January 10, 2019. The day I quit. No more Truvada, no more little blue pills. Now, a few weeks later, I begin to understand why I did something none of us is supposed to do. Go off my prevention meds. We were going to put the whole world on Truvada, right? Yet, though many things were hard for me to give up when the time came, this one was easy. Not because it meant an end to the hassles with an insurance company that didn’t want to pay up, or the need to take it without fail each day, but because of something else.
I am a gay man now in his sixties, which means I am the demographic that got hit hard by the reality of premature mortality after years of sexual freedom. Sure, there were STDs in the 1970s, I had them, but a shot in the rear made them go away. You remember if you’re my age when things changed. When, after a youth spent exploring, something unanticipated surprised us at the end of it. In early-eighties New York, before I fled to the West Coast thinking it would be different there, friends were falling ill and dying either quickly or slowly. At first, we didn’t know what to do. Throw away the poppers, stop going to the baths, give up sex entirely? If Truvada had been invented then, who wouldn’t have gone on it? Who wouldn’t still be on it today? How many more of us would still be alive?
But it wasn’t available then, and once we figured out what safer sex might be, I and others who chose to set about to master it. The work was cerebral, a matter of will. A decision to pursue fewer hook-ups, or seek monogamy. Come on me, not in me. Dental dams? Gave ‘em a try, but it was easier to give up certain pleasures altogether. The real challenge was always condoms. Who in the world wanted to suit up? It took time, but finally, yes, I succeeded: I learned to eroticize condoms. The sound of a foil envelope being ripped open meant that something fun was soon to follow. It worked.
In hindsight, this might have been a kind of self-hypnosis. In fact, I am sure of it. I have used the same technique to stop other practices of self-harm, from too many cocktails to too few fruits and vegetables. I was a poster boy for safe-sex and safe-a-lot-of-things. It was hard work to stay uninfected in the 1980s and 1990s, and I don’t underestimate dumb luck in all of it, but eroticizing protection is, I am positive (because aren’t all?), what has kept me alive. But not entirely whole.
The not-whole part came clear when PrEP entered the scene. Oh, not for everyone: younger gay men embraced it, a way to do something always denied them from the start of their woke sexuality: fucking raw. Sure, the brochures told us to keep using rubbers in addition to the prescription. There were still nasty things out there. The ones we knew about and the ones, like HIV a million years ago from a young person’s point of view, might come out of nowhere to ambush us. Again.
Then this happened. Happily partnered, I nonetheless had an entirely innocent and safe evening with another gay man. The upshot? I wondered if such encounters might happen again. Should I prepare for that happenstance, however remote, of it not being so innocent or so safe, by “going on the pill”?
So I did.
Despite my realization that a whole slew of unhappy things could happen once fluids are shared, I found myself yearning to do all the risky things I had done in the old days. My self-hypnosis, which I thought was something hardwired into me, went flying out the window. I did things I never thought I would do. No one stopped to ask me if I wanted to use rubbers or gloves; we just did without, wordlessly. Please don’t tell me you’re different, though of course some of you may be: mounting evidence suggests you’re in the queer minority these days. Gonorrhea and syphilis are on the rise. We are returning to the sex lives we had before AIDS in this supposedly “post-AIDS age,” in part because the majority of gay men screwing around these days do not remember a time before a lethal virus, before the day when one or two deaths in your perilously near vicinity changed everything for you.
While on PrEP, my periodic, mandated tests came back negative. Negative for everything. Each time. I was lucky. But if they hadn’t, I would have had no one to blame but myself. Not that I have no reason to still be worried. For all I know, I or my partners may be infected with something the doctors haven’t identified because no one has come to them with symptoms yet. You know what? There is no test for everything because we do not know what everything is and we never will. For my generation, Truvada risks undoing the defenses the first years of the epidemic demanded we erect. And have kept us alive.
I had a decision to make. Keep going on PrEP? No. I had lived through too much terror and misery years ago. I was not going to go through that again, no matter how small the odds. This is the burden that a memory of that time has bequeathed the gay men of my generation: I do not trust any assurances given us.
The day of my first clinical appointment in the new year, I called in and said, no need. I’m going off Truvada. Thanks for the ride. I am not going to let the promise of near immunity from HIV tempt me to use my body the way I once had. I need to remove that temptation from my life—my sex life, to be specific, but with lessons for all the ways I now intend to live. And so, I ended the temptation by going off the blue pill, and its exaggerated promises of immunity from harm.
I know this is a decision that may make more sense for gay men my age than younger ones, because we have a different history: a history that makes me and my cohort suspicious of words like “undetectable,” because we know not everything is detectable. I am happier now. If presented with the opportunity for a good time in the future, there’ll be protection present. Latex, barrier protection: the best defense we still have for what lurks out there—both the things for which we have names and the things for which we do not yet.
John Whittier Treat is author of the novel The Rise and Fall of the Yellow House (Big Table Publishing, 2015).