XPost: alt.fan.rush-limbaugh, alt.politics.homosexuality, alt.po   
   itics.liberalism   
   XPost: alt.atheism   
   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   
      
   --- SoupGate-Win32 v1.05   
    * Origin: you cannot sedate... all the things you hate (1:229/2)