Box Turtle Bulletin

AHF’s Michael Weinstein mocks the CDC about PrEP

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 message has many HIV/AIDS activists disgusted at Weinstein and his organization. (HIVPlusMag)

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.

As usual, when Tinder objected, Weinstein bulldozed over them and hinted that it all could be fixed by coughing up. (Guardian)

“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.