This week the MSMGF Blog talks to Jake Sobo, creator of the weekly column, “My Life on PrEP.” At a time when few other channels candidly discussed the use of Truvada for HIV prevention (pre-exposure prophylaxis, or “PrEP”), Jake’s honest and sex-positive approach helped shift conversations surrounding new prevention technology in the United States. Jake discusses why he started the blog, the public’s response, and what he’s doing now.
Were you surprised by the response the series received?
When I started writing "My Life on PrEP” a year and a half ago, it was a barren landscape in terms of people talking openly and honestly about PrEP. The few people that were talking about it were desperately trying to stay "on message" and pretend like only guys with poz boyfriends or guys who also use condoms were going to be using PrEP. I knew immediately that this message was Polyanna bullshit, and so I started speaking out about my own experience. That upsets people -- we'd all rather keep our heads in the sand and pretend like gay men are all using condoms and everything is just sunshine and rainbows. The truth is that condoms are clearly failing at the community level, and we desperately need new interventions to help keep guys negative. PrEP is one intervention that could make a big difference, but we've got to speak frankly about sex -- gay sex, no less -- and that makes many people deeply uncomfortable. So I knew that I would be stirring up some intense emotions with this column -- that was my hope and intent.
What was the most surprising conversation generated by My Life on PrEP?
I think the moment I was most caught off-guard was when a reader compared me in their comment to Bobby Brown indirectly murdering Whitney Houston. I nearly died laughing! But it was a telling moment. To them, I was "promoting" unsafe sex and thereby murdering young gay men. The truth is that I don't need to promote not using condoms. The evidence is clear: many gay men are already not using them, and we need to fess up to that reality if we want to get serious about prevention.
What do you believe is the most effective way to teach people about risk? How should we shape prevention messages?
Obviously, this is the million dollar question. For me, the three pillars of prevention have always been testing, treatment, and non-judgmental sex education. Communities have the right to decide what kinds of HIV prevention work best for them, but they obviously need to be given accurate and sex-positive information to inform those decisions. I have serious ethical questions about the continued harassment by health practitioners to clients they perceive as doing HIV prevention "wrong." People do their best, and for many people, HIV prevention just is not a top priority. If they need to have sex for money, or need to keep their partner for economic reasons, preventing infection might not be the primary motivation guiding their sexual practices. They also may just not like condoms, even though they understand them to be effective at preventing HIV. People have a right to make those choices. So I support efforts to educate and raise awareness of critical issues in public health, but the kind of shaming and strong-arming that goes on makes me and countless others at the receiving end of those efforts distrustful and hostile to future outreach efforts. That's counterproductive.
What is the relevance of My Life on PrEP in light of bigger-picture prevention work?
What I have tried to do is cut through the clinical pussyfooting that plagues HIV prevention for gay men and is largely the product of AIDS Service Organizations (ASOs) increasingly being muzzled by their funders (namely, the CDC and state health departments). If gay men can't talk about the reality of getting fucked, pleasure, or harm reduction strategies rather than complete risk elimination, then we might as well close down shop as preventionists. That's not prevention. It's propaganda that does more to serve the interests of those whose jobs are on the line than it does the communities such efforts are allegedly intended to serve. Sadly, that's what much of the work in prevention looks like these days. It's clinical, detached from the reality of our lives, and has virtually no impact on the epidemic. In many cases I actually believe that it could be doing more harm than good. Apart from treatment and testing -- which are obviously critically important, core components -- but apart from clinical care and screening, what do ASOs have to offer prevention? Increasingly, the answer is nothing. That's a tragedy that should make everyone angry.
What’s next for Jake Sobo?
I wound down the “My Life on PrEP” series when it became clear that there were others picking up the torch and running with it. Josh Kruger started writing on PrEP, the AIDS Foundation of Chicago’s “My PrEP Experience” blog blew up, and more generally I just started seeing my arguments being taken up by other writers. That was immensely rewarding. But the time had come for me to move on from PrEP, so over the summer I launched a new column on San Francisco AIDS Foundation’s “BETA Blog” titled “Promiscuous Gay Nerd.” This new column is more broadly focused on gay sex, HIV, and stigma – all from the perspective of a research scientist and proud slut. Check it out!
Jake Sobo has worked in the world of HIV prevention for nearly a decade. He previously published a 19-part series documenting his experiences on pre-exposure prophylaxis (PrEP), “My Life on PrEP,” for Positive Frontiers magazine, which was picked up by Manhunt, translated into French, and widely read in the HIV prevention world. He has spent the better part of his adult life having as much sex as possible while trying to avoid contracting HIV. You can find Jake continuing his insightful commentary in a new column on San Francisco AIDS Foundation’s “BETA Blog” titled “Promiscuous Gay Nerd.”