When the Food and Drug Administration approved a drug to reduce the risk of HIV infections in July 2012, gay men rejoiced. If taken daily, Truvada works like a vaccine against HIV, effectively halting its spread. The Centres for Disease Control and Prevention hailed it as an “important new tool” in the fight against the disease.

Slate, the online current affairs, politics and culture magazine, described it as “a miracle drug”. Barack Obama went even farther to imagine an “Aids-free generation”.

It hasn’t worked out that way. Truvada isn’t making gay men healthier and safer; few are using the drug at all. And after years of decline, sexually transmitted diseases are spreading fast across the United States. From 2005 to 2014, HIV diagnoses jumped 6 per cent among men who have sex with men, with spikes of 101 per cent among Asians, 24 per cent among Latinos and 22 per cent among blacks.

Six in ten gay African-American men will be HIV-positive by their 40th birthday, according to some estimates. Transmission continued to climb even after Truvada hit the market.

Doctors worry that the US is heading towards a health mega-crisis, fuelled by the fantasy that sex in 2016 is safer than it was in 1986. And gay rights groups are largely to blame. Rather than educating men about Truvada, they have focused on stamping out the stigma around HIV.

Not only do these campaigns minimise the dangers of the disease, they tiptoe around strategies for prevention. After all, why worry about catching something that isn’t a big deal?

Truvada has tumbled into a culture of careless cheerleading that is putting gay men in danger.

In 2004, Truvada hit the market as PEP, or post-exposure prophylaxis, an HIV treatment. But scientists quickly saw the drug’s potential. With a couple of tweaks, PEP became PrEP, or pre-exposure prophylaxis. It works something like birth control: users who pop a pill every day are up to 99 per cent protected against HIV, even if they have unprotected sex with someone who is positive.

The FDA approved Truvada’s use as PrEP in 2012. It was precipitous timing. The rise of successful HIV treatments and broader cultural acceptance of gay life had turned HIV from grim reaper to nagging doctor, emboldening gay men to view condoms as cliché or passé; fearmongering, heteronormative shackles bullying their inner unicorn-spirit animals.

Indeed, gay slang for condom-less sex is “uninhibited”. Unprotected sex among gay men jumped 20 per cent between 2005 and 2013; 57 per cent of gay men said they had had unprotected anal sex at least once in 2011. As national sex-advice columnist Dan Savage told me, “People are acting like it’s 1978 again and we’re all at the Mineshaft.”

Truvada, researchers figured, would offer another form of protection against HIV, which 492,000 gay American men are at high risk of contracting, according to the CDC. Yet so far, only 21,000 prescriptions have been written.

One problem is cost: Truvada runs about $1,300 a month. But it is covered by most insurance plans, and Medicaid and many municipalities regularly distribute the drug for free. Gilead, Truvada’s maker, even offers discounts.

Additionally, many men are reluctant to follow a daily medication regimen. Others are just bad at keeping up with a daily pill. From 2012 through 2015, one set of researchers tried to get 557 men and transgender women who have sex with men to take the pill for 48 weeks and attend five study visits. One in five didn’t stick with it.

In another 48-week study, 200 young men were given Truvada and told to take it daily. By the end, only 35 per cent were regularly doing so. An additional 30 per cent had stopped their intake entirely.

There is also the stigma. While Truvada is gay America’s guardian angel, its users are broadly and persistently labelled “Truvada whores”: men who sleep around, unsafely. Others worry that they will be pegged as HIV-positive, since Truvada can be used as a treatment for those already infected.

One continuing study of young gay men found that 79 per cent knew about Truvada but only 11 per cent had tried it.

The vast majority of non-users said stigma kept them away. Perry Halkitis, a public health professor at New York University, says that in gay circles, Truvada is known as the “sissy pill”. “Because,” he says, people think: “Why would you take it unless you were bottoming?”

Even doctors are reluctant to prescribe it. Melanie Thompson, the principal investigator of the Aids Research Consortium of Atlanta, told NPR in 2014 that some medical professionals worry that their patients will stop using condoms if they take PrEP. In that same story, a CDC spokeswoman cautioned that healthcare providers’ lack of awareness is one of the significant challenges to PrEP’s success.

Meanwhile, the rate of new HIV infections has begun to rise among gay men, after years of decline.

In 2013, it was estimated the disease was diagnosed in 30,689 gay male Americans, up from 26,700 in 2008. Young people — that is, under 30, younger than the epidemic itself — are the largest group of new HIV cases, especially young minorities.

In the past decade, diagnoses among black and Latino men younger than 24 who have sex with men rose 87 per cent, compared with 56 per cent among their white peers. In other words, HIV is bubbling into an epidemic once again.

While the crisis is not exactly in spite of the work gay groups are doing, it is enabled by them. Some, such as the Los Angeles-based Aids Healthcare Foundation, actively opposed FDA approval of Truvada, arguing that it gives users a false sense of security because most users don’t take the drug consistently.

Others pretend that the hard, important mission around HIV is not preventing people from getting it, but, rather, the more familiar battle of accepting those who are infected, of sharing stories and cloying hashtag slacktivism. Rather than trying to destigmatise Truvada, in other words, they are destigmatising Aids.

“Since the 1990s, HIV education has been about ‘awareness’ and demystifying, destigmatising the virus — much, much more than actual prevention,” Savage says. “They’re mostly [HIV-positive] guys themselves who are in it to reclaim their place in society. They talk about gay men like they’re all smart and rational, ignoring the fact that people with erections are often reckless.” Take the bewildering social-media campaign in which gay men and allies posed with glasses — trendy! — next to the phrase “HIV Smar+” (see what they did there?).

The posters offered no information about what “smart” might be. Or HIV Equal, which operates under the slogan “Everybody has an HIV status. We are all HIV equal”. Sample advertisements show shirtless men with the words “Status: Fly” and “Status: Fun”.

The campaign’s stated mission is to “help end stigma against people living with HIV (PLWHIV), and to link or relink HIV-positive individuals into proper care and treatment”.

The sunny froth reflects a broader shift in gay culture — a focus on celebration over investigation. The Out 100, an annual who’s who of gay, lesbian, bisexual and transgender influencers (and straight allies) that was published by the gay and lesbian magazine in November, included 15 activists, two YouTube stars, one meteorologist, one president of Food Network, and zero doctors, researchers or public health officials.

In an interview with Obama, Out’s Ally of the Year, HIV came up once, briefly, as a nod to the president’s early days fighting housing discrimination in 1980s Chicago. It felt as long ago as Angels in America, Philadelphia, Rent or any other artefacts of the 1990s heyday of Aids awareness.

Today’s power-of-positive-thinking optimists are hoping to rise above the fray, leading by example with a model that aims to be laissez faire but ends up as plain lazy.

Even when gay groups embrace Truvada education, their efforts seem silly. Take Public Health Solutions, a non-profit whose self-described mission is to “help illuminate critical public health issues”. In November, it debuted a profanity-laden public-service announcement on YouTube, ending with the tagline “WTF is PrEP.” So street. So effective. If that’s what the group went with, what were the ideas it rejected?

I happen to know, because, as luck would have it, last April I was part of a Public Health Solutions focus group. Twenty-five gay men, almost all white, were assembled to give feedback on some scripts and share general thoughts about Truvada.

The session was managed by Kenny Shults, a comedian who told HIV+ magazine, which goes by Plus, of course: “Why get tested? What’s the point if testing has no impact on how I live my sex life.” His day job, for the record, is working for a health consultancy.

At the focus group (full disclosure: they gave me $50 and a sandwich), one script involved a gay man readying for a big night out — getting dressed, fussing with his hair and popping a Truvada. The line was something like: “I like to party. But I like to be safe, too.” The slogan was something like: “Prep for life. Prep for possibilities.”

No, no, we all told Shults; maybe the scriptwriters were too corporate and out-of-touch to know this, we explained, but “party” is gay slang for lots of dangerous activity, including the use of crystal meth, sometimes with needles. Shults nodded, made notes and thanked us for our input.

But later, along with the outrageous advertisement came another one: it shows a blond white man dancing shirtless at a club and saying, “I like to party.” Then it cuts to him sitting on a couch, prowling Grindr, the gay social-networking app, when an alert pops up on his phone: “Time to prep.”

It’s not just that he uses the line we in the focus group all warned against. It’s that the very title of the video is “I Like To Party”. It was the activism equivalent of using the Aids Memorial Quilt for a boys-will-be-boys towelling-off after sex with a stranger.

These adverts, Shults and others say, are supposed to reach people who aren’t motivated by the “this can protect you” message. Really, though, they just turn safe sex into a joke. That’s a mistake. More than 60 per cent of new HIV infections in the US are transmitted by people who know they have the disease.

An additional 30 per cent are transmitted by the 13 per cent of HIV-positive Americans who do not know their status.

With numbers this serious, the time for sunny slogans has passed. We need to convince America’s gay men that they need to protect themselves and tell them how to do so. PrEP can help. Let’s get it out there.

• Richard Morgan, based in New York, is the author of the memoir Born in Bedlam and a freelance writer for The Washington Post among others