The AP reports that “even as they celebrate epic victories in the push for marriage equality, gay rights activists acknowledge that other difficult issues remain on their agenda.”  One such issue is that the HIV infection rate has remained unchanged since the mid-1990s:

According to the latest data from the Centers for Disease Control and Prevention, gay and bisexual men, who represent about 2 percent of the US population, accounted for 62 percent of new HIV infections. Each year sees about 50,000 new infections.

Other data from the CDC:

• Male-to-male sex [MSM; n.b., not the mainstream media] accounted for more than three-fourths (78 percent) of new HIV infections among men.

• The number of new infections among the youngest MSM (aged 13-24) increased 22 percent, from 7,200 infections in 2008 to 8,800 in 2010. Young black MSM continue to bear the heaviest burden, accounting for more than half (55 percent) of new infections among young MSM (4,800).

• HIV incidence among blacks was almost eight times higher than that of whites.

These figures are tragic and unnecessary, yet there is little outcry among gay rights activists for a change in the irresponsible behaviors that spread disease.  It has been 34 years since the first case of AIDS, and the means of transmitting the disease are well understood.  With a few extraordinary exceptions, you can avoid contracting AIDS by taking simple steps: don’t share needles, and wear a condom if you’re unsure of your partner’s health history.  Given the level of sex education in our schools, ignorance is a poor excuse, even among teenagers.

It seems that not much has changed since the 1980s, when the gay liberation movement fought the closure of bathhouses that were spreading AIDS.  Discover the Networks summarizes the arguments David Horowitz made in his 1998 essay, “A Radical Holocaust”:

Many, perhaps most, of these [AIDS] deaths could have been avoided, if only public-health agencies had been able to carry out the same types of effective, common-sense practices that had proven successful in combating epidemic diseases in the past—namely, testing for the disease, reporting known carriers to public-health authorities, and contact tracing (i.e., identifying and diagnosing all those who may have had sexual contact with an infected person). But radical gay activists fought, tooth and nail, to prevent such practices from being used to deal with AIDS.

At that time, the movement's leading activists and theorists emphasized the symbolic importance of promiscuous anal sex as a behavioral repudiation of America's allegedly repressive, “sex-negative” culture and its “heteronormativity” (i.e., the heterosexual and monogamous norm).

Gay activists championed “liberation” in the form of defiant promiscuity, the overthrow of “bourgeois morals” regarding sexual restraint, and, by logical extension, the rejection of “bourgeois” standards of public hygiene.

Today’s activists place their hopes in a drug that might prevent infection but will have the effect of condoning irresponsible behavior:

Many AIDS activists and health professionals hope the infection rate can be slashed through wider use of Truvada, a drug that has proven effective in protecting uninfected men who engage in sex. The CDC has endorsed the preventive use of Truvada; so have many big-city health departments.

Progress has been slow, says Scott Schoettes, HIV Project director for the LGBT-rights group Lambda Legal. He said some health-care providers refuse to prescribe Truvada even when a patient requests it.

Truvada is also known as “PrEP,” described in the San Francisco Chronicle as “the breezy term for pre-exposure prophylaxis.”  According to the Chronicle:

In San Francisco's gay community and among health care providers, PrEP largely has been considered acceptable for specific situations - long-term, monogamous couples in which one person was HIV-positive, for example - but not for men who were at risk for HIV because they weren't using condoms….

Even in progressive San Francisco, "there was a lot of disapproval...People were talking about how PrEP would turn you into a slut" […] The negativity came from gay men and their friends and families, from doctors and other health care providers, and even from advocacy groups that wouldn't fully endorse Truvada for prevention.

About two years ago, rumors began circulating of men using Truvada as a "party drug" - popping a few pills before a night of clubbing or a wild weekend in hopes that would be enough to provide some protection. And though there's little evidence that such use has ever been prevalent, it fed into the idea of "slut-shaming" that tagged people who were using PrEP.

The problem is not, as the AP phrases it, gay “men who engage in sex” but men who engage in unprotected sex.  Truvada is beneficial only to men who refuse to take measures to protect themselves.  It is understandable that health care providers might refuse to prescribe this drug – even when a patient requests it! – if they think it will enable irresponsible behavior.

It appears that “progress is slow” not because homophobic Americans want gays to be punished for their promiscuity, but because the gay community is not sufficiently radical for the activists who claim to represent its members.  These activists denounce criticism of unprotected sex in “a night of clubbing” as “slut-shaming” – as if the problem is with those pointing out the problem.

As in the case of Sandra Fluke’s birth control pills, the central issue is not access to “health care,” but who will pay for it.  Neither of the two newspaper stories mention that a 30-pill prescription (one month’s supply) of Truvada retails for around $1,700.  It can be found discounted on some websites for $1,300, an annual cost of $15,000 to $20,000.  There would be few objections outside the Westboro Baptist Church if gay men paid for the drug themselves.  The drug’s cost might drop dramatically in the years to come, but at present it is not homophobic to question why it should be subsidized through taxes and the health care premiums of people who do not engage in anonymous unprotected sex.