20/11/2014 06:10 GMT | Updated 18/01/2015 05:59 GMT


Sometimes I wish I could stop reflexively replying to the comment columns in Blogs about PrEP. Then I read one and feel I have to reply.

Anyway, this is my response to the comments here, on the Towleroad gay blog. Which of course is a re-posting of this. Which is a response to the reactions to this.

So here I am, yes, also helping the Net eat itself. I'm as tired of the Quinto thing as you are. But when you get responses like this...

"Too kind of him, those PrEP whores didn't merit a response."

... I take the bait.

So here we are. My reply to the comments on the reply to the comments about the interview.

"I work at the AIDS Info site, have had HIV for 30 years, and happen to be co-chair of the PROUD study - the UK study of PrEP. See this.

This answers some of the comments people have made. For instance, in PROUD and the French study IPERGAY, PrEP had higher effectiveness in stopping HIV infections than condoms [by themselves] are ever likely to have.

So although I do understand that some people prefer reassurance they can actually see - a condom in front of their eyes - that pill actually almost certainly works better, largely because it can't break, fall off or leak. Let alone be surreptitiously removed to revive a flagging erection or forgotten accidentally-on-purpose.

Some of the comments here I simply don't understand: for instance, [anon] seems to think guys who say they are on PrEP could infect him when by definition guys on PrEP are HIV negative. So if they've going to lie about their HIV status, they don't need to add on another lie.

However what I really object to, on a personal level, is that people who advocate for PrEP have somehow forgotten, or never knew, what AIDS was like.

My first long term BF was called Paul Lever. When I met him in 1985 he was a fit young south London lad. By the time he died in 1990 he was a wasted shadow covered in Kaposi's sarcoma blotches.

Don't take my word for it: This is Paul, 6 weeks before he died, when Princess Diana came to officially open the ward he was in.

As for me, I was fit and well till about 1995 then went downhill rapidly: by late 1996 I had a CD4 count of 10, had lost a quarter of my body weight, and nearly died of several opportunistic infections. I was eventually restored to full health in May 1998 by the first drug combo I wasn't resistant to.

I lost an entire generation of friends. almost everyone.

Since then I have become a writer on HIV and every study I read makes me respect more the awesome power, subtlety and ruthlessness that evolution has endowed this little biological machine with. Ebola may be quicker but HIV is hugely harder to defeat.

So, guys, I am not a proponent of PrEP because I'm complacent about HIV. I support it for the opposite reason. I do not think HIV can be reasoned with; I do not think it can be stopped by good behaviour. I don't want HIV prevalence to be a bit lower in gay men. I want it expunged, killed, vanquished. I want it to become impossible to transmit. I never want it to pass between two people ever again. PrEP is a staging post to that destination.

I think we as gay men are uniquely vulnerable to this virus. If you accept that gay men aren't just going to stop having anal sex overnight, then you have to accept that we have the kind of sex that is 18 times better at transmitting HIV than the sex heterosexuals have, and that means we are 50-100x more likely, in most places in the world other than parts of Africa, to meet a positive partner. Even in Africa, there is no country where HIV is not at least twice as common in gays than straights.

In those circumstances the answer we have traditionally had - a piece of rubber - is not enough. We need more protection. We deserve more. And, in my opinion, it is unethical to oppose moves to help gay men get more.

One of the UK's first HIV doctors, Brian Gazzard, said once, of the situation in Africa: "The risk factor for HIV in Africa is to have sex." I think it's getting to that situation in the gay community: even if incidence stays the same, prevalence, and your chance of meeting a positive partner, will remorselessly increase.

In those circumstances, I think we deserve more than condoms, moral lectures and pessimism. I think we need more things that work. And PrEP does.