CDC Gets Behind PrEP
May 16th, 2014
Federal health officials recommended Wednesday that hundreds of thousands of Americans at risk for AIDS take a daily pill that has been shown to prevent infection with the virus that causes it.
If broadly followed, the advice could transform AIDS prevention in the United States — from reliance on condoms, which are effective but unpopular with many men, to a regimen that relies on an antiretroviral drug.
It would mean a 50-fold increase in the number of prescriptions for the drug, Truvada — to 500,000 a year from fewer than 10,000. The drug costs $13,000 a year, and most insurers already cover it.
Aaron Hicklin of Out picked up the thread, summarizing some of the thinking behind the CDC’s new stance:
Although doctors advise patients to take the PrEP pill, Truvada, in conjunction with condoms, the move is an acknowledgement that after decades of public health education, condom use is in sharp decline among gay men. A C.D.C survey last November showed that the number of gay men reporting unprotected sex had risen nearly 20 percent from 2005 to 2011. Given the stigma around admitting to unprotected sex, that figure is probably much higher. Now, the hope is that by encouraging gay men who have unprotected sex to take Truvada, the number of new infections will continue to fall as scientists continue to hunt for a cure.
Even though PrEP as a regimen is not exactly new, Tim Murphy’s piece in Out last September rekindled what’s now a vigorous debate among gay men about whether or not PrEP should be offered more widely. Box Turtle’s last post about PrEP, here, is now at a healthy 69 comments (yup) with two main threads emerging. One side, now joined by the CDC, essentially says that the status quo focusing on condoms isn’t working and a new model which recommends both PrEP and condoms is needed. The opposing view, shared by Michael Weinstein of the AIDS Healthcare Foundation, worries that advocating that gay men get on PrEP will not only lead to an explosion of other STDs but also to higher rates of HIV because gay men won’t take the pill as directed and will use it instead as an excuse for unprotected sex:
“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.”
Some of the concerns have been more directly pragmatic – many assume PrEP is too expensive and, also, many clinicians either haven’t been on board or haven’t been well-informed. Back to today’s story in the NY Times:
Advocates said there were several reasons there had been little clamor for the drug regimen. First, while many doctors prescribe statins as prophylaxis against heart attacks, for example, only AIDS specialists are likely to prescribe AIDS drugs as prophylaxis. But uninfected gay men have no reason to see AIDS specialists, and usually see general practitioners if they see doctors at all.
Also, Truvada is expensive. However, private insurers and state Medicaid programs have thus far generally covered such prescriptions, and Gilead has a program covering co-pays and giving Truvada to the uninsured.
While many in the gay community still share Weinstein’s fears, the CDC’s new position is getting a lot of heavy-hitting support – today, 69 HIV/AIDS groups cheered the CDC’s new guidelines calling them “a powerful additional tool in the AIDS response.”
The Hysterical Gay Men in the Attic
April 10th, 2014
First, this, a black man talking about the first time he saw two black men, and no white men, in an airplane cockpit:
“Do you know, I can’t believe it but the first thought that came to my mind was, ‘Hey, there’s no white men in that cockpit. Are those blacks going to be able to make it?’ And of course, they obviously made it — here I am. But the thing is, I had not known that I was damaged to the extent of thinking that somehow actually what those white people who had kept drumming into us in South Africa about our being inferior, about our being incapable, it had lodged somewhere in me”
This is Desmond Tutu of South Africa, talking about how deeply ingrained are the things he heard about black people growing up that they still, to this day, after decades of fighting for his own equality, influence him.
I sense this same thing in gay people — the same tortured assumption that what we heard when we were growing up is really true, that gay men can’t control themselves sexually, that they will never bond for life, that they will never care about themselves or make good decisions when it comes to sex. This is the message from the people who call Truvada a “party drug” and it’s the same message older men put out there when the Pill came along, that women would use the Pill as an excuse to go wild, that they weren’t responsible enough to take a pill every day, that it would lead to a higher rate of STDs, etcetera, etcetera, etcetera. Yes, condoms are the only thing that prevent many STDs, but is that why many clinics won’t even mention to gay men that Truvada is out there? Imagine if Planned Parenthood refused to tell women about the Pill because they decided it would make women stop using condoms?
This is what’s happening currently with Truvada — we don’t trust gay men enough. We don’t think that if we tell gay men in a clinic that they can get on Truvada, and it will help prevent HIV, but they also need to use condoms to prevent other diseases – we assume that they will simply go wild, just like women were presumed to be wild, illogical people back in the late 60s/early 70s. Women proved those straight men wrong and we gay men can do the same.
Enough of all this religious shaming. I keep hearing that gay men don’t care about themselves, that they are stupid, that they need to just put on a condom already, and it sounds like preaching to me. It doesn’t sound rational. It sounds like a lot of us hate ourselves, or other gay people, like we’ve internalized what we’ve heard our whole lives about those partying, oversexed gay people.
We gay men are capable of making rational decisions as much as the next person. Human beings, in general, have trouble mixing arousal and logic, but this is not anything special to gay men – as Mark S. King always points out, our mothers liked to bareback too, and yet they were (eventually) trusted with the Pill and told to also use condoms to protect themselves fully.
We need to talk about Truvada and PrEP not because it’s a cure all but because it’s asinine that here we have this wonder drug and we can’t bring ourselves to educate sexually active men about it. There’s something wrong with that picture.