The Supreme Court might restrict access to this drug that prevents HIV for the LGBTQ+ community. Why is that?
Meet Chris King, a 23-year-old who starts his day much like anyone else. He rises, heads to his bathroom, puts on his contacts, and takes a pill.
But this isn’t just any pill. It’s something that gay men like him had longed for since the 1980s – a solution they could have desperately used back then.
Every day, King, along with countless other Americans, takes PrEP – short for pre-exposure prophylaxis. This medication reduces his chances of getting HIV through sexual contact by an impressive 99%. The New York club DJ and event producer sees it as “almost a medical miracle.”
However, the Supreme Court is on the verge of deciding whether insurers should still be obligated to cover PrEP and other preventive health services at no cost. This decision stems from a case involving small businesses in Texas that object to covering it, arguing it could promote “homosexual behavior, prostitution, sexual promiscuity, and intravenous drug use.” If the ruling is unfavorable, many who are dependent on PrEP could find it too expensive.
“It’s really alarming to think about a new generation feeling that their sexuality is something to be ashamed of,” King remarks.
This situation sparked intense debate on social media, revealing a wide range of opinions from both the LGBTQ+ community and others regarding sexual behavior and its perceived risks. These discussions are not new but underscore the persistent stigma surrounding gay sex and HIV.
The conversations reveal that we “are still caught in a pattern of stigma related to all kinds of sexual behavior,” notes Benjamin Goldman, a licensed mental health counselor. Many individuals experience hesitation to discuss sex, explore their desires, or enjoy fulfilling sexual experiences.
The Prejudice Against PrEP
Since its introduction in 2012, PrEP has allowed individuals to engage in sex without the fear of HIV infection. Yet, not everyone is supportive.
“While most insurance plans comply with the Affordable Care Act by covering PrEP, many gay men remain unaware of this fact or where to access the medication,” explains Daniel Jacobson López, an assistant professor at Boston University’s School of Social Work. “Furthermore, factors such as high healthcare costs, lack of information about PrEP, reluctance from healthcare providers to prescribe it, and ongoing stigma have led to many eligible gay men not receiving the medication.” Nevertheless, new HIV diagnoses dropped by 12% between 2018 and 2022, according to CDC data, likely partly due to increased PrEP usage.
Opponents of PrEP contend that it encourages sexual promiscuity. New Yorker Matt Antar shares his perspective: “When someone tells me they’re on it, I tend to make assumptions, fair or not. It seems to me that those who are on it tend to be engaging in risky behavior.”
Within the LGBTQ+ community, people’s sex lives vary widely. Some are more adventurous with casual encounters, while others prefer a more restrained lifestyle, with many falling somewhere in between.
Michael Bronski, a Harvard professor and author of “A Queer History of the United States for Young People,” addresses the accusation that PrEP increases promiscuity, calling it “flawed on several levels.” He humorously notes, “The definition of promiscuity is merely one more partner than you have.” He emphasizes that judgments about sexual choices are often rooted in moral biases rather than science.
A lot of the stigma surrounding PrEP is influenced by homophobia, racism, and transphobia, as well as moral narratives regarding who deserves sexual freedom, argues Alithia Zamantakis, an assistant professor at Northwestern Medicine. Moreover, “regardless of personal religious beliefs, we know that providing PrEP is far more cost-effective for health insurers than covering lifelong HIV treatment.”
Some worry that the stereotype of gay men being very sexual can alienate them from a more conservative society hesitant to discuss sexual topics, similar to how some women face judgment for using birth control.
Ultimately, as Calvin Bartelle, a licensed clinical social worker, puts it, “If someone is promiscuous, they will engage in those behaviors regardless of whether they use PrEP. The goal of PrEP is to safeguard against HIV for those most at risk.”
Understanding the Mental Health Implications
It’s essential for people to reflect on their sources of sexual information. Is it influenced by friends, media, or underlying stigmas about certain sexual behaviors?
When discussing topics like sex, PrEP, and HIV, it’s important to approach them gradually and with sensitivity: “Empathy and understanding go a long way in starting these conversations,” Bartelle advises. “People are more willing to engage when approached with care rather than judgment.”
Lacking a safe environment for discussing sexual health—whether with partners, friends, or mental health professionals—can lead to discomfort. “Living in shame about one’s sexuality can lead to serious psychological issues,” Goldman warns. “Effects might include anxiety, depression, and the internalization of stigma arising from that shame.”
By taking control of the narrative surrounding sexual health, Goldman emphasizes, individuals can cultivate a sex life that truly aligns with their desires.
