Asobi NY

Sex in the Age of Truvada

July 22, 2014

When I arrived in New York, the Twin Towers had already disappeared. I saw the 9/11 tragedy unfold, like most of the world, live on TV. The fact that I wasn’t physically here then didn’t diminish the sadness I felt for New York and the shock of not understanding how such a disaster could happen in the greatest city in the world.

Quickly after moving to New York City in 2007, I realized that the 9/11 memories were still fresh and alive. The war in Iraq was ongoing and conspiracy theories behind the attacks were strongly being shared on and off-line. With a clear date marked on the calendar as a day to “never forget”, It was impossible even then, not to feel vulnerable and hurt when September came by. It would be naive to say that Americans, and especially New Yorkers, feel any different now.

Almost 3,000 people died in the September 11 attacks. Although the entire country and indirectly the rest of the world was affected by this tragedy, it is not 9/11 that I want to talk about. What got me thinking about human loss and tragedy was connected to a different catastrophe that hit New York City more than 30 years ago: the AIDS crisis. According to official estimates, this pandemic has taken the lives of more than 25 million people around the globe since the first cases were reported right here in this city in 1981. These first cases were all among gay men like myself.

fear-of-unexpected-annihilationIt may be because there’s a been a lot of talk in the media recently about the initial AIDS crisis, or perhaps because what started as an off-Broadway play in 1985, created to bring awareness of the crisis in those days has finally been made into a film for TV featuring Julia Roberts and other big names. Or perhaps because I’m suddenly aware that a lot of men around me are HIV positive. I don’t know. The feeling I’m getting is that I’m mourning this loss that felt perhaps alien to me at one point- I was six years old in 1981. Like the threat of a terrorist attack, AIDS was then a fear of unexpected annihilation that could suddenly materialize. Or was such a thought simply paranoia?

In New York, the very first gay man I met happened to be HIV positive. He had gotten the virus a few years earlier but even when we met, he was still struggling with what it meant to live as ‘poz’. He was not however, the first person I met who carried the virus.

That happened in Japan in the year 2000. I had just moved to Tokyo and one night clubbing I met an American guy who was a DJ at the time. He had a motor bike and was kind of cool although not quite my type physically. But I was horny, a bit drunk and lonely. We went to his place and at some point in the night, he sat on me, bare. Personally, my least favorite sexual position. I didn’t make much of a deal about it.

Two days later I started to feel like my dick was going to explode. I went to see a doctor and it was clear that I’d gotten an STD. My doctor asked me to speak to the guy I’d just had sex with. When I called my American DJ buddy, he revealed he was HIV positive. “I assumed you were taking a risk of your own,” he said after I asked him why he hadn’t shared that information with me in the first place. “You didn’t ask,” was his conclusive explanation.

The wait for my first HIV test results was painful. The only comfort I received came from a dear friend of mine in London who kept on telling me that my risks of contracting the virus were low since I had been ‘the top’. Somehow I wanted to believe that. When my results came about and I saw ‘non-reactive’, I swore to myself to never have unprotected sex again.

My six years in Japan were a period of sexual awakening with multiple partners and I did a very good job at practicing safer sex. However, I made an exception when I went into a ‘monogamous’ relationship, only to find out that my partner hadn’t really been that committed to keeping the sex just between us. In all honesty we weren’t a great sexual match, but our desire to ‘work it out’ regardless kept us trying to stay together. Nonetheless, it was clear that it had to end somehow. One of us was going to sleep with someone else at some point. I’m sure this all sounds familiar to you. My story is not unique. The question is whether you can really trust somebody else? Or more importantly, can you trust yourself?

Moving to New York City meant for me another phase of sexual experiences. This time around, I started to explore ‘bottoming’, something I had not dared do since my first ‘boyfriend’ back in Peru. My ‘kundalini awakening’ period, as I like to describe it, was propelled by a late encounter with marijuana. I’m not saying that ‘bottoming’ is the same as experiencing a kundalini awakening, or that weed activates kundalini energy. But I can only describe my experience as the birth of my creative side, a typical occurrence when kundalini energy is activated.

Opening up to receiving sexual pleasure and letting go of my fears about doing something ‘wrong’ such as smoking pot, helped me bring balance to my life in the sense that it allowed me to calm down the mind. I am not advocating for the use of marijuana necessarily but I have decided to follow the inquisitive aspect of the old Tantrikas, known among other things for their use of psychoactive substances, like cannabis, for the exploration of ‘ecstasy‘ or ‘liberation’. I do not support however the idea of using drugs such as crystal meth for sex. Tina is a deadly and vicious drug that is destroying the lives of many people, gay men in particular, and much more should be done to bring awareness to its devastating effects in body and mind.

But I digress. I still remember how amazing I felt after having been fucked properly! My mind was not only relaxed because I’d smoked weed but because I had kept my decision to enjoy bottoming by always being safe. My body went through a period of exploration unlike any other before and I became a lot more interested in doing things for fun, in dancing, performing, acting, photography and video, and a sense of joy and liberation at allowing myself to ‘be more gay’ stayed with me for long periods of time.

The downside of my kundalini awakening was a compulsive and addictive desire for sex. When I finally decided to commit to a relationship with a local New Yorker, we both agreed that monogamy wasn’t for us, that an open relationship was a much more honest way to approach our sexual needs. We did, however, agree on always having safer sex with others and that any barebacking would be exclusively between the two of us, in private. These were interesting times and it was fun to have a partner I could engage in threesomes and groups with, while at the same time have a relationship that provided me strong and creative support. An artist himself, my partner and I collaborated in creative projects as much as getting laid. I felt fully alive and fearless. But the fun wouldn’t last for too long.

everything-changedAt the end of 2008, I left New York for three months in order to document my experience working at a factory in Japan, a typical job of many South Americans living there. To my surprise, only three weeks after leaving the city, and precisely on my birthday, my partner in New York called me to say he’d contracted HIV from someone he barely knew. Everything changed at that very moment.

I was shocked and sad for him but my anger was stronger. I was angry at my partner for not sticking to our agreement (that we wouldn’t bareback outside of our relationship), angry at the guy who’d given him the virus, and angry at myself for my poor understanding and empathy. It was especially devastating to listen to my partner over the phone telling me how weak he felt, how he thought he wasn’t going to make it, how he was completely alone with no one to care for him. Even before he zero converted, he had a weak defense system, usually suffering from one ailment to another, and we had talked several times before of how dangerous it would be to become infected with such a sensitive body.

When I returned to New York two months later, our relationship was not the same anymore. His body had adjusted to the medication and he was slowly regaining the weight he’d lost. But when I first saw him, it was clear that he wasn’t the same person I’d decided to live with. It’s hard to describe in words what I felt but it seemed as if a part of his soul had died. Perhaps what had died was the spirit that had gotten us together in the first place. I didn’t trust him anymore and he knew I was eventually going to leave him. We stayed together nonetheless.

Our new life together lacked the thrill of sex. My mind had closed off and my desire to have sex with him was dead. We didn’t have sex with other men either. We both knew our relationship was coming to an end. One day, as if to prove to each other that we could still work things out we decided to have safe sex and the condom broke. A few hours later, I was for the first time, taking a cocktail of drugs known as nPEP (non-occupational post-exposure prophylaxis) to prevent a possible HIV infection. I was on the cocktail for a month. It was not fun. My body instantly felt different, lighter, weaker, as if I’d smoked the biggest joint in the planet, leaving me without the desire to do anything. That was not fun for me, I am not the kind of pot head that yearns to become a vegetable. What was even more disruptive was my sleep. Nightmares were very common and they were so deep that I had a hard time starting my day on a positive light. Although my dreams stabilized in about two weeks, I’ve always wondered how powerful the drugs must be for their side effects go that deep into the psyche. I felt so relieved when the treatment was over. Spending the rest of my days on medication like that is certainly not something I’d look forward to.

can-a-pill-bring-back-trust-5So now that Truvada is on everybody’s mouth as an FDA-approved preventive drug against HIV infection, my first reaction is numbness. I wonder if Truvada could’ve saved my relationship had it been available back then as PrEP (pre-exposure prophylaxis) treatment. Can a pill bring back trust?

As I ponder upon this thought, I’m reminded of a comment a client of mine made. I’ll call him Ted. Ted had shared with me the dynamics of his long-term relationship. They had decided from the onset of their partnership to have an open relationship. My client defined himself as a ‘happy’ bottom. His partner provided him with not just physical satisfaction but their emotional connection allowed Ted to fully surrender to his partner. Ted had also gotten to enjoy threesomes given the fact that his partner, an exclusive top, had a tremendous sexual appetite and really got off by watching Ted get fucked.

Ted’s partner, however, was not just a voyeur but turned out to be a sex addict (for which he later started a twelve step program). His sexual adventures reached a low point when Ted found out through others that his partner was at high risk of HIV infection and suddenly the question of ‘have we all got it?’ started to ring in his mind. Again, this is not a unique story. However, what I found to be particular about their relationship was that Ted knew his partner was having unprotected sex with several other men and continued to allow his partner to penetrate him without a condom. “It’s less likely for a top to get it;” Ted told me. That was the same thought that got me into thinking that maybe I wasn’t at that much risk very early on in my sexual history. But then, how it is that an ex-partner of mine got it? How is it that a dear friend of mine, described as 99% top, became infected in 2005?

Luckily for Ted and his partner, the results came out negative, and since then they both check their status regularly. The sex between them though has dwindled. Not necessarily because of this incident but it sounds more like a natural progression of their relationship. What I found admirable was the level of open communication that Ted and his partner had from the verybeginning of their relationship. I’d argue that it’s one reason why they have remained together as a couple. They trusted each other and they still do.

But going back to PrEP, several supporters of Truvada say that it’s the perfect preventive measure for mixed-status couples, in which one partner is HIV positive. However, according to a recent study published in the journal AIDS, the risk of infection in the long term is not zero, even when antiretroviral medication, PrEP and condoms are being used.

In all cases, nothing is ever guaranteed. Every time we engage in sexual activity, we are taking a risk, whether we’re in a relationship or not. Some of the strongest supporters and users of Truvada I know happen to be single gay men. It could be argued that single gay men are more likely to have sex with different guys, a trend that has already given birth to a new ‘label’: the Truvada whores: Men on Truvada barebacking with different men.

desire-can-never-be-fulfilledA quick look on the personal ads on Craigslist at any given time will convince anyone that this is the case. The number of ads of men looking to bareback is high, but a recent post of a young man looking for a POZ to ‘breed’ him caught my eye. He described himself as ‘negative’ and ended his ad with ‘no STD’s please.’ According to studies, Truvada has to be taken daily to be effective. It can prevent HIV infection with over a 90% rate, but it does not prevent catching other STD’s. It’s hard to fathom what the ultimate desire of this young man is. Is it the ‘high’ of taking unbelievable risks? A desire to show AIDS that we are invincible again? Or does he really just want to fuck up with our minds?

Even though we are not in the 80’s anymore and the number of new HIV infections has declined compared to those days – thanks to the advancement of medicine and higher awareness of safer sex – our sexual desire and how that translates into our behaviors remains a challenge. Not a day goes by that sexual desire is absent from our minds. Desire after all is pervasive in everything we do. Technology has given us new tools to materialize some of these desires, from creating popular apps to make money, to satisfying an instant urge to have sex with an unknown neighbor just a couple of text messages away. Unfortunately, desire can never be fulfilled: we will always want more, a new experience, something else. Desire, however, can be transformed.

Larry Kramer, one of the most important voices in the history of advocacy for gay rights, recently described as ‘cowardly’ the act of taking Truvada as PrEP rather than using a condom. HIV positive himself, Kramer was advocating against the side effects of the pill and what it can do to one’s body. Many spoke out against his comments publicly, but I wonder if Kramer’s words had a depth that most don’t get to see.

‘The Normal Heart’, the autobiographical play written by Larry Kramer and now an HBO film, shows Kramer’s character, Ned, as an outsider, opposed to the free-sex attitude of gay men and later, as the AIDS crisis kicked in, as the loudest voice in the country, demanding attention to an epidemic that was widely being ignored politically. Ned was demanding we pay attention to love instead of promiscuity as much as he was pressing for political action in the height of the AIDS crisis. If Kramer calls those taking Truvada ‘cowards’, he must be advocating for a change of behavior among gay and bisexual men that goes beyond using a condom. After all, acting cowardly means living in fear.

kramer-truvada-cowwardsChanging behavior is not done by taking pills. Medication can protect us and help us battle disease; however, it is a remedy but never a cure. If we take an objective look at desire, it is easier to understand that what we want so badly right now is ultimately a thought, a cloud in our minds which sometimes can turn into a storm propelling us into action without care about consequences. Not that such an act is necessarily wrong- as a matter of fact, I believe that it is part of our human experience to err. A thought, nonetheless, can be conquered with a stronger mind.

Exercise, yoga, meditation, development of creative endeavors, and taking care of others all help to build a strong mind. The responsibility is heavier on those old enough to know better than to just act out of simple impulse. According to Dr. Donna Futterman, director of the adolescent AIDS program in the Bronx, young black and Hispanic gay and bisexual men are especially at risk of infection. If our youth is most at risk, let’s become caring mentors if we are engaging sexually with guys younger than us. If I had a teenage son who was starting to be sexually active, I would not want him to rely on a pill to protect him from getting HIV. I would want him and I would encourage him to strengthen his mind and make choices that are both connected to his emotional heart as well as his mental and physical well-being. It is sad to assume that we cannot have self-control nor inner wisdom to make a choice, and I don’t support that assumption. On the contrary, we can be educators and examples. We can have playful safe sex with different partners or we can choose carefully to engage in unprotected sex with another man if the bond shared is based on love, mutual care, and built on trust.

Sadly, this is not the kind of ‘propaganda’ the gay culture likes to promote. We’re still caught up for the most part, in the promotion of random sex, perfect bodies, youth and parties. Perhaps once gay marriage stops being a fad and becomes a mature choice, we’ll be able to talk more seriously about trust, love and care for one another.

I do not oppose the use of PrEP, quite the contrary. If I had to rely on one single source to make a point in favor of Truvada, I’d choose the following excerpt taken from a piece that appeared at  by Michael Bouldin, an ACT UP New York member: Here he starts reminiscing about the days when he was HIV negative, about a decade ago:

Millions of Deutschmarks, Pounds and Dollars thrown at ‘Use a condom, every time’ might as well have been set on fire as far as my actions were concerned. The fear that underlies AIDS education for me was now fatally damaged, its sting neutered by something far more powerful: longing and the aesthetics of the perfect male body. 

The dark side of absolutist HIV prevention based on fear, the unintended consequence, lies not only in the corruption it inflicts on any human soul capable of love; it lies in its brittleness. A hair crack will eventually shatter any pane of glass. Barebacking, which is what I was doing before I even knew the term, was exactly such a hair crack; wonder of wonders, contrary to what I had been told ad nauseam, I had done the unthinkable and was okay. Quite possibly, the emperor had no clothes, or maybe not for me, young, beautiful, and immortal as I was. 

Michael eventually became HIV positive, but my point is not to say that he got burned because he was playing with fire. My point is that I consider his words his truth:

The ultimate purpose of barebacking isn’t a matter as vulgar – vulgar in our puritanical Anglophone societies at least – as pleasure (though why pleasure itself shouldn’t be sufficiently valuable to seek out on its own merits eludes me), it is intimacy. To feel another human body with soft warm skin and a beating heart all his own, for a few shining moments set aside the fear of death for the possibility of love.

supportIf barebacking with different men became for Michael a window for a “possibility of love,” who is anyone to say that he is wrong or has a distorted point of view? The reality is, there are many men who understand Michael’s argument because they feel it as true, and being that truth is relative, then it is valid according to the person that experiences it. We would have to argue on the meaning of love here and as such we could say that loving and lusting after someone are two very different things. But I know from experience that a lot of men struggle with the dynamics of intimacy, sex and love. Do I support a lifestyle that evolves around having unprotected sex with different men? No. Do I condemn it? No. It just exists and I respect it.

Support for a more aggressive and wider endorsement of PrEP and nPEP is popping up more frequently in the press and even the State of New York has announced a plan to “end New York’s AIDS epidemic” by 2020. The state’s goal is to reduce the number of HIV infections to 750 from the current 3,000 a year. Promotion of Truvada is part of the plan. This is certainly great news, if in fact, help is available to those who need it the most: young black and Hispanic gay and bisexual men. The very recent recommendation by the World Health Organization that “men who have sex with other men [should] consider taking antiretroviral medicines as an additional method of preventing HIV infection (PrEP) alongside the use of condoms,” is as Think Progress reports meant to encourage an analysis of our behavior and take action according to how risky our sexual conduct is. 

Human loss, whether caused by natural disasters, fear, disease, terrorism or war, is unfortunately part of our history. The challenge we face is how to proceed, how to move on and learn lessons from mistakes made in the past. But most of all, it is an opportunity to reflect on the time we spend being alive. Living in fear is certainly a choice. Struggling for balance and awareness in our lives is a practice. The need or urge for sexual satisfaction will eventually die too but what will always remain is the love and care we are all capable of providing to others if we simply stop being so busy thinking about ourselves and our needs and wishes all the time.

Care for someone else and honor yourself, in body and mind: that is a first great step in changing our impulsive behavior.

© Alex Amaru 2014

Illustrations by Brad Ackerman Design

Age of Consent premieres in New York City (Saturday, July 26th) Metta Meditation for Hot Male Action or — how to practice love in sleazy bars
Age of Consent premieres in New York City (Saturday, July 26th)
Metta Meditation for Hot Male Action or — how to practice love in sleazy bars

Comments to “Sex in the Age of Truvada”

  1. Reply

    Thank you providing this touching and insightful piece. Nothing speaks more powerfully than anecdotes from personal experiences. I was once a skeptic and ignorant of the benefits of PReP… as risky behavior with those infected was a problem of everyone else except me. However, I do realize that I am human and do have moments of weakness. I thoroughly changed my mind (as a Truvada user now) after I spoke about this topic on a more serious note with some well-informed friends (some of whom are physicians… but these are people I trust who thoroughly conduct due diligence on everything and anything). They explained the finer risks and my takeaway was that this is a no-brainer. Why not for the additional level of protection and peace of mind? There is also a Facebook group that is actively posted on that talks about this topic (directly and indirectly) and provides many anecdotes and shared stories. It is also in this group that I learned that there are ways to obtain Truvada for free (something that I wouldn’t have explored since I’m a professional with good health insurance… but now I get to save on the co-pay!).
    Thanks for your thoughts on this subject, Alex.

  2. Reply

    As the author points out, trust is the factor that weighs in most on informed decisions around bare-backing. No one is 100% protected and having this second option is something to be celebrated.
    Nice job using personal experiences to facilitate an informed, sex-positive conversation on such an important topic.

  3. Reply

    So much to think about here and in your other post about Tantra on this site. What’s clear is that you take a wholistic approach to sexuality and its part in our search for happiness and fulfillment. I appreciated how you discuss the use of Truvada as a tool — not a pill-sized path to damnation, nor a panacea without drawbacks or side-effects. Just an unusually sensitive and thoughtful discussion free of the one-sided rants and judgment that characterize so many of our conversations in the gay community. Thank you!

  4. Reply

    I think this was a thoughtful and open-hearted discussion of sexuality, how we deal with our drives, and most importantly how they are connected to our deeper emotional needs. You discuss Truvada as one of many potential tools to keep a person safe and I was impressed that you didn’t feel you had to either condemn its use or hail it as a miracle prophylactic without side effects (or drawbacks.)

    Nicely done!

  5. Reply

    Great article on PrEP. I find it funny how people within the gay community can criticize Larry Kramer’s opinions – he comes from a place of understanding and with a deep-rooted history on the issue. He understands the fear of HIV has become a business for big pharma companies and PrEP is their response to continue making money from fearful “cowards”. Usually Larry means well, but his words can come across as aggressive. The issue of PrEP will continue to be controversial, but I agree with you, the pill should be used a tool for prevention not as a cure.

  6. Reply

    After reading this i have to say i quite agree with your sentiment. Im in an open marriage due to our high sexual appetites and the fact that im often in another city my husband and i both turn to others to fulfill our sexual needs. We have the sane agreement that we will not BB except with each other and i have to say Truvada scares me a bit as i already encounter so many people who are willing to have unsafe sex with someone they dont know. This attitude frightens me as i grew up in the 80’s and watched so many people die. As much as i love sex im not willing to risk my health over it and i truly wish all men would be more willing to communicate with their sexual partners and be truthful. I dont think a pill can bring back trust but rather it gives us the option to keep it out of the equation altogether which i find disheartening to say the least. Respecting yourself , your partners and the people whom you pleasure is the only way to go in my book.