Purity, Pleasure, and HIV in Trump's Second Term
This essay grew out of my contribution to a panel on purity culture hosted by Feminist Studies in Religion at the American Academy of Religion in November 2025. Many thanks to Lauren Sawyer and Kimi Bryson for inviting me to participate in the panel!
I had an unusually difficult time putting my thoughts about the logics of purity in this political moment to words, so I will begin by naming some of what is happening.
In the first half of 2025, paving the way for its America First Global Health Strategy, the Trump administration shuttered the US Agency for International Development (USAID) and slashed funding to the National Institutes of Health (NIH). USAID and NIH had been supporting Human Immunodeficiency Virus (HIV) vaccine research through medical consortia in the United States and Africa. The trials have lost their funding.
The grant terminations are particularly tragic because, after forty years of searching for an HIV vaccine and some 40 million AIDS-related deaths worldwide, the research was bearing fruit, thanks to the developments in mRNA technology that have helped lessen the effects of SARS-COVID-19.
Between May and July 2025, three trials of mRNA vaccines—two in the United States and one in Rwanda and South Africa—demonstrated the mRNA technology’s ability to generate antibodies necessary to produce immunity to HIV. Then, in August, Robert F. Kennedy Jr., the United States secretary of health and human services, cancelled $500 million in funding for mRNA vaccines.
There have been other profound developments in HIV/AIDS medicine that warrant note. A variety of PrEP (Pre-Exposure Prophylaxis) was approved by the Food and Drug Administration (FDA) in 2012. When taken daily, PrEP (in the pill forms of Truvada, Descovy, or Truvada’s generic) reduces the odds of acquiring HIV through sex by around 99 percent and through intravenous drug use by at least 74 percent. In December 2021, the FDA approved a long-lasting form of PrEP called Apretude administered by shot every other month. And in June 2025, the FDA approved Yeztugo, injectable PrEP administered twice a year.
The injections are fabulous news, aren’t they, particularly for those of us who may struggle to take pills daily.
But Gilead Sciences—the manufacturer of Truvada, Descovy, and Yeztugo—is charging $14,109 per injection of Yeztugo, or $28,218 a year. It already exists as a treatment for those living with HIV, for $39,000 a year. Researchers say it could cost as little as $25 to manufacture. It is difficult to say how many people who do not take the daily pill would start PrEP through Yeztugo, but the high price will lower that number by scaring off pharmacies and insurers from providing coverage.
You may have seen ads for Gilead’s balms while watching Pose or heard them while listening to a favorite queer podcast, but the dystopically named company does so much to prevent its products from reaching those who need it.
Millions are slated to lose health care due to Trump’s cuts to Medicaid, and Supplemental Nutrition Assistance Program (SNAP) benefits have been suspended and toyed with, raising food insecurity.
I am a theologian, writer, and publisher, not a public health expert, but I have studied HIV/AIDS enough to know that these are the conditions in which disease spreads.[1] For communities whose access to healthcare is already tenuous, including people without steady jobs or places to live and lower-income families, the effects will be worse. Indigenous, Latine, and Black people in the US, who are uninsured at higher rates than white people, will be disproportionately affected. Women and queer and trans youth will be disproportionately affected.
These are also conditions in which individuals are made to bear more than they can carry.
Personal responsibility, especially in the domain of sex, is stressed over institutional responsibility. Queers are expected to sacrifice pleasure, the practices and institutions that facilitate it, and the relationships it builds for the health of the family, the nation, the church, or the greater LGBTQ community. Similarly, young white women are burdened with the responsibility to put aside sexual desire entirely or harness it toward producing families of good white Christian families (and with them, the church and a Christian nation) that they must protect from queers. A young woman’s failure to keep “pure” will make her as good as a new pair of white shoes passed around, worn, and soiled by the whole football team, to use one metaphor I recall from my own formal sexual education. Worse, she will become a vector of sexual disease.
Suspicions of and prohibitions against pleasurable activity—an injunction at the heart of purity culture—intensify when the reality and fear of disease spreads. Isolation, an incubator of fascism, becomes praxis. The desire to mitigate one’s own risks grows alongside the real need for collaborative political efforts that slow, reform, and abolish systems that trade on precarity.
These are also conditions, then, in which purity culture and health cults thrive. Evangelical purity culture arose in the 1990s, the second decade of HIV/AIDS as such.[2] There is a direct link between the two, as scholars like Sara Moslener have shown.[3] Those of us who have been influenced by either phenomenon may seek to make our bodies spectacles of health and strength, perfectly gendering them to represent our capability to produce and sustain life and ward off the fear of death. This was true of both gay men in the 1980s and 1990s and evangelical women in the 1990s. For the former, musculature became a totem of sexual health; for the latter, modesty suggested fit for the inevitable horizon of heterosexual marriage and raising a family, and until then, celibate singleness. Musculature and modesty became aesthetic forms of untouchability.
In both gay/lesbian and evangelical spaces in the 1990s, monogamous marriage was pursued as a solution to the risks and dangers—real and imagined—of sex. A channeling of energy from AIDS activism into gay marriage activism in that decade oscillated public focus away from the gay man and a gay community as sites of sex, illness, and death, whose relationships were not protected by law (resulting in horrible stories of lovers prohibited from visiting their dying beloveds) toward the gay male couple seeking dignity through full recognition by the state in marriage and adoption.
The hard push for gay marriage in the 1990s and 2000s in courts and churches and through the growth of a massive fundraising and advocacy apparatus has been spoken of as trading liberation for respectability, but it may also fruitfully be considered alongside purity culture. Theologies of LGBT inclusion in the church have disciplined queer sexuality into forms of marriage and celibacy that are unfit for many of us.[4] But beyond harming queer Christians, purity culture offers LGBTQ Christians an idiom for inclusion in churches through subjecting gay desire to sexual constraints already recognizable as Christian. These constraints are welcome and good for some of us and deforming impositions for others. The visible and invisible roles HIV/AIDS has been given in the development and constraint of gay sexual theology will be discussed in my first book.
It is odd to be at an age now when I can worry for young people, but I worry for those who are coming into their sexual selves in the era of COVID and Trump. I fear an increasing threat of disease produced by the Trump administration will cause not only the young, but many of us of all ages, to abandon sex as a generative, unwieldy, and unpredictable source of various kinds of relationships.
In the wake of PrEP’s increasing availability, queer men and trans women have begun to talk about cruising again.[5]
Cruising is first a cultivation of vision. The cruiser keeps their eyes open and alert to passersby who are similarly alert. Following initial eye contact, a second shared look establishes interest. The second look is a successful cruise. The cruisers may or may not follow one another home or into the woods or a bar and consummate their vision.
Cruising is also a cultivation of space and spatial awareness. Known cruising grounds run through public parks and bathrooms, and they’re invisible if you don’t know to look for them, or unless a new cruiser makes a clumsy mistake and veers off the beaten path.
Cruising is one iteration of sexual desire bent toward encounter with another, typically a stranger. Samuel Delany’s Times Square Red, Times Square Blue famously describes how cruising, and the urban spaces built to facilitate it in New York City prior to Mayor Giuliani’s rezoning laws, brought together people of different economic statuses and races who would otherwise never engage one another. One need not cruise to connect with a stranger, but cruising is a ritualized means of connecting with strangers that is available to queer men. It is a sometimes romanticized practice. And it produced a wealth of gay literature from the 1950s on that has informed the imaginations of subsequent generations of gay men. Depending on location, cruising can also be a highly risky—because public—practice. According to The Gothamist, between June and September 2025, the Amtrak Police Department in New York arrested or detained almost two hundred people for “public lewdness” or “indecent exposure” at a bathroom in Penn Station. Of these two hundred cruisers, twenty were immigrants who were subsequently detained by ICE.
A few times during Trump’s first and second terms, I have heard older LGBTQ people say that this all feels familiar. Greedy drug manufacturers, a US government content to kill its people, and the sudden absence of lovers were hallmarks of the Reagan years.
A couple months ago, I ran into an older gay man from my gym at a rave. I was coming off the dance floor and saw him sitting alone at the bar. He was moving to Mexico soon. “All the dancing—,” he said, “it’s like the early ’80s. Everyone laughing and having a good time, but people are starting to disappear.” I asked him when his move was, and he said next week. “I’ve lived through this shit once. I don’t want to do it again.” I hugged him goodbye and sobbed on the speedwalk home.
If these are familiar times, we may have familiar resources to meet them. We need to encourage intergenerational friendships and reading to share wisdom learned from earlier fights and put it to use.
Before and after effective antiretrovirals were introduced in 1996, allowing those with healthcare to live with HIV, queer men developed approaches to sex and society amidst AIDS. Some avoided sex. Some sought monogamous relationships, believing they could thus avoid the virus. Some believed that sexual pleasure and the culture built around it were not solely sources of risk, but sources of life. Among them, some kept up with developments in medicine about what was gay cancer, then Gay-Related Immunodeficiency, then HIV/AIDS, while continuing to have sex, now with condoms, or simply masturbating together. Others, for any number of conceivable reasons, did not adjust their sex practices to new prophylactic norms. Debates, sometimes terribly personal debates, arose between those who understood pleasure, risk, and responsibility differently. Bathhouses and gay bars closed. The internet opened.[6]
One necessity of this moment of fascism and AI is to sustain queer life, love, and history in the flesh. The Trump administration’s nihilistic health, immigration, and censorship policies threaten each of these. We must develop and nurture practices that turn us outward toward each other, not inward, in ways that are meaningful to us in our particularities. For some of us, these may include sexual practices that insult notions of purity and health-as-purity; for some, new forms of political organizing that throw wrenches in the gears of white Christian nationalism and fascism; building networks of care, procuring hormones and antiretrovirals for those who need them however we can; getting in the way of ICE; publishing the unsayable. For others of us—imagine—political and sexual practices will go hand in hand, buoying each other as we build for whatever it is that comes next.
On the day of the “Beyond Abstinence-Only” panel at the 2025 annual meeting of the American Academy of Religion (AAR), I thought of Kevin Gordon, who I've written about previously on The Rearview here and here. He was a gay Catholic theologian and sexologist killed by AIDS in 1989. He sought a model of sexual relationship “that is not necessarily monogamy on the one hand, nor genital anonymity on the other”—something truer to the “delicate” desires and relationships of gay men. Kevin presented some of these thoughts in “Gay Men’s Experience and Christian Sexual Ethics,” a paper he gave to the Ethics Section at the annual meeting of AAR on November 23, 1985. That was a couple of years before the founding of the Gay Men's Issues in Religion Unit (now Gay Men and Religion Unit). And forty years before the Feminist Studies in Religion panel on purity where I gave a version of this paper.
I turned my talk notes into this essay when I was invited to publish the talk in a journal alongside the panel's other really great contributions. When the journal's publisher would not allow me to keep my copyright, I withdrew my piece. I am grateful to the journal's editors for their efforts to accommodate my concerns.
Copyright—ownership of one's own words—is important, and the widespread and casual exploitation of labor in academic publishing is a problem. The problem particularly affects the transmission of queer writing and history, which I am learning as I acquire projects for Homodoxy. It also affects those who do not have dependable jobs and pay. We must value ourselves, each other, and our words more.
If people are interested, I might write about this subject for a future issue of the Rearview.
[1] See, variously, Agbonkhianmeghe E. Orobator, From Crisis to Kairos: The Mission of the Church in the Time of HIV/AIDS, Refugees and Poverty (Paulines Publications Africa, 2005); Jih-Fei Cheng, Alexandra Juhasz, and Nishant Shahani eds., AIDS and the Distribution of Crises (Duke University Press, 2020); Steven W. Thrasher, The Viral Underclass: The Human Toll When Inequality and Disease Collide (Celadon Books, 2022).
[2] Although not identified as a retrovirus and named “Human Immunodeficiency Virus” until the 1980s, the two strands of HIV have affected humans since the first half of the twentieth century. For a consideration of the costs of historicizing HIV/AIDS in the United States as a phenomenon of the 1980s and 1990s, see Theodore (Ted) Kerr, “AIDS 1969: HIV, History, and Race,” Drain 13, no. 2 (2016).
[3] Sara Moslener, Virgin Nation: Sexual Purity and American Adolescence (Oxford University Press, 2015), 103.
[4] See Lauren D. Sawyer and Victoria Houser, “Purity Culture and the Limits of Queer Evangelicalism,” Theology & Sexuality 29, no. 2–3 (2024): 200–18.
[5] Among many books, see Alex Espinoza, Cruising: An Intimate History of a Radical Pastime (The Unnamed Press, 2019); Brontez Purnell, The Cruising Diaries, Expanded Edition, with illustrations by Janelle Hessig (Silver Sprocket, 2021); Leo Herrera, (Analog) Cruising: A Manual (Leo Herrera, 2024). See also the rise in popularity of Sniffies, a map-based platform hosted on a website, rather than an app, so not beholden to app regulations. The locations of users are approximated on the map, and users can add markers for local cruising grounds and information on how to access them. Gabe Gonzalez and Chris Patterson-Rosso, "Cruising 101," with guest Leo Herrera, Sniffies’ Cruising Confessions, June 13, 2024, podcast, 40 min, 13 sec.
[6] The history of discussion of pleasure, risk, and HIV/AIDS is vast, varied, and an essential partner to the study of purity culture. And the discussions are ongoing. Some relevant entries: Michael Callen and Richard Berkowitz, How to Have Sex in an Epidemic: One Approach (News from the Front Publications, 1983); Leo Bersani, “Is the Rectum a Grave?,” in Reclaiming Sodom, ed. Jonathan Goldberg (Routledge, 1994); Bill Smith, “Liberation as Risky Business,” in Changing Conversations: Religious Reflection and Cultural Analysis, ed. Dwight N. Hopkins and Sheila Greeve Davaney (Routledge, 1996); J. Michael Clark, Doing the Work of Love: Men and Commitment in Same-Sex Couples (Men’s Studies Press, 1999); David M. Halperin, What Do Gay Men Want? An Essay on Sex, Risk, and Subjectivity (University of Michigan Press, 2007); Tim Dean, Unlimited Intimacy: Reflections on the Subculture of Barebacking (University of Chicago Press, 2009); Martin B. Duberman, Hold Tight Gently: Michael Callen, Essex Hemphill, and the Battlefield of AIDS (The New Press, 2014); Marlon M. Bailey, “Black Gay (Raw) Sex,” in No Tea, No Shade: New Writings in Black Queer Studies, ed. E. Patrick Johnson (Duke University Press, 2016); Tim Dean, “Afterword: The Raw and the Fucked,” in Raw: PrEP, Pedagogy, and the Politics of Barebacking, ed. Ricky Varghese, The Exquisite Corpse (University of Regina Press, 2019); Marlon M. Bailey, “Black Gay Men’s Sexual Health and the Means of Pleasure in the Age of AIDS,” in AIDS and the Distribution of Crises, ed. Jih-Fei Cheng, Alexandra Juhasz, and Nishant Shahani (Duke University Press, 2020); Kane Race, “Reluctant Objects: HIV Prevention and the Problem of Sexual Pleasure,” in A Pill for Promiscuity: Gay Sex in an Age of Pharmaceuticals, ed. Andrew Spieldenner and Jeffrey Escoffier, Q+ Public (Rutgers University Press, 2023).
