Gay guy here. I know LOTS of people taking prep because they want to bareback and I think it's a train wreck waiting to happen. I have so many thoughts on this, I will try to be concise.
First of all, the original NYC HIV epidemic didn't just come out of nowhere. If you talk to a lot of the men from the 70's and 80's, it was routine to run into friends at the clinic while being treated for any number of infections like chlamydia, gonorrhea, syphilis, etc. They just kept taking antibiotic after antibiotic after antibiotic, with no regard for how it was destroying their immune systems. Is it any wonder that when HIV came along, it preferentially targeted gay men, whose immune systems were already in the gutter, and spread like wildfire? I've communicated with health professionals who worked in NYC at that time, and they all said that they were super worried for years that the situation was going to brew some kind of super bug. And that's exactly what happened, albeit from a foreign source.
Now we have the same situation happening again with PREP. Men are having rampant bareback sex with strangers, contracting all of the non-lethal STIs, and being treated over and over with antibiotics, while they are secure in the knowledge that, "I'm safe from HIV and everything else is fixable." Meanwhile, prep is super toxic itself and compromising their long-term health. There's also other kinds of viruses transmitted through semen, like cytomegalovirus, EBV, and maybe even unknown viruses that we can't test for.
Also? In the province I live in, in order to get on the free prep program, you have to fill out incredibly invasive questionnaires on a regular basis. They ask you all about your sexual lifestyle, in great detail. Who databases this information? Why are so many gay men self-reporting themselves AS GAY as well as listing in detail all their sexual habits? Do we really want the government databasing all the gay men?
I am extremely worried about this situation. Modern medicine's hubris about prep being invulnerable combined with the laissez-faire attitude around barebacking is making my head spin. And not just me, but also the survivors of the HIV epidemic. It's like everyone has just forgotten the plague years and are happy to go on barebacking like it's the 1970's again.
I think prep and the culture around it is a major disaster waiting to happen and I am so incredibly tired of the positive spin being put on it by the community health professionals, especially the gay ones. They say things like... people on prep know their status, which is much safer than people who don't know their status and aren't taking prep. Or... it's incredibly safe to have sex with an HIV+ person who is on meds, they are practically seronegative. Okay, that's true, but it's also putting A LOT of faith in the pharmaceuticals to always work. According to the science I've read, it shouldn't be possible for HIV to adapt -- but what if it somehow does? Nature is often smarter than us.
Anyway... I could go on and on. I don't like this Truvada thing. It's enables the most toxic part of gay culture to continue doing what it does and I'm not at all convinced we are invulnerable yet.