A lusciously sensual Under Milk Wood

My review of this film adaptation of Dylan Thomas's Under Milk Wood first appeared in TheGayUK in October 2015.

I studied  Dylan Thomas’s “Under Milk Wood” for my English A Level, rather more years ago now than I choose to mention and it came as quite a surprise to me to realise that I still remembered, almost word for word the narrator’s first long speech, beautifully spoken here by Rhys Ifans.

“Under Milk Wood” is really an extended dramatic poem for voices. It was first conceived as a radio play, commissioned by the BBC in 1954, with Richard Burton voicing the narrator. Later it was turned into a stage play, and there is at least one previous film (1972) with Burton reprising his narrator role, and with such luminaries as Elizabeth Taylor, Peter O’Toole and Glynis Johns amongst the cast.

Whilst remaining absolutely true to Thomas’s original text, the screenplay of this new film, brings out more than any I’ve seen or heard, the sheer earthy, lascivious and hilariously funny filthiness of Thomas’s dreamscape, a true celebration of the joys of sex. Only most of the sex in this story takes place in people’s minds, their fantasies and desires brought out in full, luscious technicolour glory. 

The film looks superb, for which director of photography Andy Hollis deserves enormous credit.

Director Kevin Allen has at his disposal an excellent cast of Welsh actors, many of them faces well-known from TV, all perfect for their roles. Rhys Ifans, who also doubles as Captain Cat, is quite as effective as Richard Burton in his long opening speech, his accent, though perfectly intelligible, just that bit more Welsh, where Burton, targeting a 1950s audience, slightly Anglicised his tones.

Charlotte Church, making a very successful screen debut, is cast as Polly Garter. She has a plump, rounded, wholesome sexiness that is absolutely perfect for the fertile baby machine, that the rest of the village like to gossip about.

Ultimately, though, the film is also about loss; loss of community, loss of a way of life. Captain Cat is old and dying and his demise is symbolic of the death of the village Llareggub (Bugger All spelt backwards). There hangs over the film a purveying sense of nostalgia for a time that never waa. Gritty realism is swept away with a click of the camera, and for 85 minutes we can escape into a world of dreams and fantasy. I enjoyed it immensely.

4 stars

We Need PrEP And We Need It Now

This is a transcript of a speech I recently gave in Edinburgh to HIV Scotland. I am hoping that much of the slut shaming I had to deal with when I first went onto PrEP is dying out, but experience tells me that there is still quite a bit of it out there. It's time we just accepted that there is nothing shameful about wanting to have sex without condoms, and that we can do it without risking getting HIV.

Ok. I’m not a medical professional or a scientist. I am simply someone who is on the PROUD study in England, and I’m here because I believe passionately in PrEP.

I’m going to talk about what being on PrEP has meant to me personally, and also about how people – friends, family, and the community in general – have reacted to the news that I am on PrEP.

So first some background.  I had never even heard of PrEP until November of 2013, when one of the nurses at the WMP suggested it to me. I’ve always believed in total honesty about my sexual encounters when visiting a clinic, and, though I hadn’t realised it or admitted it to myself, it seemed my behaviour was becoming more risky, enough for me to fit into that at-risk group that would definitely benefit from taking PrEP.  I talked it through with my best friend, who has been on Truvada as part of anti-retroviral treatment for a few years now, and decided it was something I’d like to try. I then applied, was accepted and was delighted when I was put onto PrEP straight away, not into the deferred group that they had at that time. It was all very quick and I’ve now been on PrEP for almost two years. I can honestly say I had no side effects, apart from some vivid dreams the first week or so.

Physically then, the effect was minimal, or negligible. But how about the psychological effects?

 

Well at first nothing much changed, but, as it gradually began to dawn on me, that I was protected from HIV, a cloud started to lift. 

You see, I’m a product of the pre AIDS generation. When I came out there was no HIV, or at least we didn’t know about it. I’m one of the lucky ones. I didn’t die and I remained HIV negative, obviously or I wouldn’t be on PrEP. How I got here is no doubt down to a little judgement and a lot of luck, and I mean a lot of luck. Statistically I should be a statistic. 

Back in the 80s the fear of AIDS stopped me having sex completely for quite a while. Fear of death does that to you and those were scary times. But once I did start having sex again, for the first time in my life, I started using condoms. I hated them. Sex didn’t feel so good anymore, but if you wanted to stay alive, there was no alternative. Sex had become a dangerous business. I mean people I knew were dying. If you didn’t see someone for a while, you hardly dared ask what might have happened to them.

I didn’t get tested. In those days a positive diagnosis was tantamount to a death sentence.  We were even told that the mere knowledge that one was positive could be enough to precipitate a downturn in one’s health. So I worried. I fretted.  I remember I panicked about it so much that at one point I even started suffering from night sweats. There was nothing wrong me.  And anyway, at that time, what was the point knowing?  But closing my mind off like that also meant that I remained ignorant of the advances in HIV treatments as they happened. Then, in 2001, a very close friend of mine died. He was admitted to hospital with pneumonia. He had never been tested for HIV and by the time pneumonia took hold he had no immune system left to fight the disease. He died soon after. If he’d only been tested and on treatment then he’d still be with us today. I got tested straight after my close friend’s funeral, and from that day on I became much more aware of my sexual health. 

However, even after this, my adherence to safer sex started to falter. Not straight away of course, but little by little I was slipping. At first it was just what they call dipping, you know  when you just put it in for a few minutes without a condom, and think, oh well that doesn’t count. I’m not actually fucking. But actually it does. Then there would be other occasions when I wouldn’t use a condom at all. There would be discussion, risk assessment if you like, and I would decide to take the risk. It may have been calculated, but it was still a risk. And I found every sexual encounter was beginning to become a minefield. I was finding it harder and harder to use condoms. I’d lose my erection. I’d become so fixated on the  business of getting the packet open, and the bloody thing on, that I could barely think of anything else. They say condoms don’t have any side effects. Well isn’t erectile dysfunction a side effect?  I was beginning to give up the idea of penetrative sex altogether. So PrEP seemed like a miracle, and it changed my sex life. 

Mainly, and importantly, because it has removed anxiety. Gone. That’s it! I know I can’t get HIV. I know I can’t pass it on. For the best part of 30 years now, there was a voice whispering in my ear every time I had sex. “Be careful. You could get HIV.” And, you know what? That voice has gone. I can’t tell you how liberating that is. After years of worry about HIV, suddenly I don’t have to worry anymore. To me it was a no brainer. Short of a vaccine, this seemed to me to be the most important advance in HIV research since the discovery of anti-retroviral treatments for HIV positive people.

And because I felt so liberated, because I felt it was such an amazing breakthrough, I decided  I wanted to get the message out there, be totally honest about what I was doing, and extol  the virtues of PrEP. I thought that it would be greeted with open arms, and this is when I was surprised.

Now I have always been totally open about what I did and do for a living, which has given me a small amount of notoriety within the gay scene, and it is no doubt this notoriety which has enabled me to speak out about PrEP in the gay media and at certain gay events I’ve been invited to. I’ve had articles in Qx and in TheGayUK, my Truvadawhore photo has been in Attitude and is about to be published in French music magazine Les Inrockuptibles. 

What actually got me involved and out there writing about PrEP was an article written by one of my co-writers at TheGayUK which condemned the use of PrEP. It was very negative and inaccurate on many points, and I decided I needed to retaliate with an article that got the facts right (Sheena McCormack was a great help here) and to shed a more positive light on PrEP. In my naivety, I expected people would be more open to it once they read the facts, but I actually ended up being on the receiving end of some pretty nasty comments. I’d worked in the sex industry for many years, but this was the first time I’d experienced real slut-shaming. I was called an irresponsible slut who didn’t give a damn about the sexual health of anyone else, which, considering the reason I was doing PrEP was precisely because I was concerned about my sexual health and that of those I was having sex with, was a little hurtful.

After I’d calmed down a bit from suffering those reactions, I started to look at the possible reasons for this negativity, for without understanding those reasons, we will  never be able to address them, or break down prejudices.

I questioned why the reactions of my family and straight friends were so positive, when those of some of my gay friends were not. Could it be that straight and gay people saw condom free sex in different ways?  For straight people, condom free sex was not just about pleasure, it was also about conceiving. It was about life. Whereas, for us, it had become associated with death. 

Now a few months ago, I saw a video of a speech by the magnificent Irish drag queen, Panty Bliss, which discusses the inherent homophobia that exists within our society, that homophobia which makes us ever alert, unable to make the slightest unconscious gesture of affection towards our partner without first checking our surroundings to see if it’s safe. He touches on the fact that we have become so used to this situation, that we have come to accept it as ok. He points out that this homophobia comes down to a basic distaste for what we do in bed, specifically anal sex, and that these homophobes, when they look at us don’t see a person, they just see a sex act. 

And I think our problem lies in an internalised homophobia, which makes us ashamed of who we are, and, more importantly, ashamed of what we do in bed, particularly if we enjoy anal sex. 

Let’s face it sex, any kind of sex, has long been about shame, unless it was to bring about a new life, which of course made gay sex more shameful still. I suppose we enjoyed a few years of relatively guilt-free fun when sex between two men was no longer illegal, as long as it was in private of course, and the only risk attached to it was the chance of an easily treatable STD. Then AIDS came along. We had to deal with the shame of realising that our pleasure was killing us, that anal sex was one of the main transmission routes for this terrible virus. Worse still, the Reagan administration in the US didn’t lift a finger to help us because it and a great swathe of America didn’t actually care that we were dying. That’s pretty hard to deal with.

Eventually, due to the efforts of campaigners like Peter Stalley, we came up with drugs to keep us alive and we discovered that we could save ourselves and our partners by wearing a condom, and the term safer sex was coined . And that’s when condom free sex became really shameful. 

Now, for all the advances that have been made in recent years, for all the new therapies, the fact that we now know positive people with an undetectable viral load can’t pass on the virus, that shame about condom free anal sex still persists.

We feel shame about that time we were drunk or high and threw caution to the wind. We woke up the next morning and felt shame.

We felt shame about that time we realised we didn’t have any condoms but went ahead with it anyway.

We felt shame about that time the condom split but we kept going because it felt so much better, and, here’s the thing, we felt really ashamed about admitting, even to ourselves, that one fact. Sex without condoms feels better. There I’ve said it. And apparently I’m not alone, as the majority of people on the PROUD study gave the reason that “it felt better” as the main one for having condom free sex. Not being high or drunk.

Such is the shame about condom free sex, that we even coined a new word for it, a loaded word that carried with it a sense of risk. Barebacking. And more and more people were willing to take the risk. We might not actually want to get HIV, but at least we now weren’t going to die if we did. 

Now I wish we could get rid of that word “barebacking”, banish it from our vocabulary, because barebacking when you’re protected isn’t risky, or shameful, it’s just natural. 

That said, I understand why it’s going to take some time for that message to get through, and it’s only by people like me being up front and talking about it that the message will get through.

I think I’ve probably now heard every argument imaginable against PrEP, and most, to be honest,  are just side issues, but the one I hear most often is that it will encourage promiscuity, which was exactly the main objection to the birth control pill for women back in the 60s. Well we were able to get over that problem, and the birth control pill is now, in the west at least, the most commonly used form of contraception for the majority of women, mostly because they were able to take control of their own sex life.

And this is the point about PrEP. It puts me in control. I don’t have to worry about whether a partner is telling me the truth about their status. I take my pill every day and I know I’m protected. The problem with condoms for some is that they leave all the negotiating to the final moment, when we can do things against our better judgement. If we’re on PrEP, then we have taken care of that side of things beforehand, and it means we are still protected from HIV, should our judgement be impaired.

The other good thing about PrEP is that we don’t necessarily have to be on it for the rest of our lives. Circumstances change. When I started the PROUD study I was taking risks with multiple partners. In the last few months I have entered into a monogamous relationship and I am beginning to consider coming off it. The IperGay study in France suggests that people can also target their PrEP use, depending on their sexual activity. 

This is the good news we need to give MSM. That PrEP allows us to take control of our own sexual health. PrEP can eliminate the difference between positive and negative and we can become a community that is no longer split by our HIV status. 

Quite the opposite of being irresponsible, PrEP is taking responsibility for our own health, and those with whom we have sex. That’s why we need PrEP – and we need it now!

PROUD Film Premiere on July 1st

This is the trailer for the PROUD film by Nicholas Feustel, which will be premiered at the Cinema Museum, 2 Dugard Way, London SE 11 4TH on July 1st at 7.30pm. The full video will be available to view after that date. I was one of the participants and will be on the panel for a Q&A session after the premiere on July 1st.

TRAILER: The Proud Study from MRC Clinical Trials Unit at UCL on Vimeo.

I am absolutely convinced that PrEP is a major breakthrough in HIV prevention, and that the NHS should now be offering it to those who are most a risk. We now now that HIV positive people, who are on treatment, and who therefore have an undetectable viral load, cannot pass on the virus. If HIV negative people, who were at risjk were on PrEP, then we could bring down rates of HIV transmission down dramatically within a decade. We need to be proactve.

We need PrEP! And we need it now!

This is a transcript of the speech I gave at the EATG/AVAC conference on HIV Prevention in Brussels in January this year. There is a certain amount of overlap with my Qx article which I posted yesterday, but there are also some differences as the target audience was different. I thought it worth posting as I truly feel we need PrEP and we need it now. 

Speaking at the EATG/AVAC conference in Brussels

Good morning. First of all I should point out I am no expert, no scientist, no medical professional. I am just a participant in the PROUD study, and I’m here to talk initially about what being on PrEP has meant to me personally. I’ll then talk a bit about how people – friends, family, and the community in general – have reacted to the news that I am on PrEP.

I attend the Working Men’s Project at St Mary’s Hospital in London, which is a Sexual Health clinic for men who work in the sex industry. I suppose I should point out at this time that I was once an adult model and performer, and worked as an escort, and though I no longer do any of those things, I do, as a tantric masseur, still work on the peripheries of the industry, so I still go to the same clinic.

I tell you this to explain how I came to be offered the chance to become a participant in the PROUD study in the first place.  I had never even heard of PrEP until November of 2013, when one of the nurses at the WMP suggested it to me. I’ve always believed in total honesty about my sexual encounters when visiting a clinic, and, though I hadn’t realised it or admitted it to myself, it seemed my behaviour was becoming more risky, enough for me to fit into that at-risk group that would definitely benefit from taking PrEP.  After it was suggested to me, I first went away and discussed it with my best friend, who is positive, and on Truvada as one of his anti-retroviral drugs. I’d pretty much decided that I wanted to do the trial anyway, but it helped to talk it through with him. I then applied, was accepted and was delighted when I was put onto PrEP straight away, not into the deferred group that they had at that time. It was all very quick and I’ve now been on PrEP for over a year. I can honestly say I had no side effects, apart from some vivid dreams the first week or so.

Photo by www.mileselliotpictures.co.uk

Physically then, the effect was minimal, or negligible. But how about the psychological effects?

Well at first nothing much changed, but, as it gradually began to dawn on me, that I was protected from HIV, a cloud started to lift.

You see, I’m a product of the pre AIDS generation. When I came out there was no HIV, or at least we didn’t know about it. I’m one of the lucky ones. I didn’t die and I remained HIV negative, obviously or I wouldn’t be on PrEP. How I got here is no doubt down to a little judgement and a lot of luck, and I mean a lot of luck. Statistically I should be a statistic.

Back in the 80s the fear of AIDS stopped me having sex completely for quite a while. Fear of death does that to you and those were scary times. But once I did start having sex again, for the first time in my life, I started using condoms. I hated them. Sex didn’t feel so good anymore, but if you wanted to stay alive, there was no alternative. Sex had become a dangerous business. I mean people I knew were dying. If you didn’t see someone for a while, you hardly dared ask what might have happened to them.

I didn’t get tested. In those days a positive diagnosis was tantamount to a death sentence.  We were even told that the mere knowledge that one was positive could be enough to precipitate a downturn in one’s health. So I worried. I fretted.  I remember I panicked about it so much that at one point I even started suffering from night sweats. There was nothing wrong me.  And anyway, at that time, what was the point knowing?  But closing my mind off like that also meant that I remained ignorant of the advances in HIV treatments as they happened. Then, in 2001, a very close friend of mine died. He was admitted to hospital with pneumonia. He had never been tested for HIV and by the time pneumonia took hold he had no immune system left to fight the disease. He died soon after. If he’d only been tested and on treatment then he’d still be with us today. I got tested straight after my close friend’s funeral, and from that day on I became much more aware of my sexual health.

However, even after this, my adherence to safer sex started to falter. Not straight away of course, but little by little I was slipping. At first it was just what they call dipping, you know  when you just put it in for a few minutes without a condom, and think, oh well that doesn’t count. I’m not actually fucking. But actually it does. Then there would be other occasions when I wouldn’t use a condom at all. There would be discussion, risk assessment if you like, and I would decide to take the risk. It may have been calculated, but it was still a risk. And I found every sexual encounter was beginning to become a minefield. I was finding it harder and harder to use condoms. I’d lose my erection. I’d become so fixated on the  business of getting the packet open, and the bloody thing on, that I could barely think of anything else. They say condoms don’t have any side effects. Well isn’t erectile dysfunction a side effect?  I was beginning to give up the idea of penetrative sex altogether. So PrEP seemed like a miracle, and it has changed my sex life.

Mainly, and importantly, because it has removed anxiety. Gone. That’s it! I know I can’t get HIV. I know I can’t pass it on. For the best part of 30 years now, there was a voice whispering in my ear every time I had sex. “Be careful. You could get HIV.” And, you know what? That voice has gone. I can’t tell you how liberating that is. After years of worry about HIV, suddenly I don’t have to worry anymore. To me it was a no brainer. Short of a vaccine, this seemed to me to be the most important advance in HIV research since the discovery of anti-retroviral treatments for HIV positive people.

And because I felt so liberated, because I felt it was such an amazing breakthrough, I decided  I wanted to get the message out there, be totally honest about what I was doing, and extol  the virtues of PrEP. I thought that it would be greeted with open arms, and this is when I was surprised.

Now I have always been totally open about what I did and do for a living, which has given me a small amount of notoriety within the gay scene, and it is no doubt this notoriety which has enabled me to speak out about PrEP in the gay media and at certain gay events I’ve been invited to. In fact I have an article in this week’s Qx, one of the weekly London scene mags that you can pick up in any gay venue in London.

Going back a bit to July last year, an article written by one of my co-writers, appeared in TheGayUK condemning the use of PrEP. It was very negative and inaccurate on many points, and I decided I needed to retaliate with an article that got the facts right (Sheena was a great help here) and to shed a more positive light on PrEP. In my naivety, I expected people would be more open to it once they read the facts, but I actually ended up being on the receiving end of some pretty nasty comments. I’d worked in the sex industry for many years, but this was the first time I’d experienced real slut-shaming. I was called an irresponsible slut who didn’t give a damn about the sexual health of anyone else, which, considering the reason I was doing PrEP was precisely because I was concerned about my sexual health and that of those I was having sex with, was a little hurtful.

After I’d calmed down a bit from suffering those reactions, I started to look at the possible reasons for this negativity, for without understanding those reasons, we will  never be able to address them, or break down prejudices.

I questioned why the reactions of my family and straight friends were so positive, when those of some of my gay friends were not. Could it be that straight and gay people saw condom free sex in different ways?  For straight people, condom free sex was not just about pleasure, it was also about conceiving. It was about life. Whereas, for us, it had become associated with death.

Now a couple of weeks ago,  I saw a video of a speech by the magnificent Irish drag queen, Panty Bliss, which discusses the inherent homophobia that exists within our society, that homophobia which makes us ever alert, unable to make the slightest unconscious gesture of affection towards our partner without first checking our surroundings to see if it’s safe. He touches on the fact that we have become so used to this situation, that we have come to accept it as ok. He points out that this homophobia comes down to a basic distaste for what we do in bed, specifically anal sex, and that these homophobes, when they look at us don’t see a person, they just see a sex act.

And I think our problem lies in an internalised homophobia, which makes us ashamed of who we are, and, more importantly, ashamed of what we do in bed, particularly if we enjoy anal sex.

Let’s face it sex, any kind of sex, has long been about shame, unless it was to bring about a new life, which of course made gay sex more shameful still. There were those few hedonistic days when it finally became legal and the only risk gay sex carried was the possibility of picking up an easily treatable STD. Then AIDS came along. We had to deal with the shame of realising that our pleasure was killing us, that anal sex was one of the main transmission routes for this terrible virus. Worse still, the Reagan administration didn’t lift a finger to help us because it and a great swathe of America didn’t actually care that we were dying. That’s pretty hard to deal with.

Eventually, due to the efforts of campaigners like Peter Staley, we came up with drugs to keep us alive and  we discovered that we could save ourselves and our partners by wearing a condom, and the term safer sex was coined . And that’s when condom free sex became really shameful.

Now, for all the advances that have been made in recent years, for all the new therapies, the fact that we now know positive people with an undetectable viral load can’t pass on the virus, that shame about condom free anal sex still persists.

We feel shame about that time we were drunk or high and threw caution to the wind. We woke up the next morning and felt shame.

We felt shame about that time we realised we didn’t have any condoms but went ahead with it anyway.

We felt shame about that time the condom split but we kept going because it felt so much better, and, here’s the thing, we felt really ashamed about admitting, even to ourselves, that one fact. Sex without condoms feels better. There I’ve said it. And apparently I’m not alone, as the majority of people on the PROUD study gave the reason that “it felt better” as the main one for having condom free sex. Not being high or drunk.

Such is the shame about condom free sex, that we even coined a new word for it, a loaded word that carried with it a sense of risk. Barebacking. And more and more people were willing to take the risk. We might not actually want to get HIV, but at least we now weren’t going to die if we did.

Now I wish we could get rid of that word “barebacking”, banish it from our vocabulary, because barebacking when you’re protected isn’t risky, or shameful, it’s just natural.

That said, I understand why it’s going to take some time for that message to get through, and it’s only by people like me being up front and talking about it that the message will get through.

I think I’ve probably now heard every argument imaginable against PrEP, and most, to be honest,  are just side issues, but the one I hear most often is that it will encourage promiscuity, which was exactly the main objection to the birth control pill for women back in the 60s. Well we were able to get over that problem, and the birth control pill is now, in the west at least, the most commonly used form of contraception for the majority of women, mostly because they were able to take control of their own sex life.

And this is the point about PrEP. It puts me in control. I don’t have to worry about whether a partner is telling me the truth about their status. I take my pill every day and I know I’m protected. Just as women knew when they took their pill every day that they couldn’t become pregnant.

This is the good news we need to give MSM. That PrEP allows us to take control of our own sexual health. PrEP can eliminate the difference between positive and negative and we can become a community that is no longer split by our HIV status.

Quite the opposite of being irresponsible, PrEP is taking responsibility for our own health, and those with whom we have sex. That’s why we need PrEP – and we need it now!

#Truvadawhore

This article is a potted version of a speech I did for Pat Cash's Let's Talk About Gay Sex & Drugs back in December 2014. It was published in Qx Magazine on 22 January 2015

Photo by Miles Elliot

I’m Greg Mitchell and I’m a Truvadawhore. I take one pill a day (Truvada) and that stops me getting HIV. It’s called PrEP (Pre-Exposure Prophylaxis). However some in the gay community think taking PrEP makes me a bad person; irresponsible, a slut, a whore.

I’m a product of the pre AIDS generation. I remember a time when there was no HIV. Somehow I survived the worst of the AIDS epidemic and I’m still HIV negative. How I got here is no doubt down to a little judgement and a lot of luck. Statistically I should be a statistic.

Back in the 80s the fear of AIDS, well the fear of death, stopped me having sex completely for quite a while. But the sexual imperative is a strong urge, and eventually I started again. I used condoms, I hated them, but the alternative was too horrible to contemplate. Sex could still be good, but it wasn’t the same. 

However, with the advances in HIV treatment, I’ll admit my adherence to safer sex started to falter. At first it was just what they call “dipping”: when you just put it in for a few minutes without a condom, and think, “that doesn’t count. I’m not actually fucking”. Then there were other occasions when I wouldn’t use a condom at all. There would be discussion, risk assessment if you like, and I would decide to take the risk.

I was finding it harder and harder to use condoms. I’d lose my erection. I’d become so fixated on the  business of getting the packet open, and the bloody thing on, that I could barely think of anything else. I was beginning to give up the idea of penetrative sex altogether. So PrEP seemed like a miracle, and it has changed my sex life.

Because it has removed anxiety. I know I can’t get HIV. I know I can’t pass it on. That is a liberating feeling.  Short of a vaccine, I thought it the most important advance in HIV research since the discovery of anti-retroviral treatments for HIV positive people. My family and my straight friends agreed, so I was astonished to find that many in the gay community were less enthusiastic. Why?

Ultimately I think some of the negative reactions come down to shame. Gay sex, any gay sex, has long been about shame. It wasn’t that long ago that it became decriminalised here and in most Western countries (in fact it was still illegal when I was growing up), and in 81 countries around the world it is still against the law. Then in the 1980s it became even  more shameful as we discovered it was one of the transmission routes for a deadly disease.

Before that time condoms were for preventing babies. No gay man would ever consider using one, but, as our brothers started to die around us, we realised it was either put a rubber on it or become another statistic.

And that’s’ when condom free sex became shameful. We even coined a new word for it, a loaded word that carried with it a sense of risk. Barebacking. More and more porn was bareback, revelling in its risky nature. New treatments meant that HIV was no longer deemed a death sentence. Still, I’ll wager most of the people indulging in occasional condom free sex end up feeling guilty for ages afterwards, hoping against hope that when they next test they will be ok. But that probably starts a pattern. Once you get away with unsafe sex, you try again and again, until one day you go for that test and it comes back positive.

I am also convinced that many of those who condemn the use of PrEP are under the misapprehension that those gay men testing positive are just the dirty gay guys, the ones who go to weekend sex parties and take lots of drugs, and no doubt there is an undercurrent of feeling that they deserve it. People get sorted into the good gays and the bad ones. Good gay guys subscribe to the hetero-norm, they meet the man of their dreams and settle down in a monogamous relationship, while the bad ones have multiple partners and go to cruise bars and sex clubs.

But many of these good gays, the ones with boyfriends, the ones who think they are in monogamous relationships, are still testing positive. In fact more than half of all new HIV cases come from the primary partner. Maybe some of these good gays are not as good as they like to think they are; maybe we should stop condemning people who choose a different life style from our own; maybe we should all stop being so damn judgemental. Because PrEP can eliminate the difference between negative and positive. We can become a community that is no longer split by our HIV status.

Quite the opposite of being irresponsible, PrEP is taking responsibility for my own health and the health of those I have sex with. If that makes me a Truvadawhore, then so be it.

Speaking at Let's Talk About Gay Sex & Drugs - December 2014

The Curing Room at the Pleasance Theatre, London

“It made the recent Globe production of Titus Andronicus look like a teddy bear’s picnic!” said my companion, as the lights went down on Stripped Down Production's The Curing Room.And indeed over 90 minutes we had been subjected to a deluge of blood, guts and gore, coupled with full frontal male nudity the likes of which I have never seen before on the stage.

David Ian Lee’s  The Curing Room throws seven Soviet soldiers into the empty cellar of  a monastery, stripped of all belongings and their clothes. Abandoned by their captors, and left without food, the men resort finally to murder and cannibalism in order to survive. The play asks questions about how we redefine ourselves in extreme circumstances, how the constraints of normal civilised society and military rank cling to us, or don’t.

The play is something of a tour de force for the seven brilliant actors, who literally bare all before the  audience. Director Joao De Sousa is unflinching in his depiction of cannibalism and there is, as I said earlier, a lot of blood. My companion spent much of the latter part of the evening with his head turned away from the stage.  This play is definitely not for the faint-hearted, and if your only reason for going is a prurient desire to see seven men naked, well you soon get used to that. The gore is harder to cope with.

It would be invidious to pick out any one of the actors. They all work as a close knit team, and all, without exception give excellent performances. De Sousa’s pacing is brilliant, and I was gripped throughout. Once away from the theatrical brilliance of it all, though, a few minor doubts crept in about the writing and about the play itself. For much of the play, the characters come across as mere cyphers, as representatives of certain types; the stiff upper lip captain, the honourable senior-lieutenant, the slightly simple young private, the old retainer and so on. This could be the reason I found it ultimately less involving than I should have. Though the horror of what unfolds before you certainly draws you in,  ultimately ones cares little about the fate of these soldiers as individuals.

None the less, The Curing Room is gripping drama and well worth seeing if you have the stomach for it. I doubt we will see anything like it again for some time.

4 stars

The Curing Room is at the Pleasance Theatre until November 9^th.

So Why Are So Many Gay Men Opposed to Prep?

This article was first published on TheGayUK a week ago, and I have to say I have been astonished and saddened by some of the negative and downright vitriolic responses I have received. I had not realised till then how polarised the gay community is regarding HIV, and how the disease is still stigmatised and discriminated against within our own community. In the constant battle against HIV and AIDS, how anybody can see the discovery of PrEP as anything but a good thing is completely and utterly beyond me. 

So why are so many gay men adamantly opposed to PrEP, the daily dose of the anti-retroviral drug Truvada, which is at least 90% effective at protecting against HIV? Indeed, according to a recent iPrEx open-label extension (iPrEx OLE), to date the largest demonstration project of HIV Pre-Exposure Prophylaxis, daily taking of Truvada could be as  much as 99% effective.

This is a question I’ve been asking myself quite a lot recently, especially after reading some negative  articles in the press and one, by Joshua Vaughan here in TheGayUK a couple of weeks ago, which was actually inaccurate on several points.

About nine months ago, the GUM clinic I regularly attend (the Working Men’s Project at St Mary’s in Paddington) offered me the chance to be part of the PROUD study, which examines the impact on gay men of using Pre-Exposure Prophylaxis (PrEP), and I jumped at the chance, not only because I wanted to do my bit for the community, but because it offered me an extra level of protection against HIV, regardless of whether I was using condoms or not.

Before moving on to the whys, let me tackle some of the issues and downright inaccuracies in Vaughan’s article. Rather than rely on hearsay and prejudice, I spoke to Professor Sheena McCormack, the lead doctor for the PROUD study, who is also Consultant Physician at 56 Dean Street.

Vaughan states that there has been a significant drop in HIV transmission rates between 2001 and 2012, but though this is true globally, there has been no drop in the rates amongst gay men, and there is evidence to suggest that, on the contrary, they are rising. This may have something to do with an increase in the number of gay men presenting themselves for testing, but it is worrying none the less. Vaughan also enumerates at length the terrible side effects which can accompany the taking of Truvada, but fails to mention that those that suffer these side effects constitute only a small proportion of those taking the drug. A recent large study of over 4000 HIV negative men and women in Kenya and Uganda, found that there were very few significant differences when compared to placebo, and only a minority (less than 10%) of HIV positive people taking it in combination with a third drug discontinue because of side effects due to Truvada . Anyone taking Truvada for PrEP who suffers side effects can simply stop taking it, but so far, according to Professor McCormack, only one person has stopped because of problems with the medication.

Vaughan states “The WHO believe that medicating ALL homosexual men will provide an additional method of preventing infection. Along with condom use and regular testing. But activists have suggested that introducing government mandated antiretroviral would discourage the use of condoms, currently the best method to prevent the transmission of sexually transmitted infections. Resulting in an increase of other sexually transmitted infections such as gonorrhea, chlamydia and hepatitis in the gay community.” First of all, the WHO is not saying that all gay men should be given PrEP, but that they should be offered it, which is slightly different. Nor has any of the data surrounding possible increases in other sexually transmitted diseases been analysed yet, though the Partners PrEP study suggested no significant change in behaviour.

Regarding the cost, I have no idea from where Vaughan plucks his figure of £10,000 per person per year, but Professor McCormack assures me this is far beyond the mark. Though it would be difficult to put an exact figure on it, because of the National Health’s buying power and their ability to get large discounts, the figure is more likely to be in the range of £5,000. Already it is being offered in the private sector for around £500 per month. He says this is a lot of money to spend on a preventable disease, but that is exactly what the medication is for, and, with a 90% (and possibly even a 99%) success rate, it actually makes it more successful than condoms.

To quote from a United States C.D.C. study of 2013, “We are also unclear about to what extent condoms actually prevent HIV transmission in anal sex. This last fact may seem surprising, given that condoms have been recommended since the mid-1980s as the only effective HIV prevention method for gay men who have anal sex. In fact, there is only one large study in gay men, dating from 1989. In this study of 2914 gay men, HIV incidence among those who said they used condoms 100% of the time was 70% lower than in men who did not use them at all. There has been one small study in the era of antiretroviral treatment (ART), which found an efficacy of approximately 75%.”

Vaughan states that introducing the drugs could run the risk of the virus evolving immunity to the drug, but this is in fact only likely in cases where a participant is seroconverting when they start taking the medication. It can also be a problem for HIV positive people who have a gap in their treatment, this being a particular problem in parts of Africa where people have to travel miles to get their medication and end up missing doses.

So, given so many positives, how can offering PrEP be a bad thing, and why is there so much resistance within the gay community? Professor McCormack is mystified. “This is a good thing,” she tells me, adding that most of her colleagues that work in Sub-Saharan Africa (who are friends and mainly female and straight!) queried why WHO did not specifically mention women in the recent consolidated guidance. And indeed we ought not to ignore the needs of other communities that have been shown to benefit from PrEP, including intravenous drug users, and heterosexual men and women.

We can bang on as much as we like about better, more targeted sex education in schools, but there is little to suggest it would have a major impact on the epidemic. It has had little effect on unwanted pregnancies, even though no-one leaves school without knowing where to go for contraception. It may be that the UK’s problems come down to an age-old embarrassment about talking about sex. In countries like the Netherlands and Scandinavia, where they have traditionally been more open and matter of fact about sex, teenage pregnancies and STD infection rates amongst young people are far lower. The problem could be more cultural than anything else.

Coincidentally, I think that most of the resistance to PrEP boils down to shame about admitting to enjoying condom free sex. In the study on condom use cited above that figure of 70% was amongst gay men who said they used condoms 100% of the time. My italics. How many of those were actually lying, or conveniently forgetting that time when the condom broke, or they indulged in dipping, or actually didn’t use a condom at all because they were drunk or high?

Gay sex itself has been about shame for a long time. It wasn’t that long ago that it became decriminalised here and in most Western countries, and in many countries around the world it is still against the law. After it was decriminalised, there was a brief period when gay sex was fun and the only risk it carried was the possibility of picking up an easily treatable STD. Then in the 1980s it became shameful again as we discovered it was one of the transmission routes for a deadly disease. Many people died because of it, and it took a lot of time, and a lot of campaigning, for gay men to take on the safer sex message. Before that time condoms were for preventing babies tout court. No gay man would ever consider using one, but, as our brothers started to die around us, we realised it was either put a rubber on it or become another statistic. Gay sex was shameful again. The advice was cut down on partners, use condoms or die. I remember for a few years I pretty much gave up sex altogether, with or without condoms.

Then the new combination treatments came along and people began to survive, though many of those first drugs had some pretty terrible side effects. But the advances in the last 10 years or so have been immeasurable. People don’t die anymore. Nor do the new treatments have such terrible consequences. People with HIV can now live a normal life. What’s more, whereas once it was deemed better to hold off treatment as long as possible, because of the toxicity of the drugs, now it is better to get people onto therapy as soon as possible as the therapy quickly brings down their viral load to undetectable, which means they cannot pass on the virus.

It is of course quite possible that the fact that we are no longer seeing people suffering or dying around us had made us complacent, and this could be the reason we are seeing higher rates of HIV incidence amongst gay men. I’ll admit it; I was taking the odd risk that I wouldn’t have taken even 5 years ago. It may have been a calculated risk, but it was a risk nonetheless.

Why take the risk at all, you might ask. Well, because I don’t like condoms. For years I have been having sex and not really enjoying it because I have had to use a condom. But even on those occasions I took a calculated risk, enjoyment was difficult because there was always a doubt at the back of my mind. We may have discussed it, but how sure were we? Could I, or the person I was with, actually unknowingly have the virus and pass it on? We may have both tested negative recently, but how sure were we? And so on.

Two years ago I wrote an article condemning the indiscriminate practice of barebacking, but the landscape has changed completely since then. There is still much in that article I agree with, and I have not ditched the condoms altogether. I rarely fuck or get fucked at a sex club, but if I did I would still use a condom. Though, pre-AIDS, I would never have dreamed of using condoms, I would only now go bareback with someone I had a more intimate relationship with. What PrEP does is it removes that lingering anxiety, and how liberating that is.

I’ll give you an example. A couple of days ago I had sex with a guy I have known now for about a year, a fuck buddy rather than a relationship if you want to put a label on it (I don’t). We have always used condoms before, even though we are both sure we are negative. On this occasion we didn’t, and the knowledge that I am on PrEP allowed us to have the kind of joyful, unbridled pleasure in each other that we had both forgotten existed, in the sure knowledge that neither of us could give each other HIV. That is a liberating experience, yet the moral police out there, would prefer that we didn’t have it. After all, gay sex is shameful, isn’t it? And condom free gay sex is even more shameful.

I am convinced that many of those that are condemning the introduction of PrEP are also under the misapprehension that those gay men testing positive are just the dirty gay guys, the ones who go to weekend sex parties and take lots of drugs, and no doubt there is an undercurrent of feeling that they deserve it. (I don’t agree, by the way). Indeed only recently, former gay soldier James Wharton (one of the good gays) recommended closing down gay saunas, with the outrageous claim that they were standing in the way of equality and were breeding grounds for drugs and HIV. Good gay guys subscribe to the hetero-norm, they meet the man of their dreams and settle down in a monogamous relationship. But it would seem that many of these good gays, the ones with boyfriends, the ones who think they are in monogamous relationships, are still testing positive. Maybe some of these good gays are not as good as they like to think they are; maybe we should all stop being so damn judgemental; and maybe we should just welcome the advances in medical science that have brought us PrEP.

There can be little doubt that much of the debate surrounding PrEP has been couched in moral terms. Only recently Michael Weinstein, the CEO and President of the AIDS Healthcare Foundation poured considerable funds into fighting its approval and went as far as calling Truvada a “party drug”, an outrageous comment on a drug that can help prevent transmission of the virus to a wide range of people, including gay men, sex workers and HIV-negative individuals in relationships with people living with HIV. A petition has been started to have him removed from office for trying to block one of the most revolutionary developments in the history of the AIDS epidemic. To quote Eric Paul Leue, Mr Los Angeles Leather 2014, who started the petition,

“This petition is about whether we, the people, should be allowed access to accurate information, free of stigma and discrimination. Since 1980, HIV and its prevention has been framed in moral terms, and the people carrying the virus blamed. The head of our largest AIDS service organization should know that HIV prevention is not “a party.””

PrEP is not widely available in the UK yet, but the PROUD study, of which I am a part, could result in it being offered to gay men more widely; offered to them, not forced on them. Isn’t it always better to have choices? If I am offered the chance of an extra level of protection against HIV, why should I be judged for accepting it? My body, my choice.

Professor McCormack has written a little poem about the benefits of PrEP, and performs it here on this youtube clip.