I’m slightly resistant to writing this piece, because it requires me to reveal some personal truths that have nothing to do with my politics (which I’m very used to expressing with little reservation). But a somewhat bizarre conversation is happening around a relatively new use for a not so new drug on the market. And much the same way as gay activists from Harvey Milk to Frank Kameny once proffered, coming out of the closet is the quickest and best way to turn a homophobic tide, it seems like there is a new tide, and a new closet from which to emerge.
Pre-exposure prophylaxis (PrEP) is a relatively new HIV prevention approach where HIV-negative individuals use anti-HIV medications to reduce their risk of becoming infected if they are exposed to the virus. In 2012, despite efforts to derail it, Truvada became the first and only medication approved by the Food and Drug Administration (FDA) for HIV prevention. Doctors had been prescribing it off label well before the FDA approved it, and for good reason.
The use of PrEP is being hailed by some, including physicians as one of the most promising new drugs in the reduction of new HIV infections, which now total about 50,000 a year in the U.S. according to a recent Associated Press story that focused on PrEP or its brand name, Truvada.
As the AP story put it, the remarkable efficacy of Truvada has led to a “rancorous debate among gay men, AIDS activists and health professionals over its potential for protecting uninfected men who engage in gay sex without using condoms.” And how remarkable exactly? In a 2010 clinical trial funded by the National Institutes of Health and published in the New England Journal of Medicine, even in those patients who didn’t adhere perfectly, their risk of contracting HIV still dropped by more than 90 percent. Yes, you read that correctly — 90 percent.
For those taking Truvada daily, as prescribed? A whopping 99 percent reduction.
The results of three successful PrEP studies, iPrEx, PARTNERS and TDF2 are pretty much incontrovertible. As Joe Biden would say, this is a big fucking deal.
The latest battle lines around PrEP have been simmering for a while already. And as expected, the usual suspects, like the divisive Andrew Sullivan, are front and center of the discussion. But a reckless quote in the AP story by Michael Weinstein of AIDS Healthcare Foundation, in which he called PrEP a “party drug” catapulted the issue into the spotlight, sparking appropriate outrage along with much needed conversation on the one hand, and petitions calling for Weinstein’s resignation on the other.*
One can appreciate the uphill struggle it has been to get youngsters to take HIV seriously, or view it as anything more than a mere inconvenience, when their only real reference to HIV and AIDS have been glossy magazine ads touting the latest HIV medications with visual depictions of gorgeous, healthy, perfectly sculpted men scaling mountains with bikes on one shoulder. Which, despite the confusion that can result from that kind of messaging, is infinitely better than the much-maligned poster campaign by STOP AIDS Project San Francisco, which included vivid images of some of the negative effects of AIDS, such as diarrhea, facial wasting, night sweats and crix belly.
Not to mention the extent to which negative portrayals of people with HIV unnecessarily offend and scare people who are living with the virus (particularly those who are asymptomatic), and even worse, scapegoat, isolate and denigrate an entire group of people who happen to be carrying a virus that does not discriminate.
Against that backdrop, are a slew of coming out of the PrEP closet stories by the likes of Lucas Films porn studio owner and actor Michael Lucas, (coupled with his decision to compete in the rapidly growing bareback porn market — and bareback porn star inventory — by ditching condoms once favored along with studios like Titan and Falcon). The latter continue to produce condom-only porn, but the appetite for bareback frustrates the efforts of current HIV prevention strategies, which continue to advocate for condoms or abstinence, despite their demonstrable limited overall effectiveness in reducing transmission.
Lucas’s porn star status, and financial incentive to promote the virtues of safer, guilt-free barebacking, dilutes his message and thus his potency as an appropriate PrEP poster man. Andrew Sullivan’s holier-than-thou sanctimony can be a royal pain in the ass to many people, but he is able to elevate a conversation that penetrates mainstream media. And although Sullivan is HIV-positive, (and thus not part of the constituency for whom PrEP is an available HIV prevention strategy), he has been touting preventative medication since 2006, and credit is due where credit is due.
SF AIDS Foundation strongly supports PrEP, and has teamed with a slew of other agencies to promote its use and make it available, including a blog featuring Jake Sobo, a pseudonymous, sexually promiscuous HIV negative man, who early on reclaimed the PrEP whore label. And while it’s great that Jake Sobo unashamedly documented his PrEP life, his anonymity inadvertently perpetuates the very thing he seeks to eliminate. That there is shame involved in using PrEP. Something to be hidden or unspoken.
But what really is going on here, and why Weinstein’s comments lit such a fuse of outrage, is that he attempted to demonize a potentially revolutionary HIV prevention tool rather than cop up to the abject failure of HIV prevention messaging. And his complicity in it. The failure of which, ironically, for better or worse, sustains his relevance and enables him to command six figure compensation packages. ($398,650 to be exact, according to some digging by activist Michael Petrelis). Without AIDS, who needs AHF? It has been an issue for AIDS, Inc. ever since HIV became a manageable disease and no longer a death sentence.
Michael Weinstein’s comments were not only idiotic and counter productive, they were designed to mock and humiliate people for making intelligent, and not necessarily easy, choices. Using, no less, the same tactics one would expect of the recently deceased Fred Phelps of the Westboro Baptist Church, not the head of an organization who receives much of its funding on the premise it will help eradicate AIDS, not attack and punish those acting in alignment with those goals and worse, preclude them from gaining access to tools that allow them to make the best possible health choices.
Continue reading at The New Civil Rights Movement.