore the risks associated with unprotected anal intercourse? Pitching personal responsibility to the wind, or rather to pharmacological option is more than absurd.
Joseph John Amato commented June 26
June 26, 2018
Title - the end of safe sex rampant and just stupid.
Surely we need this reminder that our love mean safety first.
How can we love and then be careless with the one - mainly one, we love sexually. Best we remind all that disease is what we must care to avoid and giving the gift of love and sex is very high civility and just not to ever fool oneself and another. Be true, be kind and have safe time to enjoy both brains firstly....
Title - the end of safe sex rampant and just stupid.
Surely we need this reminder that our love mean safety first.
How can we love and then be careless with the one - mainly one, we love sexually. Best we remind all that disease is what we must care to avoid and giving the gift of love and sex is very high civility and just not to ever fool oneself and another. Be true, be kind and have safe time to enjoy both brains firstly....
Mark S. King commented June 26
As someone carrying HIV antibodies older than Mr. Kelly, let me assure him that the decline in use of the once-obligatory condom does not spell the end of civilization, gay or otherwise. Instead, gay men are making, by and large, informed choices and adjusting behaviors as best they can in the current, non-crisis climate. And as an old AIDS activism warhorse, that is exactly why I fought in the streets decades ago. If the price of a greatly diminished AIDS crisis is some classic youthful apathy, then great. I'll take it.
Most offensive of all is Mr. Kelly equating passionate, risky choices to some kind of death wish or psychosis. Please. Can you imagine anyone writing this way about the hetersexxual STI's or unplanned pregnancies? ("Carnivorous sexual selves?" "Primordial?") Gay men are human, nothing more or less, and capable of the same urges, mistakes, and escapist behaviors of anyone else. Only when this kind of finger-pointing and double standards stop will be ever be able to approach gay sex -- and gay men -- as healthy and worthy of pleasure and self care.
Most offensive of all is Mr. Kelly equating passionate, risky choices to some kind of death wish or psychosis. Please. Can you imagine anyone writing this way about the hetersexxual STI's or unplanned pregnancies? ("Carnivorous sexual selves?" "Primordial?") Gay men are human, nothing more or less, and capable of the same urges, mistakes, and escapist behaviors of anyone else. Only when this kind of finger-pointing and double standards stop will be ever be able to approach gay sex -- and gay men -- as healthy and worthy of pleasure and self care.
Dan Stackhouse commented June 26
All good information, but I doubt the populations at risk will pay any attention to it. AIDS still exists, there is no vaccine, there is no cure, and yet condom use is plummeting. So, people are in denial, and they want to live hedonistic lives unafraid of the consequences. So they will suffer the consequences.
I'm a straight guy who doesn't have sex often (sadly), nor do I ever inject drugs, so AIDS really isn't a threat to me. But I still use a condom all the time. Maybe I'm just older and smarter than the people who are choosing to rely on blind luck rather than condoms to avoid AIDS and S.T.I.'s.
But since I'm doing the smart thing, I have no sympathy for people who choose not to do the smart thing, and wind up getting infected. There is plenty of information out there about how to avoid infection. If people make bad choices, that's really on them.
I'm a straight guy who doesn't have sex often (sadly), nor do I ever inject drugs, so AIDS really isn't a threat to me. But I still use a condom all the time. Maybe I'm just older and smarter than the people who are choosing to rely on blind luck rather than condoms to avoid AIDS and S.T.I.'s.
But since I'm doing the smart thing, I have no sympathy for people who choose not to do the smart thing, and wind up getting infected. There is plenty of information out there about how to avoid infection. If people make bad choices, that's really on them.
REJ commented June 26
At the risk of sounding like a terminal prude I'd like to point out a capital T Truth. Two virgins that remain in a monogamous relationship for life will never contract ANY STI. It certainly points to the wisdom of 'old-fashioned' sexual morality.
Ecce Homo commented June 26
I agree that gay men should use condoms. But I've been reading this kind of alarmist talk, literally for decades now, about how gay men have supposedly stopped being careful. I don't think the data bears out the alarm, and unnecessary alarm risks alienating the very people who need to be reached.
HIV-related mortality in the U.S. has dropped drastically since its peak - just 6,465 deaths in 2015, the most recent year for which the CDC has published final data. Diabetes killed 79,535 that year; heart disease took 633,842 lives.
The author neglects three matters that should reduce his level of alarm.
First, although the author acknowledges that many HIV-negative gay men are taking PrEP, he fails to consider the fact that many HIV-positive men are taking highly effective anti-HIV medications that reduce the infected person's viral load so low that it is undetectable in blood tests. These medications have dramatically reduced new infections.
Second, HIV-positive gay men may choose to engage in condomless sex with other HIV-positive men. There is no risk of new infection from sex between two HIV-positive partners.
And third, even when HIV-positive and HIV-negative partners engage in condomless sex, they may limit their sexual practices to those that pose little to no risk of infection to the uninfected partner.
It's not accurate to condemn all gay men who do not always use condoms as having "no memory or interest in the devastation" that AIDS once caused.
HIV-related mortality in the U.S. has dropped drastically since its peak - just 6,465 deaths in 2015, the most recent year for which the CDC has published final data. Diabetes killed 79,535 that year; heart disease took 633,842 lives.
The author neglects three matters that should reduce his level of alarm.
First, although the author acknowledges that many HIV-negative gay men are taking PrEP, he fails to consider the fact that many HIV-positive men are taking highly effective anti-HIV medications that reduce the infected person's viral load so low that it is undetectable in blood tests. These medications have dramatically reduced new infections.
Second, HIV-positive gay men may choose to engage in condomless sex with other HIV-positive men. There is no risk of new infection from sex between two HIV-positive partners.
And third, even when HIV-positive and HIV-negative partners engage in condomless sex, they may limit their sexual practices to those that pose little to no risk of infection to the uninfected partner.
It's not accurate to condemn all gay men who do not always use condoms as having "no memory or interest in the devastation" that AIDS once caused.
iain mackenzie commented June 26
"More troubling, condom use among non-gay men is also down significantly."
I was straight... now I am "non-gay"???
I was straight... now I am "non-gay"???
James commented June 26
Thanks, Patrick, for being like so many other liberal, white LGBT activists who never fail to find some way to point out how horrible life is for "black men who have sex with men." Clearly, we're all suffering from AIDS, so next time you or one of your friends is contemplating a relationship, do like so many of the dating apps allow one to do, and screen the other person's race so you can lower your % of catching AIDS! Do you not see how publishing such statements can be harmful? I'm sure you'd have some high-minded response...
Ben Ryan commented June 26
This author gets a lot of his interpretation of the data wrong. The bit about PrEP being associated with a 44.6-fold increase in syphilis points solely to the fact that people who go on PrEP are having very high-risk sex, which is why they went on PrEP in the first place. That analysis said nothing about whether PrEP led men to get more STIs while they were on it; the Australian study was the one that said that. Also, one cannot conclude that the CDC's shift from "unprotected" to "condomless" verbiage is encouraging condomless sex; that shift was necessary to speak more precisely about safer sex in the age of PrEP, when taking PrEP makes someone protected against HIV in particular without the need for a condom. The author also strangely suggests that one needs to "develop AIDS" to go on HIV treatment, whereas for three years now the World Health Organization has recommended immediate treatment for all those who test positive for HIV.
Cuernavaca Andalusia commented June 26
I’ve counseled many men, working on issues regarding their relationship to their fathers, only to find that heterosexual feelings emerge. Not even addressing their homosexuality! There was the resolution of an inner conflict, and something different arose.
But today you cannot mention this. People will call me a hater and will tell me how awful, blah blah blah, yet the gay identity is something (at least sometimes) worthy of interrogation. That is what pushes many men into dangerously promiscuous lifestyles. What’s terrible and dangerous is to just sweep contrarian voices under the rug. That is immoral.
But today you cannot mention this. People will call me a hater and will tell me how awful, blah blah blah, yet the gay identity is something (at least sometimes) worthy of interrogation. That is what pushes many men into dangerously promiscuous lifestyles. What’s terrible and dangerous is to just sweep contrarian voices under the rug. That is immoral.
SaraK commented June 26
As a physician, I wish this article were a little more balanced. By that, I mean quote Infectious Disease specialists and do not cherry pick 2 articles that are validate the author's thesis.
Let us not forget that education and prevention are always option #1, yet point out that still many gay and straight people are using condoms. Remember the pill, you know the oral contraceptive that many thought would encourage horrendous unsafe behavior in women, but did not? Let's take a deeper look at the data, the behavior and recall that perhaps there is some reporting bias here. More medical monitoring will always yield more disease, since there will be more people who are diagnosed but that does not mean there is an increased rate of infection.
I am glad there is a message of caution, but let's tell the whole story. And yes, let's keep using condoms.
Let us not forget that education and prevention are always option #1, yet point out that still many gay and straight people are using condoms. Remember the pill, you know the oral contraceptive that many thought would encourage horrendous unsafe behavior in women, but did not? Let's take a deeper look at the data, the behavior and recall that perhaps there is some reporting bias here. More medical monitoring will always yield more disease, since there will be more people who are diagnosed but that does not mean there is an increased rate of infection.
I am glad there is a message of caution, but let's tell the whole story. And yes, let's keep using condoms.
Fletcher Sandbeck commented June 26
The decline in condom use has been going for a lot longer than PrEP has been available. People who are on PrEP are taking a positive step to ensure that they don't contract the most serious sexually transmitted disease. Don't demonize people who have taken this positive step. Instead, see the fact that they are concerned about their health as an opportunity to educate them about the need to use condoms in addition to drugs.
I'm reminded of the stigma that attaches to going to a public health clinic STD test. The fact that I'm there doesn't mean that I'm "promiscuous" or engaged in risky practices. It means that I'm human and I care about my health. People waiting in line for STD tests should be applauded not shamed.
I'm reminded of the stigma that attaches to going to a public health clinic STD test. The fact that I'm there doesn't mean that I'm "promiscuous" or engaged in risky practices. It means that I'm human and I care about my health. People waiting in line for STD tests should be applauded not shamed.
David Gottfried commented June 26
The author is correct. A sort of historical amnesia has set in.
I remember the early days, when it was called "Gay Related Immuno Deficiency Disease.
Back in the days when AIDS was the illness that dare not speak its name, people with AIDS were subjected to extraordinary persecution. I remember a case, in NYC Housing Court in 83 or thereabouts, in which a man with AIDS was ruthlessly attacked. The landlord sued him for eviction. The tenant wanted to depose the landlord tto question him (available in eviction actions if one demands a plenary action -- explaning plenary actions will take up too much time). The landlord's attorney said there should be no deposition because, HE ALLEGED, IT WOULD BE TOO DANGEROUS TO SIT IN A ROOM WITH SOMEONE WHO HAD AIDS. He wanted to evict the tenant without any questions being asked because the tenant was supposedly wildly infective and could infect one without any touch at all.
I fear what will be upon us if there is a new epidemic. Viruses and bacteria can mutate. A couple of years ago, a very aggressive strain of meningitis (I don't remember the causative organism) was rampaging through the gay community. Ir was nipped in the bud. We might not always be so lucky.
I remember the early days, when it was called "Gay Related Immuno Deficiency Disease.
Back in the days when AIDS was the illness that dare not speak its name, people with AIDS were subjected to extraordinary persecution. I remember a case, in NYC Housing Court in 83 or thereabouts, in which a man with AIDS was ruthlessly attacked. The landlord sued him for eviction. The tenant wanted to depose the landlord tto question him (available in eviction actions if one demands a plenary action -- explaning plenary actions will take up too much time). The landlord's attorney said there should be no deposition because, HE ALLEGED, IT WOULD BE TOO DANGEROUS TO SIT IN A ROOM WITH SOMEONE WHO HAD AIDS. He wanted to evict the tenant without any questions being asked because the tenant was supposedly wildly infective and could infect one without any touch at all.
I fear what will be upon us if there is a new epidemic. Viruses and bacteria can mutate. A couple of years ago, a very aggressive strain of meningitis (I don't remember the causative organism) was rampaging through the gay community. Ir was nipped in the bud. We might not always be so lucky.
Matt Pizzuti commented June 26
As a gay man who cares for my community, it’s disappointing to see gay writers throw others under the bus before a mainstream audience that may be unfamiliar with the nuances of our issues.
To be clear: the horror of the HIV/AIDS crisis was a nightmare and we are glad and grateful that we have science and medicine that is putting it behind us.
PrEP is a treatment that allows us to live and love without grave fear, and with few/no side-effects. That’s science for you. Condoms are a great tool, but now that they aren’t the only tool, we now have choices.
Treatment As Prevention (the knowledge that people with HIV can become non-infectious after being on treatment) means that our friends with HIV no longer have to be alienated from their partners and community. They have real choices now too.
When I was young, we all learned condoms were important. Yet as a health strategy they were failing, as 50,000 new HIV infections showed up in our community each year.
Today, HIV infection rates are plummeting. The new strategy is working far better. The thought that this is a reason to scold and be woeful is absurd to me.
We owe a lot to our elders who fought through the HIV/AIDS crisis—but we don’t owe suffering to anyone. The fact that we are not dying now is a good thing. The fact that we have options now is a good thing. People are talking about HIV and safe sex more openly now, and taking responsibility for strategies they know they can stick to. That’s a good thing.
To be clear: the horror of the HIV/AIDS crisis was a nightmare and we are glad and grateful that we have science and medicine that is putting it behind us.
PrEP is a treatment that allows us to live and love without grave fear, and with few/no side-effects. That’s science for you. Condoms are a great tool, but now that they aren’t the only tool, we now have choices.
Treatment As Prevention (the knowledge that people with HIV can become non-infectious after being on treatment) means that our friends with HIV no longer have to be alienated from their partners and community. They have real choices now too.
When I was young, we all learned condoms were important. Yet as a health strategy they were failing, as 50,000 new HIV infections showed up in our community each year.
Today, HIV infection rates are plummeting. The new strategy is working far better. The thought that this is a reason to scold and be woeful is absurd to me.
We owe a lot to our elders who fought through the HIV/AIDS crisis—but we don’t owe suffering to anyone. The fact that we are not dying now is a good thing. The fact that we have options now is a good thing. People are talking about HIV and safe sex more openly now, and taking responsibility for strategies they know they can stick to. That’s a good thing.
Caleb McG commented June 26
People sometimes mock Christians for being prudes (and sometimes they mock justly), but there's a lot to be said for fidelity in context of the convenant of marriage. And there's a lot to be said against promiscuity, which winds up being about people using one another, no matter how one tried to spin it.
Most of us would naturally choose promiscuity over faithful marriage. Furthermore, it is difficult to remain faithful. But the consequences of our choices tell an important tale, like it or not.
Most of us would naturally choose promiscuity over faithful marriage. Furthermore, it is difficult to remain faithful. But the consequences of our choices tell an important tale, like it or not.
3 REPLIES
Dobby's sock commented June 27
Caleb,
Who thinks christians don't cheat? We all know they do, just as much as non-xtians. Check out our "Baby Xtian" Trump as living proof.
Who thinks christians don't cheat? We all know they do, just as much as non-xtians. Check out our "Baby Xtian" Trump as living proof.
raix commented June 26
No. Promiscuity, as you so call it can be about sharing pleasure with close friends or loving more than one person. You seem to equate all non monogamous sex with animal type lust.
For those of us who believe monogamy isnt for them, nor is marriage a "covenant", but a secular choice to share your life with another person, sex is an expression of caring, or an experience to share. Its fun, its enjoyable, it can be romantic or deep, but its nothing sacred. No ones "using" anyone, as feelings and expectations are discussed with any partner beforehand.
My faithfulness to my spouse is one of deep emotional fidelity. Sex doesnt enter into that fidelity, although we discuss our boundaries and relationship regularily and always practice safe sex. I have had many partners and have never gotten a disease or pregnancy. Is it more risky thn having one partner your entire life? Sure. But so is many other things humans do for fun, or the experience.
My life is fulfilling. Ive been in a non monogamous marriage for nearly 15 years. Im happy. Is it for everyone? No. But the difference being, I dont look down on those who choose to be monogamous. However, many people who view sex as sacred look down on people like me, assuming we are miserable, "it cant work" or somethings wrong with us. People would get along better if we take the time to remember "not everyone holds the same values as you.".
For those of us who believe monogamy isnt for them, nor is marriage a "covenant", but a secular choice to share your life with another person, sex is an expression of caring, or an experience to share. Its fun, its enjoyable, it can be romantic or deep, but its nothing sacred. No ones "using" anyone, as feelings and expectations are discussed with any partner beforehand.
My faithfulness to my spouse is one of deep emotional fidelity. Sex doesnt enter into that fidelity, although we discuss our boundaries and relationship regularily and always practice safe sex. I have had many partners and have never gotten a disease or pregnancy. Is it more risky thn having one partner your entire life? Sure. But so is many other things humans do for fun, or the experience.
My life is fulfilling. Ive been in a non monogamous marriage for nearly 15 years. Im happy. Is it for everyone? No. But the difference being, I dont look down on those who choose to be monogamous. However, many people who view sex as sacred look down on people like me, assuming we are miserable, "it cant work" or somethings wrong with us. People would get along better if we take the time to remember "not everyone holds the same values as you.".
Nreb commented June 26
More than the specific public-health risks of declining condom use among gay men is the shocking speed with which a sort of historical amnesia has set in ready for the next scourge to occur..
Cephalus commented June 26
Compensatory behaviour is ubiquitous. Helmet laws have been implicated in dangerous cycling behaviour, seat belts and safer cars in more aggressive and careless driving, cheaper more accessible alcohol in rising alcohol consumption. When people believe negative consequences of their behaviour are less likely, they behave worse -- just watch undergraduate students away from mom and dad and their home campus on a spring break. Preaching responsibility and hammering away at the longer term risks has gotten us, and will continue to get us, precisely no place. Gay culture is centered on hedonism and sex; promiscuity and risky behaviour are not unexpected in the absence of external constraints, social pressure and fear, just like partying is not unexpected among undergrads on spring break.
Kathryn McDonald commented June 26
A few months ago, I looked for all the early articles about GRID, AIDS, and HIV in The New York Times archives.
I was young during the height of the AIDS crisis, and it was fascinating and depressing to read about all the supposition, false leads, and crazy theories before finally pinning it down: it's a virus and it's transmitted through unprotected sex, sharing needles, and blood transfusions. (There was a theory floated for a while that the symptoms of AIDS were merely an immune response to promiscuous sex with dozens of men every month.)
It was also fascinating and depressing to read all the sheer rage coming from the gay community towards any efforts to contain the spread of the disease.
Close the bathhouses? You may as well go back to hanging gays in the public square!
For women, sex has never been "safe." It's always come with some risk -- pregnancy, STDs, sexual assault, rape, slut shaming, honor killings. Even if you're married to a loving husband, you can die in childbirth. There's not even a guarantee that it's going to feel good.
There's no civil right to consequence-free promiscuity and there never has been. Men need to do what women have always done: minimize risk and take responsibility for your own actions.
It's certainly not a civil right to expect society to pay up to $1300 a month for you to have the kind and amount of sex you want, especially when women can't get basic birth control.
I was young during the height of the AIDS crisis, and it was fascinating and depressing to read about all the supposition, false leads, and crazy theories before finally pinning it down: it's a virus and it's transmitted through unprotected sex, sharing needles, and blood transfusions. (There was a theory floated for a while that the symptoms of AIDS were merely an immune response to promiscuous sex with dozens of men every month.)
It was also fascinating and depressing to read all the sheer rage coming from the gay community towards any efforts to contain the spread of the disease.
Close the bathhouses? You may as well go back to hanging gays in the public square!
For women, sex has never been "safe." It's always come with some risk -- pregnancy, STDs, sexual assault, rape, slut shaming, honor killings. Even if you're married to a loving husband, you can die in childbirth. There's not even a guarantee that it's going to feel good.
There's no civil right to consequence-free promiscuity and there never has been. Men need to do what women have always done: minimize risk and take responsibility for your own actions.
It's certainly not a civil right to expect society to pay up to $1300 a month for you to have the kind and amount of sex you want, especially when women can't get basic birth control.
AG commented June 26
Having seen the AIDS crisis first hand, this is as stupid a human trick as could be conjured, to the point I do not give a damn to expend an ounce of pity for these folks who do not care for themselves. Drug resistant STD's are on the rise. Oral and anal cancers are on the rise Taking HIV meds for your entire life is a stone disaster, expensive and toxic.
The gay men I know blush at the suggestion of condoms and say oral sex is not truly sex, not knowing or caring about many STD's. Say I'm the only person that ever asked them before we had sex. Stupidly knows no bounds.
The gay men I know blush at the suggestion of condoms and say oral sex is not truly sex, not knowing or caring about many STD's. Say I'm the only person that ever asked them before we had sex. Stupidly knows no bounds.
Eric Key commented June 26
Once more we are confronted with a population that has no memory of how we came to be where we are. Witness the rise of the anti-vaxers who have no memory of the scourge of polio. Sadly, this is just more of the same.
S.L. commented June 26
This is making other people pay for irresponsible behavior. When AIDS was a death sentence the gay communities complained that the rest of us weren't doing enough for them. These were people who complained when NYC closed down bathhouses, where their activities in the locker rooms would have gotten heterosexuals arrested. Aids may not be the death sentence it once was but it is very expensive to treat. I am not interested in paying insurance premiums to fund irresponsible behavior. It used to be an embarrassment if someone contracted a venereal disease. Now having an STD among the gay community seems to be no problem. Their attitude is that everyone else should pay for their expensive drugs. If you don't take precautions pay for the drugs yourself. If you are proud to be gay be proud to protect yourself and your partners.
HKGuy commented June 26
As a gay man, I find it silly — at best — to compare STDs like gonorrhea and syphilis to HIV. The former, while having potentially serious consequences, are easily treatable; the latter lasts a lifetime, and, even with the meds currently available, is, like any serious chronic condition, no walk through the park.
2 REPLIES
Caleb McG commented June 26
it's not true that they are always easily treatable. there have been drug-resistant strands. plus people without health insurance may fail to get needed help even when treatable.
Ryan Xavier commented June 26
Then you need remedial sex education. There are strains of syphilis now in existence that cannot be cured by any known antibiotics.
J commented June 26
"AIDS is no longer a crisis, at least in the United States, and that is a phenomenal public-health success story."
Since it took over 30 years for HIV statistics to turn around, I'd call that a a disgraceful public health failure.
Since it took over 30 years for HIV statistics to turn around, I'd call that a a disgraceful public health failure.
Nikki commented June 26
Thank you for mentioning and linking to more information about PReP use in women. Women are often overlooked with regard to HIV and AIDS, despite making up approximately 24%of Americans living with HIV.
Thom McCann commented June 26
70,000,000 dead worldwide from AIDS.
Don't we get the message?
70,000,000 dead worldwide from AIDS.
Don't we get the message?
3 REPLIES
Dan Stackhouse commented June 26
People do not get the message that they don't want to hear. Fortunately, there is no shortage of humans. In fact, increasing death tolls can only benefit the planet.
Susan Anderson commented June 26
It's not just gays.
In a real world, we have lost common sense, thinking we can make stuff up.
Reality is not fake, and illusion is not reality.
In a real world, we have lost common sense, thinking we can make stuff up.
Reality is not fake, and illusion is not reality.
Eric B. commented June 26
"But a 2016 study by the University of California, Los Angeles illustrated that PrEP users were 25.3 times more likely to acquire gonorrhea and a shocking 44.6 times more likely to develop a syphilis infection (other studies have found no significant uptick in S.T.I. rates, however)."
The difference between 25-45 times more likely and "no significant uptick" is staggeringly large. Obviously one or more of these studies has a flaw, or some crucial caveats haven't been stated.
I use PrEP in conjunction with condoms as recommended, for obvious reasons, by the manufacturer and my prescribing doctor. I select a relatively small number of partners with caution and full disclosure. For me, PrEP is just an extra shield against HIV infection. If a PrEP user is more likely to acquire another STI, the problem isn't PrEP but the adoption of risky behavior. If PrEP encourages some users to forego other protection, than our efforts are better spent getting more education into the PrEP prescription process rather than maligning the drug itself. All other factors being equal, PrEP drastically reduces the chance of HIV infection.
The difference between 25-45 times more likely and "no significant uptick" is staggeringly large. Obviously one or more of these studies has a flaw, or some crucial caveats haven't been stated.
I use PrEP in conjunction with condoms as recommended, for obvious reasons, by the manufacturer and my prescribing doctor. I select a relatively small number of partners with caution and full disclosure. For me, PrEP is just an extra shield against HIV infection. If a PrEP user is more likely to acquire another STI, the problem isn't PrEP but the adoption of risky behavior. If PrEP encourages some users to forego other protection, than our efforts are better spent getting more education into the PrEP prescription process rather than maligning the drug itself. All other factors being equal, PrEP drastically reduces the chance of HIV infection.
Ami commented June 26
It's not just gay people who are forgetting that condoms save lives. My niece is going to college and we've been doing a lot of dorm room shopping. I insisted that she buy a box of condoms and she told me she didn't need it because she has an IUD. When I was her age it was the height of the aids crisis and the idea that condoms were only to stop pregnancy was unfathomable for me. We were taught in school and on TV that condoms were the best protection against STDs especially HIV and AIDS.
In only a generation we've forgotten everything we learned. Hopefully she will need my warning that she needs to protect herself from more than just pregnancy. We want our young people to be free of the fear that we lived with but a healthy dose of caution is the best medicine when it comes to being healthy and staying alive.
In only a generation we've forgotten everything we learned. Hopefully she will need my warning that she needs to protect herself from more than just pregnancy. We want our young people to be free of the fear that we lived with but a healthy dose of caution is the best medicine when it comes to being healthy and staying alive.
Daniel commented June 26
I think another factor the author did not mention is that HIV+ people who have an undetectable viral load are no longer considered to be able to transmit the virus. While not as significant a factor as wider adoption of PrEP, I believe that is a factor as well.
Vin commented June 26
I am gobsmacked that people would choose to put toxic chemicals into their bodies instead of practicing safe sex.
Decades of brainwashing by the pharmaceutical industry have paid off.
Decades of brainwashing by the pharmaceutical industry have paid off.
TrueLeft commented June 26
Relying on PrEP isn't Gay, it's American.
PrEP is a high tech, high expense intervention. By contrast, condom use is a readily available community-wide, low-tech, low expense public health approach.
PrEP is a high tech, high expense intervention. By contrast, condom use is a readily available community-wide, low-tech, low expense public health approach.
37Rubydog commented June 26
This is a slippery slope. Why risk it? How quickly will men who take PrEP decide - "I don't need PrEP....in all likelihood my partner takes it or is HIV-negative."
Such logic may have led to last year's loss of Composer/Lyricist Michael Friedman.
Such logic may have led to last year's loss of Composer/Lyricist Michael Friedman.
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