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Tenofovir: The New Party Drug?

Some Circuit Boys 'Disco Dose' to PrEP for Unsafe Sex

Written by Steve Weinstein

You remember Huey Lewis, the über-preppy rocker who sang about wanting a new drug? Be careful what you wish for, as St. Theresa of Avila warned us. Some gay men have taken to swallowing a dose of tenofovir, a compound anti-HIV retroviral, before having sex.

The practice, known as “disco dosing” in some circles, allows them to have unprotected sex. Or so they believe. Called “PrEP,” for “Pre-Exposure Prophylaxis,” taking an HIV drug before exposing oneself to the virus is an unknown at best, highly risky at worst.

Nevertheless, some men are doing it. The reason? Condom burnout. After over two decades into the AIDS epidemic, many gay men have become sick of using condoms. Many more have not known anyone HIV-positive who has died or even gotten very sick— ironically, thanks to those same anti-retroviral drugs they’re trying out for a night on the town.

Whatever the reason, there are definitely guys out there doing it, although hard stats are difficult to obtain. There have been some studies, including one of black men. Published in a highly respected peer-reviewed journal a few years ago, the study involved a group of researchers on both coasts who looked at black urban men who have sex with men. The scientists found a surprisingly high number of men queried at black-oriented Circuit events had heard of PrEP—nearly onethird— and several had tried it or knew someone who did.

Some men are actually doing this because they take safer sex seriously indeed. One doctor told me of two patients who took the drug before they had protected sex with strangers as an added preventative in case a condom breaks.

But for the vast majority of gay men, PrEP means a key to not using a condom. That’s what makes it such a hot-button issue among AIDS researchers, doctors and activists. The theory behind it is that the anti-retroviral drug prevents HIV from grafting itself onto healthy cells and replicating. When HIV first enters the human body, there isn’t much of it; theoretically, if those few viruses swimming around the bloodstream don’t have anywhere to go, they’ll die out—just as do millions of germs we come across every day that don’t affect us.

One prominent doctor in Boston maintained that PrEP, despite its bad rep, is necessary as one more tool in the arsenal of AIDS fighters. But others see it as an enabler for those men who don’t want to bother using protection.

“Disco dosing” has actually been around for a few years. The guys who do it are usually into PnP (Party-and-Play), which is to say, taking crystal methamphetamine or GHB, or possibly both,in combination with sexual activity. One pill makes you taller and one pill makes you smaller, as Alice told us, but in this case, one makes you hyper, the other tired—but both horny as hell.

How do they score the drugs? These days, it’s easy enough for a friend or a de facto HIV-drug “dealer” to lie to a physician or pharmacist or case worker and get a new prescription. “Patients don’t get the fifth degree if they say they’ve run out,” says Kenneth Mayer, director of Brown University’s AIDS program and medical researcher out of Fenway Community Health in Boston. “It’s easy enough to get more.”

It should be emphasized that nearly all AIDS physicians argue vociferously that PrEP is a poor substitute for that silly little millimeter of latex between dick and ass. But they also wearily acknowledge that many gay men have grown sick of condoms. Another problem with condoms is that, barring Viagra or another little helper, one’s johnson flags in that dead space between the passionate foreplay and the housekeeping of getting the condom out of the wrapper (itself no easy chore for lubed-up hands) and slipping it on.

If it’s difficult to find any doctor who advocates for PrEP among sexually active gay men, it’s not impossible. I did manage to find one West Los Angeles doctor who has prescribed anti-retrovirals for at least one patient who has not tested positive for HIV and has unprotected sex, but he would only discuss it on deep background.

The Centers for Disease Control is taking PrEP seriously. It has undertaken research in countries overseas and in the United States to try to see whether it can be effective in fighting HIV infection.

Although CDC and other groups don’t advocate for PrEP, they understand that in certain situations—women with non-condom-using partners; rape victims; sex workers—it may be the only alternative. They are testing the same way as other possible downthe- road prophylaxes, such as rectal microbicides. These would be a topical agent, delivered with a lube or enema. There are other international studies going on with PrEP involving thousands of men and women.

No doctor argues that PrEP is a substitute for safer sex. “Doctors will still recommend people use condoms,” says Dr. Albert Liu, researcher in the San Francisco health department. “It would need to be combined with other strategies.”

But there are also several indications that something new is needed. Bareback porn is moving from the fringes to the mainstream (recently, a major porn producer announced it would be doing barebacking DVDs). Rates of HIV infection among gay men are rising. So are rates for other STDs, which indicate less condom use.

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