AHF exports opposition to PrEP to the UK
January 22nd, 2016
In the United Kingdom, PrEP is not yet available through the National Health Service, the nationally subsidized health care system. This means that those people choosing to protect themselves from potential HIV infection by use of pre-exposure prophylaxis must do so out-of-pocket.
The NHS is considering approval of Truvada for PrEP and the BBC ran a newsnight special about this consideration. Supporting making PrEP available was Dr Michael Brady from the Terrence Higgins Trust. And, as it appears that the only opponents to PrEP-based HIV prevention on the globe may be the AIDS Healthcare Foundation, speaking in keeping PrEP unavailable was Jed Kensley, senior director of the AIDS Healthcare Foundation.
Kensley presented absolutely no logic or justification for his position. He just stated it and then tried to talk about people using it contrary to the guidelines of the US FDA (which, as far as I know, does not dictate UK policy).
There is no reason for AHF to interfere in UK policy. Except to try and discourage any further acceptance of PrEP overseas which could, in turn, encourage use in the US.
And as much as AHF claims that it supports PrEP for those “who have multiple partners and never use condoms”, they went on BBC to support the NHS’ policy of providing PrEP to no one at all. Tis far better, in the minds of the directors of AHF, that those “who have multiple partners and never use condoms” in the UK continue at risk for seroconversion than that someone who uses condoms – well, most of the time – has the chance to protect themselves further.
The more I hear from AHF, the harder it is for me to believe that they want people to stay uninfected.
AHF files complaint against Gilead
January 21st, 2016
Earlier this month, AIDS Healthcare Foundation and its president Michael Weinstein issued a press release accusing Gilead of creating a direct-to-consumer advertisement which encouraged situational PrEP use in violation of FDA guidelines.
As we illustrated, it was filled with falsehoods and insinuation and made claims that even at the most casual glance proved to be false.
Well now AHF has gone one step further. They’ve issued a letter of complaint against the maker of pre-exposure prophylaxis (PrEP).
On Thursday, AHF sent a letter to Dr. Stephen Ostroff, M.D., Acting Commissioner of the U.S. Food and Drug Administration (FDA), alerting him to the fact that Gilead financed a video ad campaign promoting situational use of its AIDS treatment, Truvada, for PrEP, misleading viewers into believing that Truvada is safe and effective for use on a situational basis, despite knowing that the drug is not FDA approved for such off-label use.
So why does Weinstein and his organization continue a campaign of deception? I think there is a purpose behind the complaint.
As anyone who actually watched the video knows, it did not promote off-label use. And it wasn’t launched by Gilead. So that’s not the issue. AHF knows that their letter does not reveal any wrongdoing and I don’t think that’s their intent.
Rather I suspect that Weinstein is hoping that the theme of the video (“I like to party”) will frighten the FDA and will elicit a fear based response along the lines of “you can’t promote drug use!!!”
This isn’t about truthful marketing, it’s about punishing Gilead and hindering the advancement of Truvada as a tool against the spread of HIV. And if Weinstein can imply that Gilead tacitly supports the use of illicit drugs, that might be sufficient to push politicians to apply pressure.
So this is where Weinstein’s recommendations for punishing Gilead become interesting:
In contravention of statute and regulations, Gilead launched an ad campaign to mislead viewers into believing that Truvada is safe and effective for use on a situational basis despite knowing that the drug is not approved for such use. Consequently, the ad campaign constitutes impermissible off-label promotion, and we urge the FDA to take immediate action to (1) require Gilead to cease and desist all such off-label promotion; (2) require Gilead to publically [sic] correct the misinformation disseminated by the ad campaign; and (3) impose any sanctions permitted by law.
But Gilead hasn’t performed any off-label promotion which it can cease or desist. And sanctions would not hold up in any court. So what would this mean in practical terms?
A clue is found earlier in the press release:
Gilead, which we believe has been deliberately mounting an under-the-FDA-radar, guerilla-style marketing and media campaign for PrEP for the past three years by funding scores of community and AIDS groups across the nation to promote PrEP…”
AHF wants to put pressure on Gilead to cease funding other community and AIDS groups. Yes, it appears that Weinstein and AHF want to reduce the funds that community groups across the country use to fight transmission and treat those infected with HIV. That is unthinkable, but that is what they are asking.
And as despicable as this seems, it might not to be a novel attitude for AHF. They have been accused by many AIDS activists of a long pattern of seeking to diminish funding for other groups so as to funnel more funds, more program support, more connections, and more political power to AHF and Weinstein.
And as it is primarily community based HIV activists who are encouraging and driving the effort to get those persons at high risk for HIV transmission on the preventative drug regimen, these are the voices that Weinstein and AHF need most to silence in order for their campaign against PrEP-based HIV prevention to succeed. That these local activists are the front-line warriors in the fight against the HIV pandemic is immaterial, and the message seems clear: they must be taught that standing up against Weinstein and AHF comes with consequences.
I’m beginning to think that “vile” and “abhorrent” are adjectives that need a revival.
Michael Weinstein doubles down on “PrEP = Party Drug”; lies about video
January 8th, 2016
Public Health Solutions is a NYC based non-profit that performs both research and outreach on public health matters. As part of their focus, they support the increased use of pre-exposure prophylaxis as a prevention for the transmission of HIV.
A couple of months ago, Public Health Solutions uploaded three videos to their YouTube channel; one about PrEP and love, one targeting African-American men, and one targeting young men who party. The videos were part of a video intended to drive high-risk individuals into a clinical survey.
Here is “I Like to Party”:
Although the visuals of the video only show drinking in a bar, the implied message is that some young men use substances as a part of sex. And, indeed, the video campaign deviser said as much. (HuffPo)
The “Time2PrEP” campaign from Public Health Solutions is a series of video shorts that talks to different individuals across the queer spectrum about their experiences with PrEP and why they utilize the groundbreaking medication. Kenny Neal Shults of ConnectedHealthSolutions.com told The Huffington Post:
“When we sat down to consider the best audiences for the campaigns we knew only one thing for certain — we wanted to address gay men who might fall under the puritanical ‘Truvada Whore’ classification. That is, we wanted to reach men whose sexual and recreational drug behaviors both put them at a greater risk for both contracting HIV and being stigmatized for even considering going on PrEP. It seemed obvious to us that judging the men who could benefit most from PrEP for the behaviors that we think they should abandon and replace with consistent, unfaltering condom use was not our job. Our goal as HIV prevention professionals is to reduce HIV infections, and to communicate to those at high risk that they don’t deserve to be punished with HIV for ‘misbehaving.’ I mean, that’s the tacit implication of these reactionary pulpit platforms isn’t it; you either use a condom every time — behave — or you’re shamed and set apart from the rest of the community.”
Today it seems that Michael Weinstein of AIDS Healthcare Foundation has become aware of the video. And he’s decided to use it to further his attack on PrEP and those who use it. And, as seems consistent with Weinstein, his statement is long on accusation and short on facts.
AHF’s press release starts with a statement that is shockingly lacking in truth.
In what looks to be the first direct-to-consumer drug advertising paid for by Gilead Sciences, Inc. for use of its AIDS treatment, Truvada, as pre-exposure prophylaxis (PrEP) to prevent HIV infection in non-infected individuals, Gilead has paid for an ad that violates Food and Drug Administration (FDA) guidelines for PrEP by promoting off-label use of the drug by encouraging situational PrEP use for those who “… like to party.”
Oh so many lies.
First this is not a direct-to-customer drug advertising. It is an online video by a non-profit organization that never ever mentions the name of any drug.
Next, the video was not “paid for by Gilead Sciences, Inc.”, or not in the sense that Weinstein claims. Mary Ann Chiasson, the Vice President, Research and Evaluation at Public Health Solutions clarified.
As the Project Director, I can set the record straight. The time2prep project was funded by a grant from Gilead for educational videos about PrEP targeted to high risk men who have sex with men in New York City. The videos were designed to be provocative and to encourage men to go the New York City Department of Health PrEP/PEP website to learn more. Gilead played no role whatsoever in determining the content of the videos. In fact, I’m not sure anyone at Gilead has ever even seen the videos.
But the big lie, the heinous smarmy lie is this: “…an ad that violates Food and Drug Administration (FDA) guidelines for PrEP by promoting off-label use of the drug by encouraging situational PrEP use…” Further in the press release, Weinstein states,
When I referred to PrEP as a party drug two years ago, it created a nationwide scandal. Now Gilead—in what looks to be its first official paid advertising for Truvada as PrEP—explicitly promotes PrEP as a party drug for situational use in direct violation of FDA regulations. This is illegal and we will seek to hold them accountable for their irresponsible and illegal advertising,” said Michael Weinstein, President of AIDS Healthcare Foundation, which has criticized and cautioned against the widespread deployment of PrEP as a community-wide public health strategy, such as the CDC’s recommendation that 1.2 million individuals go on PrEP, but supports its use on a case-by-case basis decided upon between a medical provider and his or her patient.
If indeed this was a promotion of PrEP for situational use, rather than as part of a daily regimen, that would be in violation of FDA regulations. The FDA has approved Truvada for PrEP under certain conditions. While I would certainly phrase some of these requirement differently, AHF’s press release lists them:
Guidelines issued by the FDA for PrEP for individuals include 1) an initial baseline negative HIV test; 2) daily adherence to the Truvada medication; 3) ongoing periodic HIV testing to ensure the individual on PrEP remains HIV-negative; and 4) continued use of other prevention methods, such as condoms.
AHF’s points 1 and 3 cannot be determined one way or another from the video. But we can clearly see whether the video promotes daily adherence and condoms.
At 0:03 JD Phoenix (a young porn actor) reaches for items on his counter as he heads to a bar. They consist of condoms, lube, his keys and a baggie with pills of some sort (it is not clear as to the nature of the pills). From this we conclude that condoms are a part of Phoenix’s sexual encounters.
At 0:21 Phoenix’ alarm goes off on his phone informing him that it’s “time to prep!” He then reaches for a daily pill organizer and takes that day’s blue pill. From this it is clear that Phoenix is on daily adherence to the drug.
So Weinstein’s claims about “situational use” appear to be false. And his threat about “holding accountable” seem nothing more than empty threats used to bolster his own implied moral superiority.
And, of course, Weinstein couldn’t pass up the opportunity to portray himself as a great prophet:
It now appears AHF President Michael Weinstein made a prophetic comment to an Associated Press reporter in April 2014 when he offhandedly referred to PrEP as a “… party drug.” Since then, both he and AHF have been repeatedly and harshly criticized by the gay and AIDS communities for the observation, while Gilead itself now funds and promotes party use of Truvada as PrEP in violation of the law and FDA regulation.
Neither Gilead nor anyone else is promoting “party use” of Truvada as PrEP in this video. Or certainly not more than the other two videos promoted “black use” or “love use.” It’s a video targeting a high-risk community. That’s all.
But Weinstein has latched only the word “party” and sees it as validation for his opposition to PrEP. He objects to the idea that people who use drugs might use Truvada to allow them to have unfettered sex. Naughty dirty drug-induced porn star sex. And it’s “irresponsible” for Gilead, or anyone else, to help these party sex people remain HIV negative.
It’s hard to ignore the implications of Weinstein’s position. If party people shouldn’t proactively protect themselves from HIV transmission, does that mean that they deserve what they get? Is HIV the wages of sin?
And, really, it seems to me that this is what is behind Weinstein’s campaign of shame, it’s all about demonizing people who have sex in ways of which Weinstein disapproves.
And I don’t think the prophet reference is casual. I think that is how he sees himself, as a great moral leader casting down as whores and riffraff those who oppose him and declaring the one and only true and holy way to have sex.
AHF’s Michael Weinstein mocks the CDC about PrEP
December 22nd, 2015
In 1987 there was little to no hospice care available for dying AIDS patients. Several activists united and petitioned LA County Board of Supervisors for funding and the AIDS Hospice Foundation was born with Michael Weinstein at its helm.
In 1995 – 1996, antiretroviral medication changed the face of HIV. Those infected with the virus no longer could expect an onset of opportunistic maladies followed by an early painful death. Now HIV, if properly treated, has no significant impact on quality of living or life expectancy. And the need for specialized AIDS hospice care diminished significantly.
So Weinstein rebranded the organization as AIDS Healthcare Foundation, and began offering medical services to those infected with HIV. Over time, AHF has grown tremendously, with revenues in the hundreds of millions of dollars (much of it through either grants or Medicare) and programs dotting the globe. Also growing has been Weinstein’s political power (and compensation – about $400,000 in 2012).
Michael Weinstein has not been hesitant to use his connections and power, using public media attacks and lawsuits as his primary methods. In 2012, they spent over a million dollars on legal fees.
Many of Weinstein’s efforts have been controversial, and most come across as heavily moralistic. Taken cumulatively, they paint a picture of a man and an organization determined to stop others from having sex in ways in which he disapproves.
In 2007, Weinstein decided that Viagra was being used by people who were doing drugs. Disapproving, AHF held a press conference accusing Pfizer, the maker of Viagra, of contributing to HIV and announced a lawsuit against them over their marketing and demanding that they contributed to AHF. (Bay Area Reporter)
The Los Angeles-based AIDS Healthcare Foundation has charged the pharmaceutical company Pfizer with “promoting Viagra as a party drug … leading to more infections with sexually transmitted diseases such as HIV,” according to its president Michael Weinstein.
AHF filed suit in a Los Angeles court Monday, January 22 to force the company to end those ads, begin an education campaign on the responsible use of Viagra, and pay an unspecified sum to the organization to help care for people infected with HIV.
Weinstein had no facts to back up his assertions.
When pressed during a telephone conference call Monday to back up his assertion with data, Weinstein mentioned recently speaking with a group of black youth who said crystal meth “use is rampant” within their community.
I can’t find the results of that lawsuit, so it may have been nothing more than a bluff or an attempt at extortion.
Also in 2007, AHF began running ads in Indian newspapers accusing Cipla, an Indian company, of price-gouging. They did not get the support of local non-profit organizations who saw a conflict of interest. At the time, a leading Gilead exec was on AHF’s Board and they provided funding to Weinstein’s organization. (Gilead denied any connection with Weinstein’s effort.) (IndiaTimes)
Cipla had refused Gilead’s offer to sell the latter’s anti-AIDS drug Viread under a licensing agreement. Cipla is also the only Indian company opposing Gilead’s patent application for its blockbuster anti-HIV drug Viread in India.
In recent years, Weinstein has decided that he disapproves of people watching bareback porn and waged a war of accusation and innuendo against producers. Even though there is testing and prevention efforts in porn – both gay and straight – Weinstein and AHF seemed determined to stop its production altogether and in all circumstances.
In 2012 AHF spearheaded an initiative on the ballot in Los Angeles County which required porn actors, gay or straight, to wear condoms during anal or vaginal sex. Weinstein was not shy about his desire to monitor other’s desire. (Weinstein op-ed)
The fact that most straight porn is made without condoms sends a horrible message that the only kind of sex that is hot is unsafe.
Though opposed by the Libertarian Party, the Republican Party, and local newspapers, Measure B passed the vote with 60% of the vote. And, as could be expected, the $6 billion industry – and its economic benefits – moved out of Los Angeles County with sadly ironic consequences. (SF Weekly)
Last year, after Measure B pushed several companies to Nevada, the industry saw its first on-set transmission in over a decade. Though the performer tested negative for HIV before his shoot, the test used was not the RNA plasma test that is the standard here in California. By the time he shot the scene, his viral load had increased to the point where he could transmit the virus to someone else.
Undeterred by real life consequences, Weinstein presses on seeking a statewide initiative forcing his ideas about acceptable porn production throughout California. There may be an initiative on the 2016 ballot to mandate Weinstein’s views.
In 2012, as the result of a county audit finding that AHF had overcharged LA County by millions of dollars, Weinstein sued the County in an effort to punish Supervisor Yaraslovsky, with whom Weinstein had feuded. (LA Times)
The lawsuit arose out of an audit by the county, which claimed the foundation had overcharged $1.7 million for its AIDS services by billing for costs that should have been allocated to other sources. The judge did not rule on which side was correct, only saying that the county has the right to audit its contractors.
Weinstein, defending his political tactics, told the paper that regardless of who was billed for the costs, the money was spent serving patients: “We would not have gotten to where we are today if we hadn’t fought like hell on behalf of our clients and our mission.”
A U.S. District judge ruled for the county this week. “Rather than a sincere attempt to vindicate their First Amendment rights,” the paper quotes the judge saying, “the court fears that plaintiffs instituted this action in an effort to obtain a tactical advantage in their ongoing political battles.”
To illustrate his conclusion, he included an excerpt from an email Weinstein sent to a foundation staff member shortly before the suit was filed:
“It is time to take the gloves off,” Weinstein wrote, according to the written decision reported in the Times, “We need to go after Zev [Yaroslavsky] directly and hard. He is the real power behind our problems with the county on porn, the audit and fee-for-service. Plus he is a lame duck and an arrogant jerk. His Berman-Waxman power base is dead and he and others need to be taught a lesson. The voters are with us.”
But it isn’t just the big-dollar fights and power plays that have caused controversy. So too have many of AHF’s public pleas for the public to get tested.
In Los Angeles, one can’t get away from AHF’s billboards. And they seem to share a common theme: sex is dirty and bad and people who want to have sex with you are liars who want to give you diseases.
One such campaign featured a number of couples of various races and sexes with the tag line “Trust Him?”
Though nothing in the ads tells you why one would not trust the other, but Weinstein apparently assumes that sex must include some sleazy component and had this to say about the immensely unpopular billboards. (Poz)
“While infidelity is nothing new, the level of risk in contracting STDS from bed-hopping partners is at an all-time high. We want to remind couples that STDs linger around much longer than a wandering eye and that secret sexual experiences can often produce much more than what one bargained for.”
This stigmatic view of sex and trust is both reductive in personal responsibility and stigmatizing towards HIV-positive people. It suggests that people living with the disease are akin to criminals who lie in order to have sex, or even intentionally spread the virus. Sure, the people behind the AHF campaign may argue differently. However, it is hard to ignore the criminal theme of the advertisements that, by default, further marginalize people living with HIV and keeps fear in the forefront of safer sex messaging. As one Facebook user stated, “This does not say ‘fear HIV.’ It says, ‘fear people living with HIV.'”
In addition to all the ways that Weinstein doesn’t want people to have sex, he also has opinions about how they meet. Earlier this year, another of AHF’s billboard campaigns went on the direct attack against hook-up sites.
“They’re tone deaf,” Michael Weinstein, president of AHF, told the Guardian. “It would have been much wiser for them to say that they’re concerned about their customers and look forward to working with us to help people get the checkups that they need. This would not have been the global story that it has become if they had not responded that way.”
And lest you think these ads come across as sex-negative,
“There are consequences to hooking up,” Weinstein told the Guardian. “That’s not a moralistic judgement. It’s just a fact and minimizing that is important.”
But nothing has set Weinstein and AHF apart from the HIV/AIDS community more than Weinstein’s obstinate opposition to pre-exposure prophylaxis. The battle between anti-PrEP forces (Weinstein and AHF) and pro-PrEP forces (The Centers for Disease Control, the World Health Organization, AIDS Project Los Angeles, amFAR, Gay Men’s Health Crisis, the National Minority AIDS Counsel, and virtually every gay and AIDS/HIV advocate that seeks to see an end to the transmission of the Human Immunodeficiency Virus) has turned into all out war.
The opening salvo was fired by Weinstein on April 7, 2014 (AP)
“If something comes along that’s better than condoms, I’m all for it, but Truvada is not that,” said Michael Weinstein, president of the AIDS Healthcare Foundation. “Let’s be honest: It’s a party drug.”
Obviously, Truvada is not a party drug. It is not a euphoric, a hallucinogen, a mood enhancer, nor does it have the hallmark of any other pharmaceutical whose primary purpose is to feel good. What Weinstein meant here is what he meant when he accused Viagra of being a party drug: that it was used by people doing drugs and having bad bad sex. That it prevented these naughty naughty gay boys from infecting each other with HIV was secondary to his objection to their behavior.
In August 2014, Weinstein started running ads in gay newspapers which, at first glace, appeared to say that PrEP was not very effective at preventing transmission.
Those who read the text would learn that any effectiveness was low due to low adherence – not exactly a surprise for research in high-risk and third world populations. But even if you get beyond the graph, Weinstein extrapolated from that data a conclusion set that is not supported in science: Low adherence means low effectiveness in preventing HIV and effectiveness measures whether Truvada works in the real world.
In other words, Truvada doesn’t work.
This infuriated those who have been taking strides to eliminate HIV transmission in the real world. They particularly noted the dishonesty of Weinstein who never notes that for those who DID adhere to the drug protocol effectiveness was 99% or better.
But Weinstein seems uninterested in facts. He has positions. And a sizable salary based on continued services to those who become newly infected each year.
In fact, there have been raised questions about the ethics of AFH’s testing facilities and how they feed a stream of income into the organization. In April of this year, three former staffers filed a whistleblower lawsuit against AHF:
The plaintiffs accuse AHF of an “organizational-wide criminal effort” across at least 12 States in the form of kick-backs to AHF clients and staffers. They believe that AHF has defrauded governmental programs out of tens of millions of dollars, based on their own experience with the agency going back to at least 2010.
The three plaintiffs, all former managers at AHF who were in a position to be familiar with agency policy, also include Mauricio Ferrer of Florida and Shawn Loftis of New York.
When someone tested positive in an AHF clinic, the suit claims, they were offered cash or other inducements to be linked to care in AHF clinics. Furthermore, AHF staff were provided commissions when they successfully linked someone with a positive test result to AHF services. This procedure was developed first in Los Angeles and then spread across all States where AHF has a presence.
Of additional concern is whether AHF’s (grant funded) testing centers inform those who test HIV negative that they have an options to persue PrEP. Although some communities, like West Hollywood, require all testing facilities to give PrEP referral information, many do not.
And Weinstein has made it clear that he is the face and voice of opposition to PrEP. While some, like Larry Kramer, initially had concerns, they’ve come to see the potential of the drug. Kramer joined Peter Staley and others earlier this month in releasing a statement that reads in part:
We – AIDS activists, new and old, aged 24 to 80 – have just broken bread in the same apartment where GMHC was formed, coming together for a lively discussion on how to reduce HIV infections among gay men and trans women. Although we may not see eye-to-eye on every issue we debated tonight, we all agree that Pre-Exposure Prophylaxis (PrEP) is highly effective at protecting a person from HIV infection. While PrEP isn’t for everyone, any individual who thinks they are at risk of getting HIV should have easy access to it, without judgement.
Weinstein appears to be the sole hold-out. But he is always ready to speak to any news source which is looking for “controversy” on the issue.
At the heart of Weinstein’s objections is the assertion that people at greatest risk won’t take the drug consistently. Which may be true. But it’s very implausible to assume that those who don’t have enough structure in their lives to take a pill once a day do have enough structure to have condoms ready and use them every time. Of the two, a daily pill requires far less forethought. Weinstein’s argument is laughable.
Also conveniently ignored is the consequences of occasional lapses. Failing to use a condom just one time can result in HIV transmission. But failing to take the pill just one time, or two times, or three times a week still provides enough protection to prevent transmission. In testing, those whose blood revealed adherence to the protocol four times per week have nearly 100% effectivity.
And, unlike condoms, PrEP doesn’t break.
As a corollary argument Weinstein insists that those who use PrEP won’t use condoms, which will lead to an increase in other STIs. And that too might be true. But it raises the natural question: if we find a true vaccine or a cure for HIV, will Weinstein oppose that measure as well because it would mean less condom usage? Will he insist that some continued HIV infection is a small price to pay for preventing increased gonorrhea?
That may be less rhetorical of a question than one might imagine. Weinstein has actually penned an op-ed to the LA Times calling on the federal government to cease funding for the search for a vaccine for HIV. Framed as a complaint against the wasting of funds that could otherwise be used (by AHF, I presume) to pay for treatment, it still is a chilling idea that the head of a prominent HIV/AIDS care organization opposes the search for a vaccine which could end the pandemic.
Although the opinions of both the activist and the science community have reached near consensus about the efficacy and value of PrEP as a tool in the fight against the transmission of HIV, Weinstein has been effective in his opposition. He has sown doubt in the gay community as to whether PrEP works. He has done his best to shame those who use this “party drug”. At least in part, he has contributed to the slow uptake in PrEP usage in the gay community.
And, having slowed the PrEP movement, now he’s decided that it’s time to mock the Centers for Disease Control for their struggle in convincing gay men that this preventative measure is neither shameful not ineffective.
You see, you shouldn’t push PrEP, but treatment. After all, if you pay AHF to treat people once they’ve contracted HIV, then their virus is brought down to undetectable levels and they are non-infectious. And as for PrEP, leave it to the Truvada whores who have multiple partners and never use condoms.
But the word is – finally – getting out. I see PrEP becoming a regular discussion point in some subsets of West Hollywood. Activists in New York are becoming more vocal. San Francisco City government is dedicating city resources. Social approval is on the uptick and the community – though originally fearful of another “solution” – has had time to observe and see how things went for the earliest guinea pigs.
Weinstein should get his gloating out of his system. Because I think that PrEP is going to become as common as condoms were in the 90’s and AHF is going to have to come up with some other business plan.
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