HEALTH / HIV

Gay Men Not Buying Into PrEP
Michael Weinstein, President of AIDS Healthcare Foundation
10/14/2013

It seems that gay men are not buying into PrEP.

According to an article posted on AIDSMap.com, a recent “U.S. survey of the prescribing of Truvada (tenofovir/emtricitabine) to HIV-negative people as pre-exposure prophylaxis (PrEP) … found that recipients are more likely to live in the Southern states and are more likely to be female than people receiving Truvada for HIV treatment.”

About a year ago, the FDA approved use of Gilead’s AIDS treatment combination, Truvada, for use as PrEP—a form of HIV prevention. The concept: HIV-negative individuals would take Truvada every day to reduce their chances of becoming infected with HIV.

Then as now, AHF strongly opposed formal FDA approval Truvada as PrEP. Why?

First, let’s make clear that any doctor can write ‘off-label’ prescriptions for Truvada as PrEP to individuals who request it or patients he feels may benefit from its use as prevention—and we respect such use.

Our concerns lay more with what a formal FDA approval could potentially unleash—an aggressive marketing campaign by Gilead lulling unsuspecting gay men and others into a false sense of security about a pill the company’s own research studies show to have marginal efficacy at best.

As it is, in the real world of HIV treatment, drug adherence is very spotty. This is among people who are already infected. A large percentage of patients simply do not take their medications when they are supposed to for whatever reasons.

Given this reality, how likely are uninfected men to take medications every day for the rest of their lives to prevent a possible HIV infection? And if the pre-exposure HIV medication is not at therapeutic levels in their system, they will not be protected.

In a previous Frontiers column, “Giving Up On Gay Men,” I noted that headlines heralding ‘pre-exposure prophylaxis’ to prevent transmission of HIV among gay men were largely applauded by many AIDS experts. The news came in a study of nearly 2,500 men in six countries that found that an average man taking the medication was 44 percent less likely to become infected than a control group taking a placebo.
At that time I wrote, “How very sad that we have come to this point. The applause for this approach shows just how disposable we consider the lives of gay men.”

If we were talking about protecting the general population with a treatment that was only 44 percent effective, would we be celebrating? The 44 percent who received a benefit from the medications were intensively counseled monthly. Blood tests were drawn five times in the first six months of the study. All participants were tested frequently for all manner of sexual infections. This is in no way representative of any real-world situation.

Switch to the real world for a moment. Why would anyone willingly subject himself to such drug therapy every day—therapy with potentially serious side effects—if he had any intention of using condoms?

The use of a pharmaceutical means to prevent HIV infection is based on the premise that we cannot get gay men to use condoms. What is this assumption based on? Have we really made a wholehearted effort to market safer sex in gay-friendly ways? Are condoms readily available in bars and bathhouses? Are condoms advertised on TV? Do our political, religious and community leaders speak out forcefully for protecting gay men from HIV infection? The answer to all these questions is ‘no.’

We cannot give up on gay men using condoms and getting tested regularly.

I applaud efforts to find new ways to prevent HIV transmission. However,  small baby steps forward such as PrEP are often interpreted as huge leaps in scientific knowledge. I am heartened that the gay community is wise enough not to have bought into the uncertain promises of PrEP.


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  1. andy posted on 10/14/2013 07:10 PM
    I'm so glad most healthy gay men won't take toxic drugs to prevent having to take the very same toxic drugs if they became infected. If you look at the proponents it's composed almost solely of 1) already poz men wanted to expand their pool of bb sexual partners and/or hope it will reduce the stigma they perceive. 2) People who are either directly or indirectly receiving money from Gilead the manufacturer. 3) (and this is a tiny load minority) people who've managed to remain negative but either have performance issues or a fetish for cum inside them.
  2. O'Farrell posted on 10/14/2013 08:15 PM
    Why do we keep hearing about this medication at the expense of reminding people to use condoms? I'm 41, have had sex with thousands of guys, have used condoms for butt sex and never craved a new form of safe sex. Neither have any of my friends my age, almost all of whom are also HIV-negative. Meanwhile, everyone I know who's positive got that way by *not* using condoms and some of them now struggle to either maintain or tolerate their routine, which if I'm not mistaken is usually exactly the same medication being proposed as PrEP. Who exactly is the target market for PrEP? Not me or anybody I know.
  3. O'Farrell posted on 10/14/2013 08:15 PM
    Why do we keep hearing about this medication at the expense of reminding people to use condoms? I'm 41, have had sex with thousands of guys, have used condoms for butt sex and never craved a new form of safe sex. Neither have any of my friends my age, almost all of whom are also HIV-negative. Meanwhile, everyone I know who's positive got that way by *not* using condoms and some of them now struggle to either maintain or tolerate their routine, which if I'm not mistaken is usually exactly the same medication being proposed as PrEP. Who exactly is the target market for PrEP? Not me or anybody I know.
  4. Hugh posted on 10/14/2013 09:19 PM
    Finally, a sane article about Turdvada. There are so many murky facets to this PrEP campaign. Let's start with a court ruling won by AHF where requested FOIA documents describe, and imply, collusion, suggesting the FDA worked with Gilead on what to say to get their unfavorable drug trial results spun in such a way that the FDA deemed them sufficient to approve the drug for use of Turdvada as an HIV prevention. So, the efficacy question surrounding Turdvada is an open question. At best. Next, the notion that it is an "advancement" to replace condoms with a toxic drug that may or may not prevent HIV infection, IF used perfectly, is insane. But, most alarming is the manor in which Gilead has chosen to market Turdvada at arms length because they don't want to be held accountable for the longterm outcome of prolonged drug therapy that can't possibly live up to it's hype. They are instead hiring penny ante shills to set up Facebook pages, co-opting AIDS organizations' messages by supporting the organization in exchange for sponsorship ($$$), and paying half wit writers to publish garbage in mainstream gay publications telling young gay men what a wonderful drug Turdvada is. This rollout more resembles a heroin network of suppliers, pushers, and users, than it does the Polio Vaccine. It is creepy.
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