An advertisement released last month by the D.C. Health and Wellness Center has been met with strong criticism. The commercial promotes the use of pre-exposure prophylaxis, or PrEP, which is a preventative drug that reduces the risk of H.I.V. by nearly 90 percent. Its depictions of a range of humorously suggestive clips — including a woman licking ice cream and a champagne bottle erupting in slow-motion — have led many to dismiss the content as distasteful, taking to social media platforms like Twitter to voice their opinions on the controversial advertisement.
While this advertisement may appear unnecessarily lewd at first glance, it advances a worthy cause: the fight against H.I.V. Perhaps the outcry against this obviously well-meaning commercial is indicative of an entirely different cultural epidemic altogether — a society that is on the outs with its own behavior, not yet ready to openly discuss sex and, specifically, now that sexually transmitted diseases can be prevented. In particular, we struggle to talk about the issue of sexual health and the LGBTQ community.
If any changes are to occur, whether that be combating H.I.V. or eliminating cultural taboos that limit our conversations about sex and sexual health, then these conversations must first be able to comfortably take place in the public realm.
With the advent of contraceptives, improved screening technologies and H.I.V.-prevention methods like PrEP, enduring struggles with H.I.V. and other sexually-transmitted diseases are rarely discussed these days. When it comes to H.I.V. and S.T.I.s, individuals often apply a sense of otherness: They believe these problems belong to everyone but them. They hold a conviction that they are somehow immune to these diseases and infections.
That rates of H.I.V.-infected individuals are presently declining does not signal the end of the H.I.V. crisis in America.
Of the 1.2 million Americans living with H.I.V. and AIDS, only about 145,000 actually have active prescriptions to PrEP. Most striking, perhaps, is the fact that gay and bisexual males constitute the populations that are both most affected by H.I.V. and least likely to obtain PrEP or other preventative drugs and treatments.
This is especially true for gay and bisexual men in college. Recent national surveys of sexually active college students showed that only about 13 percent of gay men and 9 percent of bisexual men were informed of PrEP by their campus clinics’ physicians. To withhold such information, then, is to deny students opportunities to safeguard their own sexual health.
Campus health clinicians should be obligated — if not professionally then ethically — to inform their patients about the resources that are available to them, especially if their patients are gay or bisexual men who are therefore most susceptible to H.I.V.
However, even when gay and bisexual male college students seek out PrEP and other precautionary measures on their own, they still face an uphill battle. Given the general stereotype characterizing the LGBTQ community as sexually promiscuous, clinicians may let their preconceptions hinder their abilities to offer objective health insights and advice to their patients.
There are certainly misplaced ethics behind what motivates health care workers to provide PrEP to some college students but not others. When the shaming of gay and bisexual male students is compounded by the hefty price of PrEP, one truth seems strikingly clear: Adequate H.I.V. treatment is primarily reserved for those who are wealthy, and more likely to be straight.
That being said, no one, regardless of their class, sexuality or membership in any other socially-constructed group, can absent themselves from the possibility of contracting H.I.V. or other diseases. This very egalitarian nature of disease should be mirrored in the ways in which colleges provide PrEP: with equal access. This is the only solution that can begin to eradicate the plague of H.I.V. in America.
If society is at all to tackle the issue of inaccessibility to PrEP, then it must first be able to comfortably discuss the topics of H.I.V. and sex.
Rather than shame the behaviors of their LGBTQ patients, health care professionals must instead foster conversations centered around information and objective fact. They need to acknowledge the reality that sex does, in fact, occur, and provide their patients with the knowledge and resources to make safe and smart decisions. The moral judgement of patients is under interrogation when the focus should be on the issue at hand: H.I.V. and its prevention. Surely, this is an issue that will require honest speakers and, just as importantly, mindful listeners.