The Viral Divide and the HIV Prevention Landscape
I stepped up to the podium at the Global Forum on MSM & HIV (MSMGF) Pre-Conference to the International AIDS Conference in Melbourne, Australia, (AIDS 2014) and introduced myself as an HIV-negative, queer-identified Latino whose father passed away from an AIDS-related illness. I was there to talk about my experience as a PrEP (pre-exposure prophylaxis) user.
The first thing I said about why I take PrEP was, "A lot went into my decision to take PrEP. I had been hearing a lot about it and I wanted to take a step that gave me, as an HIV-negative person, a hand in HIV prevention. And I thought a lot about what it meant as a show of solidarity with HIV-positive people, which I'm not saying 100% that it is. But what I'm saying is that that was a big step in me taking PrEP. The prevention of HIV is not just something that HIV-positive people have to do -- it's something that I can actively have a hand in, as well."
At AIDS 2014, there was no escaping it: HIV prevention seemed to be the topic on a lot of people's minds. I spoke at two separate events on my experiences as someone who is currently using PrEP, and several major sessions that were given prominence on the schedule were centered around HIV prevention, including the panel moderated by Sean Strub on prevention and pleasure.
Even much of the discourse around HIV criminalization (another of the conference's major themes) is related to HIV prevention. Major arguments for HIV decriminalization center on the potential of criminalization to deter people from testing and getting on treatment, which could spread the virus even further.
Yes, condoms, biomedical prevention and other modes of prevention were on people's minds, and were a core theme of AIDS 2014. However, I don't think this means we, as a community, are moving away from the needs of people living with HIV, but rather widening the scope of who we are talking about when we talk about who is affected by HIV.
The invisible chasm between those who are HIV negative and those who are HIV positive has been called the "viral divide," and in this amorphous area lie concerns about priorities, resources, sexuality and what it means to be a community.
I fight against the viral divide as much as possible, in part because I don't fit neatly on either side. Though I am HIV negative, I don't know if that is something that identifies me. Though I don't pretend to be HIV positive or move and operate in the world as someone who is positive, I also do not move and operate like someone who is HIV negative, either. Between losing my father to an AIDS-related illness, going on PrEP for HIV prevention and having entire online forums dedicated to calling me an "AIDS-infected fa**ot," I'd say I'm somewhere firmly in the middle -- a "nebulous negative" as a friend of mine has said before.
The viral divide can emerge in analyses or critiques of how much content at HIV-related conferences is prevention-focused, versus treatment-focused or cure-focused, and how this has shifted from year to year. Rather than framing the conversation in a way that pits HIV-negatives against HIV-positives, with phrases like "Why is prevention getting all the attention? We have people who are still living with HIV who need help," perhaps we can frame it in a way that is beneficial for everyone.
As an infectious disease journalist who is often tasked with writing about the advances in care and treatment, I am well aware that there are, in fact, advances in care and treatment all the time. As someone who is very open about not being a science nerd, I can't tell you about cure science -- I have no way of understanding that. However, when I see an agenda at the International AIDS Conference that is extremely heavy on prevention, it makes me hopeful that scientists are beginning to listen to the concerns of those of us, especially people in the gay community, who are living with trauma, guilt and shame around our own sexuality and around HIV.
Speaking openly about having trouble with condom use, as one noted HIV science writer did at the MSMGF Pre-Conference, is still met with stigma and disapproval. Why can't we just learn how to put on a damn condom, right? When I hear about a panel that is about prevention and pleasure, when I see that people want to discuss biomedical prevention, I am happy that those in my community who have been asking for so long for new ways to protect themselves against HIV transmission have been heard.
To speak openly and honestly about HIV prevention is, in many ways, still a taboo. Because when we talk about HIV prevention, we are usually talking about sex, and when we talk about sex, we might talk about gay sex -- and when we talk about two men finding pleasure together, we cross an imaginary line that neither you nor I ever drew.
I encourage conversations about HIV prevention because they can be conversations about sex positivity. I encourage conversations about HIV prevention because they can be conversations about ways to mend the schism that can exist between HIV-negative and HIV-positive individuals. I encourage conversations about HIV prevention because they are, in the end, conversations that look at the sex lives of people in my community and ask, "How can we make sure we can all fuck each other without being scared to death?"
I don't think an us-versus-them mentality regarding the viral divide is useful. I want more research around HIV treatment and anything that will make the lives of those living with HIV better. I wish those things had been around for my father, who was an HIV-positive drug user and died with only about 15% of his liver function. However, when I see prevention as a major theme at a conference, I don't think of it as an us-versus-them problem. I, as an HIV-negative person, ask those of you living with HIV to see me walking with you, not ahead of you, or away from you, when it comes to ending the HIV epidemic -- whether we are walking together at a conference, at a protest or on a date.
Mathew Rodriguez is the community editor for TheBody.com and TheBodyPRO.com.
Follow Mathew on Twitter: @mathewrodriguez.