Why Disclosure, Condom Use Have No Utility in Modern HIV Prevention

Published: June 6, 2013

Despite traditional prevention efforts, HIV infections in the gay male population are rising dramatically. According to the CDC, new HIV infections increased in the MSM population 12% from 2008 to 2010 with young men under 25 experiencing a dramatic 22% increase in rate of infection. Basically, this means that young gay men are no longer affected by decades-old HIV prevention efforts, particularly condom-based campaigns. Tiresome narratives of the sexiness of condoms, a fantasy akin to the idea that drugs are always bad or that monogamy is the inevitable conclusion of any committed relationship, are no longer helping the cause of HIV prevention but, paradoxically, leading to its demise. This is on stark display each time another media outlet publishes a story attesting to the fact that more gay men are reverting back to the 50,000 year old human practice of not using condoms. And today, MSM account for 78% of all new HIV infections even though they make up, at most, only 7% of the US population.

Unfortunately, condom-based campaigns and laughable demands of disclosure, including barbarous HIV criminalization efforts in over half of these United States, recall a time when modern combination therapies did not exist as they do today. Indeed, the fact that these therapies now blur the distinction between the HIV- and HIV+ “gay experience” matters a great deal in confronting HIV on its own contemporary terms. No longer powerless and at the mercy of happenstance, individuals living with HIV can assuredly relegate their HIV+ status to a banal and mostly irrelevant, at least in terms of social and sexual behavior, physical detail. Notwithstanding, HIV infection rates are on the rise, and it’s because of conventional wisdom that this is happening.

For instance, if HIV prevention workers scare teenagers into using condoms by saying they’ll get a potentially life threatening disease, they’re logically telling all 20,000 Philadelphians living with HIV/AIDS that they’re dying of HIV/AIDS. Curiously, the minute someone becomes HIV+, he is told by these same HIV outreach workers that he has no cause for despair or suicide; yet, for his entire life, he has been told by these same individuals that HIV is something to be frightened of, something to be avoided, something, by implication, dirty. This idea of the intrinsic, disgusting nature of HIV is best demonstrated by the lamentable term “clean” so popular by the anointed HIV- who have, typically by sheer luck and certainly not wits, avoided seroconversion. So, we are to surmise that somewhere along the HIV prevention continuum, from prevention to case management that someone is outright lying to the general public. Or, we are to surmise that the conventional wisdom in HIV prevention efforts is inherently flawed and logically incoherent.

Because of this obvious incongruity between fear based, sex-negative campaigns and compassionate yet misguided counsel to the newly diagnosed HIV+ individual, we have to change our perspective in relation to prevention to one emphasizing treatment as prevention primarily. Indeed, the value is obvious in approaching HIV prevention from the perspective of those living with the virus. In particular, regardless of whether or not these individuals are sober, high, barebacking, in a bathhouse, sex workers, married and monogamous, polyamorous, Democratic, or, in the most tragic of personal circumstances, Republican, they will not transmit HIV if they are on HIV medication and adhere to this medication. This is the driving point lost in modern HIV prevention efforts. And, no matter how many studies indicate that immediate access and adherence to modern drug therapies upon seroconversion prevents HIV transmission totally, we still encounter severe reactions by a large number of HIV prevention workers and activists. Basically, unless you’re willing to get on the bus of condom use and disclosure, you’re “hurting the cause.”

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