New York Revamps Safe Sex


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A “Play Sure” ad on a subway train, part of a larger campaign to prevent H.I.V. in New York City.

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Danny Ghitis for The New York Times

In summer 2014, a 22-year-old black man who had recently been diagnosed with H.I.V. walked into a clinic at Mount Sinai Hospital where he was seen by Demetre Daskalakis, an infectious disease specialist, who would soon become the assistant commissioner of New York City’s H.I.V. and AIDS prevention unit. The patient was vigilant about his own care. He carried a container that looked like a slightly oversize cosmetics compact. It neatly held condoms issued by the city, lubricant and his H.I.V. medications.

“I thought, you know, this is brilliant,” Dr. Demetre told me recently. He took a picture of the case and, when he joined the health department, he sent the photograph to an industrial designer.

The resulting creation — a free portable kit with condoms, lubricant and a section for pills, which health officials hope those at high risk for contracting H.I.V. will use to carry the preventive drug Truvada — will be distributed by the city (and through clinics that receive municipal funds) early next year. Eventually, some of those kits will contain Truvada — a starter dose of it, at least — for those who have first been evaluated by a physician. The city plans to link prospective users to providers who can help them pay for the medication long term, through patient assistance programs and other means.

This is all part of a broader initiative to promote PrEP, or pre-exposure prophylaxis, the method of using certain H.I.V. drugs, formulated into a single pill, to keep from getting the virus. While this might seem like sound, unremarkable policy, when PrEP arrived three years ago it was met with great controversy, in part because some in the gay community felt it would renew a culture of abandon, too easily relaxing the restrictions on sexual behavior that the era of AIDS and safe sex had imposed.

Has the term safe sex itself become benighted? The question rests at the center of the campaign around PrEP, which, at its most visible, features a series of new billboards in subways and on buses that are accompanied by the tag line “Play Sure,” with its implication of fun and certainty. The message explicitly conveyed is that PrEP and condoms should be used in concert, for maximum effectiveness against all manner of sexually transmitted diseases, among H.I.V.-negative men who might sleep with H.I.V.-positive men, among transgender women (there were 49 new H.I.V. infections among transgender people in the city last year), and among women who sleep with bisexual men or with men who might be using intravenous drugs.

The ads represent a wide range of sexual and gender orientation. One image has a gay white male couple embracing; a second shows the voluptuous transgender model Carmen Carrera by herself; a third depicts a heterosexual black couple; and another features a black woman by herself. In the early years of the AIDS crisis, it was widely believed that the threat to women via sexual transmission was overblown. Last year, 524 women were diagnosed with H.I.V. in the city. Of the 300 interviewed by a group the city calls its disease detectives, all reported contracting H.I.V. through sex without a condom. Most of the women were black and Latino and, as a result, minority women have become an important target of the movement to make PrEP more accessible.

The term safe sex emerged in 1983, two years into the AIDS epidemic. The coinage happened simultaneously and independently in New York and San Francisco, the AIDS activist Peter Staley told me recently. At approximately the same moment, documents outlining protocols for “safe sex” were produced by the Sisters of Perpetual Indulgence, a gay advocacy group on the West Coast whose members dressed as nuns, and three men in New York — Richard Berkowitz, Michael Callen, and a doctor, Joseph Sonnabend.

The phrase “Play Sure,” conceived by a marketing team, with its inevitable hash tag, suggests a new era in which medical technology has made it possible for public-health messaging to seem less anxious and reproving. Implicit in the phrase “safe sex” are the potential horrors of unsafe sex, a castigation of promiscuity. “Play Sure” acknowledges pleasure while promising, essentially, the elimination of risk. The promise is credible: The Centers for Disease Control and Prevention has said that PrEP, when used consistently, can reduce the risk of H.I.V. infection by up to 92 percent. A San Francisco study released in September showed that among 600 people at high risk for H.I.V., those who took Truvada regularly for two and a half years remained free of the virus.

The promotion of PrEP, underway in New York as well as several other cities, including San Francisco, follows an announcement from Mayor Bill de Blasio and his wife, Chirlane McCray, this month, that naloxone, a medication that can prevent death from opiod overdose, would become available right away in pharmacies, without a prescription. The move came in response to new data indicating that deaths from heroin and painkiller addiction have risen 56 percent in the city over the past five years. Criticism of the mayor has been rampant in varied corners of New York this year; much of it is warranted, but it is hard to find fault with his administration’s work in public health. Here, progressivism thrives.

Correction: December 20, 2015

An earlier version of this article omitted the name of one of the men who helped to produce safe sex literature in New York in the 1980s. His name was Michael Callen.



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