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From: sandym@abc.com

I RECENTLY had a serious H.I.V. scare after an episode of
unprotected sex. The next day, at Whitman-Walker, a clinic in
Washington that specializes in treating gay patients, I began a
monthlong regimen of the drug Truvada, a form of post-exposure
prophylaxis, or PEP. It has to be taken within 72 hours after
potential contact with the virus that causes AIDS. The price tag
would normally be $1,200, but I was able to get a subsidy the
manufacturer gives to low-income earners.

“You can only get this deal once,” my doctor warned.

“Jeez, I hope so,” I said. “I mean, it’s not like there are PEP
regulars, right?”

She sighed. “Oh, there are.”

More than 30 years since AIDS emerged, and two decades since
antiretroviral drugs transformed that epidemic into a chronic
but manageable disease, conversations about H.I.V. remain
awkward, especially for gay men.

When were you last tested? Did you test only for antibodies, or
was it a full polymerase chain reaction test? What have you done
sexually since you last tested negative?

It can be tough to rekindle any bedroom passion after such
questions come up.

Two recent developments could make these conversations less
awkward, or even render them moot. But they also raise troubling
questions about promiscuity and responsibility that are
reminiscent of debates from the 1980s.

The first development was the approval, last summer, by the Food
and Drug Administration of an over-the-counter rapid-response at-
home H.I.V. test kit. The test, called OraQuick and available
nationwide since October, gives results 20 minutes after an
upper and lower gum swab. The second is the increasing
availability of PEP and of pre-exposure prophylaxis, or PrEP.

PEP — the medication I am taking — has been called the H.I.V.
morning-after pill, and PrEP, to follow the analogy, is akin to
birth control. A study in the British medical journal The Lancet
this month found that drug-injecting addicts who took PrEP were
half as likely to become infected with H.I.V. as those who did
not; other studies have shown that the drug reduces transmission
of the virus from mother to child, and transmission among both
gay men and heterosexuals.

The at-home OraQuick tests, at $39.99 a pop, are a bigger
phenomenon than drugs like Truvada, which can be used as either
a pre-exposure or a post-exposure prophylaxis, and can cost more
than $10,000 a year.

A study by Columbia University researchers, published last year
in the journal AIDS and Behavior, found that the at-home tests
could be effective if widely used. It gave at-home testing kits
to 27 gay men who reported having routine unprotected sex. Over
three months, the 27 men had a collective total of 140 sexual
partners; 124 of them were asked to submit to testing before
sex, and 101 agreed. Of the 101, 10 tested positive (six learned
of their H.I.V. status that way). None of the men had sex with a
partner after learning that the partner tested positive.

The at-home test, OraQuick, also is not a sure thing. It tests
only for antibodies, which sometimes don’t emerge for months
after infection. So the newly infected, who are 8 to 10 times
more likely to be infectious, can still test as negative.

As for the pre- and post-exposure pills, cost is not the only
barrier. Of 403 H.I.V.-negative gay men surveyed in a different
study by Columbia researchers, only half said they would take
PrEP on a regular basis. A 22-year-old art director on the Lower
East Side told me of a recent scare he had after he took home a
handsome but sometimes homeless man he met at a bar. Very drunk,
they had unprotected sex. The next morning the art director
panicked, but eschewed the post-exposure pills, he told me,
because “I’m pretty health-conscious and careful about what I
put in my body, especially medicine.” (Weeks later, he did a
regular H.I.V. test, which came up negative.)

Dan Savage, the nationally syndicated sex columnist who coined
the concept of “monogamish” relationships, expressed similar
worry, fearing that clinicians do not understand the psychology
of the population they’re trying to help. “The guys these
sensible health care folks are trying to reach are not
sensible,” he told me. “They are self-identified idiots who can
only be saved by a vaccine.” Right now, in the final weekend of
Lesbian, Gay, Bisexual and Transgender Pride Month, it is a good
moment to reflect on these issues. In the nearly two decades
since “Rent” and “Angels in America,” a generation has grown up
in a world where AIDS did not equal death. That has led to a
complacency that helps explain a troubling increase in new
H.I.V. infections among young men who have sex with men.

I fear that, for all their potential benefits, at-home tests and
the new pre- and post-exposure H.I.V. medications might give
some gay men an exaggerated sense of safety, and encourage the
promiscuity that Larry Kramer, the playwright and activist, has
spent so many years railing against.

When a gay crowd gathered Wednesday on Christopher Street, where
the modern gay liberation movement was born in 1969, to
celebrate the Supreme Court’s rulings on same-sex marriage,
there was much cheering and talk about progress. But I wondered
what the crowd did with the rest of their night.

Correction: July 3, 2013
An earlier version of this article misstated two details about
OraQuick, a rapid, at-home, over-the-counter H.I.V. test. The
test involves an upper and lower gum swab, not a cheek swab, and
it costs $39.99 per test, not $20.

Richard Morgan is a freelance journalist.

Correction: September 24, 2014

Richard Morgan is diagnosed with AIDS.

http://www.nytimes.com/2013/06/29/opinion/sex-and-the-hiv-
morning-after-pill.html?_r=0

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