Truvada and politics
July 16th, 2012
The Food and Drug Administration has now just approved the use of Truvada, an AIDS drug, as a preventative medication for some high-risk HIV-negative people. To my way of thinking, this is WONDERFUL, yet another tool in our arsenal for slowing and preventing the spread of the virus.
Not everyone agrees. (Wall Street Journal)
In a media call after the decision was announced, the AIDS Healthcare Foundation called the FDA decision “a catastrophe in the fight against HIV in America” and said it was likely to lead to more, not fewer, HIV infections.
The organization has opposed FDA approval for Truvada’s use in preventing HIV in healthy people. Gilead Sciences is the maker of Truvada, which was already approved to treat people who are infected with HIV.
Michael Weinstein, co-founder and president of the AIDS Healthcare Foundation, later told the Health Blog that healthy people should be required to show proof of a negative HIV test before getting Truvada as a prevention medicine.
[UPDATE: Sorry, I left out essential information] However, Weinstein is not just demanding testing, a condition that was announced a month ago. He and AHF have led a campaign against this step altogether.
Weinstein and AHF are a bit, well, peculiar. I don’t want to trash an organization that works hard to encourage testing, but sometimes I think that Weinstein’s brand of politics is based more in micromanaging the lives of others than in utilizing tools to prevent the spread of AIDS. (He has collected enough signatures to put a proposition on the city ballot to ban the production of all porn in the city of Los Angeles that does not feature condoms. He thinks this will reduce non-condom porn – gay or straight – from being produced and marketed; I know it will simply cause a multi-billion dollar industry to move somewhere else at a time in which our city is in financial panic mode. Porn producers will provide for demand.)
Here’s what I know: some people will behave irresponsibly for a time. Here’s what I believe: that irresponsibility does not deserve sero-conversion as some sort of punishment or moral judgment. If we can limit their transmission rate, that is a good thing EVEN IF they are bad bad boys who don’t have sex the way that Michael Weinstein thinks appropriate.
HIV is not an automatic presumption for unsafe sex. And I get the impression that Weinstein – who has for years sang the mantra that condoms must be worn every time – would prefer that we act out of fear rather than truth. And here is some truth that he surely will not appreciate.
- HIV is not an every-time transmission even if anal sex is unsafe and the top is positive.
- Oral sex has such a low transmission rate that it remains more in the realm of biological plausibility than of likelihood.
- Medications are very effective and many HIV positive people have so low a viral load that they are “undetectable”. It is theorized (and widely rumored) that undetectable people cannot pass on the virus.
And I firmly believe that too many young gay men have thought “yeah, well I screwed up so I’ve probably become infected by now so why should I even try to protect myself this time”. Truth is a tool that allows us to respond and it has always infuriated me that the AIDS prevention community has been less than forthright.
I am not suggesting, hinting, implying, or advocating for giving up rule number one which is “wear a condom”. And the inclusion of counseling and risk management as a requirement for prescription is, I believe, a wise move. And there are many unanswered questions including cost of the medication, availability, and the extent to which some will see it as a magic shield.
But I also am realistic enough to know that safer sex will not always happen. Sorry, that’s just the truth. And I also know that some serodiscordant couples negotiate the risks they are willing to take so as to allow some measure of spontaneity and enhanced intimacy and I’m not going to stand in their bedroom with a clipboard and a bureaucratic tone. If this gives them an additional tool to decrease the odds of infection, then by all means allow them the tool.
I agree with AHF that everyone really needs to be tested. I would love to see a massive governmental effort (yeah, I said it) to test every single person in the country above the age of 13, regardless of who they are (preferably using the nucleic acid test twice over a two month period). I believe that people are basically decent and that knowledge of one’s status would go a long way to avoiding infecting others.
And I want to praise that organization for being on Santa Monica Boulevard in a ‘testing bus’ during the evenings when the bars are packed while the institutional (and increasingly pointless) Gay and Lesbian Center offers testing in West Hollywood from noon to 7 PM four days a week for up to 20 people per day. I also appreciate Weinstein’s support of the newly approved at-home HIV simple swab test that requires only 20 minutes and no outside participation.
I also pledge that if Weinstein proves right and sero-conversions increase rather than decrease, I will apologize and join him in calling for a reversal of the FDA’s position. But for me, fewer transmittable and fewer infectible people means less virus transmission which makes me want to stand up and dance around the table.
I think that FRC and Weinstein need to let go of the nanny instinct and find ways to utilize new tools to maximize results rather than seek to mold behavior. Because you don’t want to find yourself wondering why you feel sad, angry, and in objection on the day that we finally find an effective vaccine for this vir