PrEP Conspiracies and Stigma Are Killing Us

I first heard of Truvada in 2013, after I had graduated from college and was sleeping with folks of all genders, but unsure of how to identify and "not using labels." A friend of mine started taking Truvada as a means of PrEP.

"He's sleeping with about four different guys a week," another friend confided.

At the time that sounded like a lot of men. I didn't know anyone who'd slept with hundreds of men (at least to my knowledge). He sounded like a big ol' whore to me.

A year later and recently single, I was liberally using my Grindr account. Yet when my (gay) therapist brought up PrEP, I shook my head. "Do I really need that? I use condoms most of the time. I'm not sleeping with that many guys."

"Why not use it for an additional layer of safety?" he asked. "If you got HIV when you had access to a prevention drug at nearly no cost, would you forgive yourself?"

I took his advice. I went to my doctor's office, got tested, had my liver function checked, and started popping that blue pill daily. I still take it religiously and I consider myself lucky. Without him, I'm not sure how much longer I might have waited. Given the high number of men and women I did -- and do -- have sex with, I could easily have contracted HIV along the way.

Yet I'm not alone in my reservations. Two studies published in the May 2017 issue of AIDS and Behavior explored some of the beliefs queer men and transgender women have about PrEP, and how those beliefs decreased their likelihood of using the HIV prevention protocol. The stigma that those who take PrEP are irresponsible and slutty emerged repeatedly in both studies, but differed according to race.

Researchers Sarit. A. Golub, Kristi E. Gamarel, and Anthony Surace interviewed 180 HIV-negative men who have sex with men, all of whom reported at least one incidence of condomless anal sex with another man in the previous 30 days. Roughly 41 percent of the participants assumed that someone is promiscuous or "a slut" if they're taking PrEP. Two participants who were already taking PrEP described the need to hide their PrEP use because of the stereotype. "I don't tell people because I don't want people to think I am a big cum dumpster," said one. "I don't want people to think they can do whatever they want or that I am more promiscuous, so I don't go around telling people."

Another stigmatizing belief about PrEP use was that folks who say they take PrEP are actually HIV-positive and lying about their status. In fact, 41 percent of the men expressed this concern. Interestingly, as the study notes, PrEP stereotypes associated with "HIV status were more likely to be raised by men of color, those over 50 years old, and those who reported having less than a Bachelor's degree. In contrast, PrEP stereotypes associated with promiscuity were raised more commonly by white participants, those who had a Bachelor's degree or more education, and those who made more than $20,000 per year."

The second study, done by researchers Lisa A. Eaton, Seth C. Kalichman, Devon Price, Stephanie Finneran, Aerielle Allen, and Jessica Maksut in AIDS and Behavior, noted that a belief that PrEP was for the promiscuous was "strongly associated with lack of interest in using PrEP." But even more interesting, the individuals who endorsed this belief were more likely to report sexual risk-taking behavior. In other words, it's not the men using condoms who believe the promiscuity stigma, it's the men taking anonymous bareback loads -- the men at greater risk of contracting HIV, who would benefit the most from taking PrEP.

Another important finding of the second study is that a large minority (42 percent) believed conspiracy theories about PrEP. Conspiracy theories reflect a belief that those in power are manipulating events (or, in this case, drugs and access to them) in order to benefit themselves.

Historically, some very real manipulations have come at the expense and safety of sexual minorities, trans folks, and people of color; which may be why black men and transgender women had more conspiracy-related beliefs than white men and trans women. These beliefs reduced black participants's interest in using PrEP.

"Undoubtedly," the researchers noted, "the history of unethical treatment including serious physical and emotional abuse of race-minority populations in medical studies in the U.S. and abroad has given way to a general mistrust of medicine and medical establishments for many individuals."

These two studies reveal an alarming truth: Slut-shaming is very real, life-threatening, and hurting the queer community. Additionally, the folks who have the highest risk of acquiring HIV are the ones most likely prevented from taking PrEP by beliefs about what using the HIV prevention drug might say about them, or whether they are being used through PrEP. Stigma continues to interfere in our health care and this country's history of medical racism casts a long shadow.