Disclosure Is Sexy

Personal responsibility has become an unexpected turn-on in the age of U=U, PrEP, and Doxy PEP.

Recently, when I was looking at some online gay men’s hookup profiles, I noticed a trend emerging that I found promising. Guys were adding that they are users of Doxy PEP to avoid sexually transmitted infections (STIs).

For those unfamiliar with Doxy PEP, here is information from the California Department of Public Health. Please note that I no longer look to the Centers for Disease Control and Prevention (CDC) for factual information anymore considering it’s now run by science deniers.

In a nutshell, doxycycline post-exposure prophylaxis (doxy PEP) is taking an antibiotic called doxycycline to help prevent the bacterial sexually transmitted infections (STIs) chlamydia, gonorrhea​, and syphilis​. It involves taking one 200mg dose of doxycycline orally as soon as possible but no later than three days after having sex without a condom to help prevent bacterial STIs.​

Doxy PEP works. Science has backed up that claim. Anecdotally, the sexually active gay men I know who use it report consistently that it works for them.

I speak only from the gay community perspective, but Doxy PEP, along with PrEP and Undetectable Equals Untransmissible (U=U), have changed the sexual landscape in terms of STI transmissions.

I don’t know all the data about non-gay people using these prevention protocols, but I assume some do. I know at least one cisgender heterosexual woman who uses Doxy PEP regularly. Per this 2024 report, Doxy PEP does work for cisgender women.

At the International AIDS Conference in Munich, Germany attendees heard that another study in women found an efficacy averaged over all three infections of 67%. The efficacy against chlamydia was similar at 65% and it was 55% with gonorrhea. (Although this is the same as the efficacy against gonorrhea in the USA gay/trans study, it could have been due to chance, as this was a much smaller study. But it still contributes to overall efficacy). As for syphilis, an 8% annual incidence rate prior to taking doxycycline turned to zero infections in the cis women taking it.

I recall when PrEP was first being studied and preliminary results were being published, there was a lot of consternation in online discussions about it, even from some gay men who would benefit from the science. A friend and I published a few op-ed pieces advocating for its use and the hate messages we got were considerable. Turns out, science and facts prevailed.

Of course, many people use condoms as a prevention strategy. But condoms are not always 100% effective at preventing transmissions, so the science-based prevention strategies are still a good idea for many sexually active people even if they also use condoms.

So, all this is great science and public health news. But what struck me when looking at those gay men’s online hookup and dating profiles was how consistently I’m seeing both status and prevention methodologies listed.

I see many profiles listing STI testing frequencies. I also see a lot of “treatment as prevention” listed which means someone is HIV-positive but under treatment which means (in most cases) their viral load is undetectable and therefore they can’t transmit HIV to anyone else. Being on PrEP or using Doxy PEP is often clearly listed. Also, most gay men know that if someone is on PrEP, they are likely under the regular care that includes regular STI testing.

This has drastically changed the gay men’s sexual public health landscape, and perhaps as these and other research and discoveries emerge, it will change even further. It has also changed gay men’s culture in terms of eliminating the fear that was a dark cloud over our heads for so many years.

But what really heartens me though when I see this testing, treatment, and prevention disclosure development is that it demonstrates that gay men are actively taking care of their sexual health without sacrificing the physical intimacy they want and need.

On a personal level, if I see a guy who lists his STI testing schedule and HIV/STI prevention strategies, they become much sexier and interesting. It turns out personal responsibility and caring for oneself and the community at large is quite sexy.

Obviously, these HIV/STI prevention strategies should be discussed with one’s personal doctor before utilizing them. These are not decisions to be made without medical advice. But I hope people bring up these strategies with their primary care physician or local public health professionals because for many people they’re a good fit.

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