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
Who Are We Without the Wall?
September 25th, 2009
Yesterday, major media outlets reported that for the first time an AIDS vaccine has had partial success in humans. In trials, it was about 31 percent effective. This is a far cry from the 70- to 90-percent effectiveness typically required for a vaccine to be licensed, but it shows that a vaccine is possible and represents the first-ever major breakthrough.
Since the announcement, I’ve allowed myself to consider seriously what a world without AIDS would look like. I was born in 1983 and remember the late ’80s, early ’90s television reports on the devastation wrought by AIDS in the U.S. The reports were terrifying, and it is odd to look at them in retrospect, knowing what they foreshadowed:
Since then, even as medical advances have made AIDS a chronic illness instead of a death sentence, contracting HIV has been one of my biggest fears, which goes to show that the stigma associated with it remains. I fear hearing, “you’re HIV positive” more than being told I have an inoperable brain tumor, which I know is irrational. I’ve had probably five HIV tests, and for all except the first one, the anxiety of waiting a week for lab results has made me run to the nearest rapid HIV testing site and get an answer in 20 minutes, which is also excruciating.
I grew up understanding that gay = AIDS, an equation that I realize is outdated and perhaps prejudiced. But part of me fears that being infected with HIV would confirm all the dire predictions made for me by reorientation therapists and concerned family members. I’ve often felt the pressure to defy these predictions by leading an exemplary life — which I of course haven’t, and won’t. But the point is that AIDS has been framed as the natural “consequence” of homosexuality.
Perhaps the best-known piece of writing on the social meaning of AIDS was written by Susan Sontag, “AIDS and Its Metaphors,” in which the author talks about the ways in which we imbued a virus — which is inherently indifferent to human feelings, morals, and motivations — with exactly those attributes. AIDS was cited by people like Pat Robertson as divine retribution for sinful sex, an understanding that reversed the natural inclination to view the afflicted person as a victim. People with AIDS were “guilty,” or earned it, or something like that. You “get” AIDS; you don’t “get” a brain tumor. HIV in the blood is a “poison,” AIDS a “plague.” As dehumanizing as terminal disease is, even more dehumanizing — and disempowering – is how moral, religious, and political leaders talk about AIDS and its victims.
On the other hand, the AIDS crisis galvanized the gay rights movement, and many of the advances in equality were made during the late ’80s and early ’90s. The AIDS crisis was the tipping point for social acceptance of homosexuality, a change that is reflected in the language. It’s no longer politic to call gay people “homosexuals” or refer to the homosexual “lifestyle,” but in the ’80s these were standard phrases used by newscasters:
A lot of the momentum of Act-Up has waned, but AIDS consciousness still permeates gay culture. Gay people will tag “be safe” (code for “use condoms”) to a goodbye at the end of an evening. I’ve been accosted more than once at a New York gay bar by an awkward grad student wanting me to fill out a survey about my sex life, which includes transparent questions about condoms, meth use, and depression (I can save you the work: gays who are reckless with drugs are probably more likely to have sex without condoms, and are probably more likely to be depressed). Public health officials obsess over how to “reach” us and set up condom stands at every LGBT event imaginable. And we’ve been Riding For The Cure forever. What happens when the finish line appears beneath us?
We thought the wall would stand forever,
And now that it’s gone we don’t know who we are anymore.
The Hedwig quote probably implies a nostalgia for AIDS that I do not intend, so let me be clear: the day the AIDS crisis ends — whether it’s a gradual process or an all-at-once medical achievement — will be a great day, the end of suffering for millions around the world. But it will mark the beginning of a shift in the culture. Will condom use plummet? Will the rate of other STDs rise? Will it change the forms our relationships take?
The brief window of worry-free (or at least more worry-free) sex ushered in by the discovery of antibiotics, the pill, and abortion would open again — to the chagrin of social conservatives who have made the regulation of sex, reproduction, and sexuality an essential component of their agendas. It would deflate many of the biological justifications for religious arguments (or maybe we’d just be cheating God?).
Whereas earlier gay rights activists wanted nothing to do with heterosexual marriage, the shift has been toward assimilating and adopting marriage, which some people think is good and other people think is bad (I’m on the fence). Part of this has come from increasing social acceptance and support of gay couples, but it would be silly to deny that the re-medicalization of sex had anything to do with the rise of monogamy in the gay community. Will the end of AIDS reverse this trend? I am not saying that bathhouses will reopen their doors and meth-fueled orgies will mark the scene until the next pandemic comes around, but de-coupling sex and relationships from the fear of death, disease, and social stigma will change the dynamics. In a sense, though, sex will always be fraught with anxieties: the virgin won’t stop wondering whether he or she will be good for their partner, and people will still feel the sting of betrayal when they find out they are being cheated on.
I’ve hesitated to use the word “freedom” or “liberation” in discussing the de-medicalization of sex. There is something mundane about equating this with human freedom. It seems a rather nihilistic, ’60s-’70s understanding of it. I have no idea what it really entails, but I doubt that freedom just means you have nothing left to lose.
This commentary is the sole opinion of the author and does not reflect the opinion of Box Turtle Bulletin’s other contributors.
HIV Vaccine Results Encouraging
September 24th, 2009
Eventually it had to happen. Eventually one of the promising vaccines trials for HIV had to provide at least some protection.
And it has. Partly. The trial showed that a vaccine was about 31.2% effective. (NY Times)
“I don’t want to use a word like ‘breakthrough,’ but I don’t think there’s any doubt that this is a very important result,” said Dr. Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases, which is one of the trial’s backers.
“For more than 20 years now, vaccine trials have essentially been failures,” he went on. “Now it’s like we were groping down an unlit path, and a door has been opened. We can start asking some very important questions.”
This is not the vaccine that will announce the end of the era of AIDS. But it is the first vaccine that has shown any effectivity at all and it allows researchers an opportunity to build upon this start to find something that will really work.
Scientists Pessimistic on AIDS Vaccine
April 25th, 2008
Britain’s The Independent newspaper surveyed more than 35 leading AIDS scientists in the U.K. and the United States found that most of them blieve that a vaccine against HIV may never be possible. Only four were more optimistic than they were five years ago. Thirty-five seems like a very small sample to go on, but The Independent, ever proud of its own exclusive polling, is touting this as “the latest in a series of setbacks in the 25-year struggle to develop an HIV vaccine.”