It's Friday night, the rain has eased, I've just got back from an enjoyable session at a sauna (that's Aussie for bathhouse) and cracked the top off a Beez Neez -- a Western Australian malt beer brewed with honey. It's been a rough week but right now, life is pretty good.

And then I notice an article about PrEP in The Daily Beast. Danger, Will Robinson, mainstream media coverage of HIV prevention! And sure enough, it's a shocker.

I'm mellowed-out enough to admit there are flashes of insight in the piece. It has all the right pieces of the puzzle, but author David Kaufman has jammed them together trying to make an altogether less optimistic picture of PrEP than their proper placement depicts.

And that's a shame, because there's enough genuine uncertainty to write a balanced piece without leaving any gay boys itching to rush out and score themselves some tenofovir.

A big part of the problem is Kaufman's deathly purple prose. AIDS, he writes, is "caught in a 30-year swirl of sex and morality" -- and he's stirring away furiously. In his article, PrEP is a "necessary evil" but "downright dangerous", "game changers", elation and alarm, and cringing PrEP proponents -- holy asslicking assonance, Batman!

HIV prevention is a big field, and there's an ongoing dialogue about PrEP -- as well as the whole complex of related issues like safe sex, versus serosorting, versus barebacking, versus social network interventions, versus combination prevention.

So when journalists like David Kaufman and before him (but even more problematically) Margaret Wente collapse all that discourse into a single dichotomy of opinion, the results are not pretty. Wente's article attacked a nameless, faceless "AIDS establishment", while Kaufman gives us "AIDS world" -- now that sounds like my kind of fun park!

According to Kaufman, "AIDS world" still tells gay men "Always use a condom". Seriously? Was he living under a rock when we fought the battles over negotiated safety, barebacking, and serosorting? When a journalist doesn't source material like this, it looks to the reader like accepted wisdom -- something so obvious it doesn't need attribution.

In fact, it's more likely just the author's personal opinion -- and every gay man thinks he's an expert on HIV prevention and HIV prevention workers are all idiots.

So it functions as a straw man. Easy to knock down in your article, but not doing your audience any favours either. It's a missed opportunity to help them understand the complexities of our task in trying to reach them with relevant prevention messages.

But in my lightly-buzzed, post-coital state, I remember Paul Kidd's message at our HIV and the Media forum last month in Melbourne: journalists have limited time and space, and stereotypes are shorthand. So I'm willing to cut Kaufman some slack... until I read this:

Long-time San Diego HIV educator Daniel Uhler reports, "We've seen quite a few drug dealers include (PrEP) meds with meth and Viagra to help better market to clients on the gay party scene."

Stereotype shorthand is one thing; reprinting dumbest of the dumb rumours is another. Kaufman had already found a doctor willing to go on record about prescribing anti-retroviral drugs to "high risk" HIV-negative men as PrEP. That's a coup! So why did he need to print such an obviously questionable rumour?

It's a variation on the "MTV" myth about a "cocktail", "party pack" or "disco dose" combining meth, tenofovir, and Viagra.

There's one simple question neither Kaufman nor his editors apparently thought to ask: how do you know that?

Has Daniel Uhlers been sending illicit drug samples for testing? I doubt it. Most likely it's a rumour he heard from a friend, who heard it from a friend, who maybe once did actually hear it from a dealer -- but seriously, who believes the drug dealer? (That's the guy who says of talcum powder, "This is gonna blow your head off!")

It took me half a second to find an article on The Body which dispelled the rumour about MTV with results from a CDC study of gay men at Circuit parties in 2005, where only 1 out of 397 neg men had ever taken PrEP. The persistence of rumours despite facts to the contrary is good evidence that their primary value is ideological, not explanatory.

What Kaufman misses about the rumour is what it says about gay men as innovators, anticipating (most likely outright inspiring) scientific research and experimenting on themselves to find ways of enjoying pleasure while minimising risk.

Kaufman's article does nicely illustrate what happens when science and then finally educators catch up. Scientists think "huh, cool" and "why didn't we think of that" because, at heart, they see technological solutions as simpler and more reliable than social ones. The medical and community people start to worry about implementation and informed consent and minimise-versus-eliminate the risk and all the other considerations that arise from our general conservatism about risk/pleasure.

"There is this cultural reluctance to giving people pills that allow them to do things we don't want them to do," says Thomas Coates, Professor of Medicine at UCLA's David Geffen School of Medicine. He's talking about the point at which fears about PrEP cross over from practical to moral-fears of a future in which PrEP, like the Pill before it, becomes as much a vehicle for pleasure as for prevention.

This is (unintentionally) a very revealing quote: pleasure is only moral in a Puritan world. Thinking he's moving on, Kaufman goes on to make the excellent point that the high cost of PrEP roll out introduces the problems that plague every other kind of healthcare in the United States -- inequitable access based on ability to pay.

Maybe I've been living in a socialist utopia for too long, but for me, that's the point when the issue becomes a moral one. Not whether we're using a medical technology to facilitate people enjoying themselves. Sexual pleasure and physical intimacy is not a luxury, like an icecream Sundae at the movies; it's a basic human need.

Kaufman rightly calls bullshit on the latest "menu-based" misunderstanding of "combination prevention", pointing out that gay men will NOT use a combination of PrEP and condoms and partner reduction: the whole point is having sex without condoms.

This highlights the dirty truth underlying all these discussions: gay men HAVEN'T abandoned condoms. In most areas, 70-80% of gay men use condoms all the time for casual sex.

The remainder are probably like the 30% of American voters who continued to think Bush was doing a heckuva job even after Afghanistan, Iraq and Katrina. And even they (the gay men, not the Tea Baggers) use condoms sometimes -- indicating some baseline/remnant adherence to safe sex motivation.

PrEP is an option for people in that tiny minority of gay men who will never use condoms. And Kaufman acknowledges that himself, when he talks about the "high risk" patients to whom Dr Conant is prescribing PrEP. It's a measure of his sexual prejudice that Kaufman automatically assumes "high risk" means all gay men.

Once you factor targeting into the analysis, along with intermittent dosing and slow-release formulations and tenofovir coming out of patent, you get the beginnings of a PrEP strategy that might not be prohibitively expensive, and that's a far cry from "keeping people negative by any means necessary".

As Elizabeth Pisani sensibly points out:

I think we should develop a vaccine even at "modest" effectiveness; for people who do not have any safe behaviour to undo, a 30 per cent reduction in risk is better than none. But I'll be curious to see if the public heath nannies agree.

Hear bloody hear. This concept of "partial effectiveness" is an important one, and we need to communicate it carefully to our community. Combined with careful, thoughtful targeting of high risk men (contrary to public health doxa that's not all gay men) it underpins all the major alternatives-to-condoms, like PrEP, rectal microbicides, treatment as prevention (Swiss Statement), and serosorting. But that's another post. Right now, my arse is numb and I need to sleep.