Op-ed: We Must End PrEP Segregation

Truvada has been approved for use as PrEP since 2012, yet we still haven't had two years worth of conversation around it. We have mostly AIDS Healthcare Foundation to thank for that – it has bankrolled a public smear campaign against PrEP that misrepresents sound research for no apparent reason. Any real, nuanced conversation around PrEP can only begin when we start with the presupposition that PrEP works. As a 25-year-old PrEP user and health journalist who writes primarily about HIV, that we as a community can't get past a simple "Does it or doesn't it work?" binary conversation is really disheartening.

Of course, like all conversations around HIV, conversations around PrEP will be multifaceted – they will be about race, gender, class, sexuality and the medical establishment. And like any conversation that deals with people's intersectionality, it will be tinctured with undercurrents of racism, homophobia, etc. Already in at least two prominent Facebook groups dedicated to the dissemination of information around PrEP, there has been some pretty insidious language around who should take PrEP and why.

At least two prominent HIV activists who have been in the field for years have said on several different occasions that PrEP will do very little to end the AIDS epidemic until it gets into the hands of young gay men of color, especially young black gay men. In this respect, many conversations around PrEP are severely disjointed. One of the most popular mottos of the pro-PrEP constituency – and a very true one, at that – is that one of the main side effects of PrEP is peace of mind. All those hours spent worrying about HIV – gone. All those sexual encounters that make you think you’ll get sick and die – gone. Thinking a simple cold is seroconversion flu – gone. However, when the conversation turns to young gay men of color, it seems we don’t get to take it for peace of mind. We have to take it for public health.

In this sense, we are living in a time of PrEP apartheid – a time of “separate development.” While white gay men get to enjoy the mental and social aspects of PrEP – peace of mind, more options for sex partners, and condomless sex – my community, well, we’re just the squeaky wheel getting the biomedical grease. We are no closer to being less stigmatized by the medical community. I’m never more hyperaware that there is a racial divide in the gay community than when I am told that not only is my community most at risk for HIV, we are holding everyone else back from parachuting onto the metaphorical aircraft carrier and declaring “Mission Accomplished!”

I don’t write this to exclude anyone from the solution. I write this in hopes of including everyone in on a potential solution. And to ask that young gay men of color help write those solutions. Taking PrEP is an extremely personal decision, and while it does have public health benefits, especially for those who are at most risk for HIV infection, the personal and public health ramification of taking PrEP should always be treated equally. It's a mistake to look at a person and see a means to an end of the epidemic. It may be better to look at someone and figure out how we can try to help end the epidemic for that person.

Recently, a prominent member of the PrEP community posted a meme on Facebook that played off of The Lion King’s famous “Hakuna Matata” song. The meme said, “Hakuna Truvada – Means No Worries.” Sure, it was just meant to be a funny, reductive meme.  But to accept this meme at face value, and to see PrEP as a pill that prevents worry, is to misunderstand what my community worries about every day. For many white gay men, it may simply be a matter of the last barrier to having a worry-free sex life. However, when you’re talking about young gay men of color, we are not solely put at risk for HIV by condomless sex. We are put at risk by poverty, lack of access to housing, lack of competent medical care, racism, heterosexism, homophobia, and stigma. Just to name a few. To hand us a pill and a prayer and send us out into the world is irresponsible. And that you know that is important. Because if you don't accept the complicated reality, then you are not my colleague in the fight. You are only here for yourself – or people who look like you.

No matter which way you slice it, personal or public health, the scope of the fight needs to be widened. Yes, let's embrace PrEP, and know that it works. But let's contextualize it, too. Let's talk about how we can be PrEP-positive, while also being anti-capitalist – which may mean eschewing the branded “Truvada Whore” name. If you’re talking about peace of mind for young gay men of color, know that a pill won’t be the end of the conversation. There are a lot of other things on our minds that PrEP will not alleviate. And in terms of public health, no conversation that begins and ends with “swallow this pill” is worthwhile. The solution is, unfortunately, harrowingly complex.

If you want to help young gay men of color in order to end the HIV epidemic, then PrEP should not be the only tool in your tool belt. You might consider taking up ending racism and homophobia, improving access to health care, prison reform, gender equity, social justice, etc. But, please, don’t just expect us to survive on pills alone.