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For thirty years now gay men have been living artificial sex lives: The advice in “How to Have Sex in an Epidemic”, published in 1982, was right, though through today’s eyes judgemental in its language. When we had no idea what was causing Gay Related Immune Deficiency Syndrome, blocking the path of the infecting agent, assuming there was even one, was a no-brainer.

Then came the discovering of HIV/HTLV3 and the work could start on investigating the virus, discovering its structure and mechanism of infection looking for weak points in its life cycle. We discovered an enormous amount about the human body, as we continue to do today. The past thirty years have seen some of the most intensive work we’ve ever seen in medicine focused on the one virus.

When prevention possibilities were decided upon in the eighties, the decision as far as injecting drug use was one of harm reduction: set up needle-exchanges, so that a user could always be using a sterile set of works. Despite teething problems like the law hanging out around the corner and nicking users for carrying works, the policy has proved remarkably successful with injecting drug users now the smallest of the traditional risk groups.

We’ve gone from the “five years” of the eighties, the life expectancy of a well, newly diagnosed person, to the news that today’s PwHIV (People with HIV), diagnosed soon after infection, have an excellent chance of living out a normal life span, possibly longer than normal, given the extra medical attention we get. The one constant throughout this has been the condom.

Because a small percentage of gay men report oral sex as their only risk activity, it’s still recommended for oral sex. I wonder how inflated those figures are? How many men have found it easier to admit to sucking the occasional cock than taking one up the arse? Perhaps, in their eyes, it’s less “gay” to suck a cock, than to sit one on one. Score one for stigma.

Condoms have a place in cocksucking: the taste, smell and feel of a condom in the mouth is so off-putting and non-sexual that they’re ideal for punishment scenes, but that’s the sadist in me talking.

“Treat everyone you have sex with as though they’re positive” – Wow! Talk about patronising! What advice do you give PwHIV? Nope: that one has always been a one-size-fits-all piece of advice, however, ill-informed it is. “Treat everyone as though they’re of a different HIV status to you” makes a bit more sense.

The trouble is that the Powers That Be have decreed that condoms are the only sure protection against HIV. But with new drugs coming along almost like clockwork, the nature of HIV has changed: we emphasise to newly diagnosed people that it’s not a death sentence any more, and point to whatever long-term survivor we happen to know (33 years in my case) and emphasise how well they’re doing.

The fact is that we’re learning that Treatment as Protection (TasP), and Pre-Exposure Prophylaxis (PrEP) can be just as, if not more, effective than condoms. We’ve successfully reduced HIV to the level of a particularly nasty STI, but one that can be treated – if not cured. The attitude seems to be: HIV is deadly, but it’s alright, it’s nothing really as long as we diagnose it in time. But another piece of the jigsaw is that many long term survivors are showing signs of the effects of early day less effective drugs and are, essentially, on salvage therapy, just waiting for the next big drug.

PrEP is proving remarkably effective in the USA (I have many American friends using it successfully and enjoying a sexual freedom they haven’t felt in thirty years). TasP is maybe a little more problematic as it requires you to believe me when I say that my viral load is undetectable (and I have to believe you when you say you don’t have any STIs). But anything that brings honesty into the sexual arena is fine by me.

Both have their disadvantages: with PrEP it’s that it’s more difficult to medicate for a condition you don’t have but at least you know that you took your pill this morning, and with TasP, it’s trusting the word of someone you don’t necessarily know. And of course, with both, there’s the increased risk of other STIs: but in the seventies, didn’t we get used to the idea of going to the clinic every three months, whether we needed too or not? And with a greater than ever way of contacting each other (and some clinics working with the dating sites on contact tracing) we never need make that phone call which starts “You probably don’t remember me, but we met a few weeks ago. I’ve just got back from the clinic and they think you ought to make an appointment…”

But PrEP and TasP, together with campaigns like National HIV Testing Week, give us the building blocks to return our sex lives to normal.

steve-banner

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