Thursday, February 12, 2015

Doing it safely

Lowering the Age for HIV Prevention - The Atlantic

I don't think I've ever posted about the issue of the use of Truvada, a drug that is quite successful as a "pre-exposure prophylaxis" for HIV.

This article gives a good background to it, while noting in particular the very depressing figures about how much HIV is still spreading amongst Americans, especially young black Americans:
 The number of new HIV infections in the United States has stabilized at around 50,000 per year, according to the CDC, but new infections continue to increase among gay and bisexual men. The trend is particularly acute among black men, and even more so among those between the ages of 13 and 19. New infections among young gay and bisexual black men increased by almost 50 percent between 2006 and 2009, a rate the CDC has called “alarming.”  An estimated 6 percent of black gay and bisexual men in the United States under the age of 30 are HIV-positive, according to data from a longitudinal study conducted by the HIV Prevention Trials Network.
It then goes on to talk about the question of whether it is a good idea to actually start letting under 18 year olds use it.   (Even though the issue of its use amongst adults is still controversial, including within the gay community, where some complain about being stigmatised by other gays if they let it be known they are on it. There was a very lengthy article about this in Slate a couple of months ago.  I think I have read that the Australian authorities are trialling it with a view to its possible use here too.)

I find this issue very confusing.

On the one hand, I think:   what the hell?  You really want to take a powerful (not to mention expensive - $1500 a month, apparently)  medicine continually so as to be able to sleep around instead of doing the following:   do not have casual unprotected sex.  If you want to have regular sex with someone, do it with someone who will have a HIV test, commit to you, or if you have any doubt at all about your or their commitment to monogamy, continue using condoms until you split.  That's pretty much how most straight people live vis a vis sex without condoms. Is serial monogamy such a difficult concept for the gay community?  

On the other hand, as I have posted many times over the years, I just can't understand how straight men over the centuries continually risked having sex with prostitutes and getting the incurable, horrible, deadly disease of syphilis.   If their example is any guide, it seems to indicate you just can't really trust men to be sensible about safe sex at all.  But then again, reliable and cheap condoms were not around for most of that time, so I suppose I should factor the difficulty of having safe sex into the equation.  

And if syphilis was still incurable, would I oppose men who insist on using prostitutes using a drug to prevent them getting the disease, or feel that they were also kinda pathetic for not being able to let reason put some control on their libido?

Or is there an argument that straight people have become more cautious about sex?  Given that (I think) a well regulated sex industry has pretty much stopped prostitution spreading disease, there's at least partial grounds for such an argument.  (I mean, I assume men just accept that a visit to a brothel means they have to use a condom, don't they?)   On the other hand, the rates of chlamydia amongst the young in Australia is truly startling, and a sign that straight young people really are careless about safe sex.  But is their carelessness more excusable if it's a disease that is pretty readily cured if it is caught?  And should I feel differently about a 16 year old girl who wants to be sexually active getting a hormonal injection so as to be able to do it with low risk of pregnancy, compared to a horny 17 gay dude (potentially) taking an antiviral to be able to have unsafe sex without condoms?  I don't think either of them are of an age that they should be regularly having sex, but the question of drawing lines here as to how "practical" we are to be is arguably pretty fine...

I do not know the answers.  It's hard to not get the feeling, though, that in the space of 60 odd years, Western society has swung from being too hypocritical and judgemental about sex to (in some respects) not being judgemental enough.    Certainly, any science fiction of the 20th century that assumed that sex would be completely safe, plentiful and without consequences in some sort of utopian, libertine future have proved very naive. 

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