What’s Up, Doc?
With 50 looming on the horizon, I’ve decided that it’s time to attend to a number of health-related things that I’ve been ignoring during the years of caring for other people. Over the past month I’ve visited the optometrist and the dentist, neither of which I’d been to in the better part of a decade. Fortunately, there were no issues with either.
I was hoping the same would be true of the last stop on my tour—the doctor. I can’t even remember the last time I had a routine check-up, but I think apart from visits for a few specific issues I haven’t been poked and prodded for the better part of 25 years.
I was slightly apprehensive when I arrived and discovered that the doctor to whom I had been assigned by my insurance carrier seemed to deal mostly with children. As I sat in a waiting room overflowing with stuffed giraffes and picture books, I wondered how she was going to deal with a middle-aged gay man who had some things to ask her of a, well, personal nature.
By and large, things went smoothly. (We’ll see when the results of the bloodwork come back.) I liked my new doctor, a woman about my own age, and she answered the handful of questions I had. But then we came to the last item on my list.
“What’s your opinion about PrEP?” I asked her.
She looked at me blankly.
“Truvada,” I tried. “It’s a pre-exposure prophylaxis for HIV.”
“Oh,” she said brightly. “I had to read about that for my boards a few months ago.”
“And?” I pressed.
“Well, is your partner HIV-positive?”
“I don’t have a partner,” I informed her.
She looked puzzled. “If you had a partner and he was HIV-positive, you might consider it,” she said. “But until then, I wouldn’t worry about it.”
Unsure how to proceed I said, “Not everybody who is sexually active has one single partner. That’s kind of where PrEP comes in.”
“Some people have multiple partners,” I elaborated. “And sometimes your partners don’t know their HIV status or don’t tell you the truth because they’re afraid of rejection.”
There was a long pause during which neither of us uttered the words “casual sex.” Then she said, “I don’t think I know enough about it to have an opinion. So, let’s talk about scheduling your echocardiogram.”
I didn’t press the issue, as this is not a huge concern for me at the moment. Still, it was unsettling. Not because I can’t get information about PrEP on my own. I can. I have physician friends. I have friends who work in HIV/AIDS education. I have friends already on PrEP. But most people don’t. Especially men in rural areas like the one I live in who might be having sex with other men.
I came out in New York City at the height of the AIDS crisis. I marched with ACT-UP and volunteered for GMHC. I wrote the first widely-used book about HIV/AIDS for young people. I’ve subsequently lived in Boston, San Francisco, and Houston, all cities with large gay populations and extensive sexual health services for men who have sex with men.
Because of this, I’m maybe more surprised than I should be that a doctor would have zero familiarity with the most effective method of preventing HIV infection to be developed since the start of the epidemic.
But then I thought about the men I’ve talked to on the gay “dating” apps that are the primary source of contact in my part of the country. If the profiles are to be believed, a huge percentage of the men around me having sex with other men are also having sex with wives and girlfriends. “Discrete” and “down low” are frequent buzzwords, along with faceless profile photos and declarations that the man “can’t host, but car action is okay.”
What I suspect is that a lot of men having sex with men here are almost certainly not talking about it with their doctors and asking how to protect themselves and their partners from HIV. And if my doctor’s response to the question is indicative of a general attitude about sexual health, nobody is being all that honest about what actually goes on between sexually active humans.
This kind of attitude is what kept the HIV/AIDS epidemic growing for years when it should have been shrinking. This kind of attitude is what keeps people ashamed of the sex they’re having, and of themselves for having it. This kind of attitude is part of the reason HIV infections are actually on the rise again in certain segments of our community.
When I published my book about HIV/AIDS for young people 26 years ago, I hoped it would help put an end to the epidemic that had decimated my generation. Now I find myself wondering if it’s about to happen all over again. ▼
Michael Thomas Ford is a much-published Lambda Literary award-winning author. More Michael Thomas Ford