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Let HIV-Negative People Decide Their Own Prevention!

April 17, 2014

PrEP (pre-exposure prophylaxis) is a proven concept. Regardless of whether opponents want to admit it or not, "bio-medical prevention" IS the key to reducing new-HIV infections in the highest-risk groups where previous risk-reductions methods have failed. Today, thanks to new research and science, we have a new method that can help those who are at the highest risk. We do not need more data; we do not need more trials to look at efficacy and safety ... PrEP is already a PROVEN concept. Anyone who says otherwise either doesn't know how to read data, is pushing their own agenda, or they are simply regurgitating the views of other people who have no clear understanding of the topic.

It is really interesting that those who are screaming the loudest in opposition of PrEP are people who could have benefitted the most from its use, had it been in existence. These same HIV-positive men say that condoms are easy to use and so effective. Then why are you HIV-positive dude? Immaculate infection?

I'm not laying blame, what I am saying is take a moment to step down off your moral-horse and contribute to an actual resolution rather than perpetuating a flawed strategy of "condoms-only." If condoms alone could end HIV then it would be over by now. Condom use, although it has been beat into our heads, seems to be an example of "Do as I say, not as I do." Since when does being an HIV-positive gay man give us authority over those who are negative and the things that can keep them healthy?

At a certain point, HIV-positive men who feel it necessary to dictate the availability of PrEP as a tool to those who are negative need to simply stop. If you are an HIV-positive man railing against PrEP, you are no different than men attempting to dictate the sexual and reproductive health of women. What is even more disturbing is that some opponents of PrEP pervert a once-authentic argument regarding efficacy and safety. And when presented with data to address this they choose to dismiss it.

Our community fought in the streets, stormed the FDA and forever changed how drugs are studied and made available to those that need them. Is the message now going to be, we will only advocate when the medications save our lives, however we won't fight on behalf of prevention? HIV-negative individuals have a right to have access to medications that can assist them with staying negative. If you are HIV-positive and an opponent of PrEP, consider how you would react if someone was attempting to block/impede/stop/derail a drug that could keep you healthy. Now realize that in your opposition you have become that person. Congratulations!

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See Also
More News and Research on HIV Medications for HIV Prevention

Reader Comments:

Comment by: Steve (Charlotte, NC) Mon., May. 12, 2014 at 8:05 am UTC
Great article. I agree except I think both neg and poz folks should let neg ppl decide with their healthcare providers what's the best prevention tool for them. Just as I feel men and women shouldn't have a say in what a woman does to or with her uterus.

There are pros ans cons to any prevention method and I think it's great that more choices are being offered
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Comment by: Ben (Chicago) Mon., Apr. 28, 2014 at 1:31 pm UTC
LOVE "immaculate infection." Def gonna use that! lol
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Comment by: Eduardo (Palm Springs) Thu., May. 1, 2014 at 8:42 pm UTC
Oh yeah, and it's totally not loaded any blame either. Because nothing could be less accusatory than a snarky phrase tossed people whose path to infection is unclear.

I don't know what I find more insulting, the straw man arguments for Big Pharma, or hatred towards people with HIV that drip from this essay. I agree with the others, Aaron should do us all favor, become the first person with HIV to take his own advice and bow out from this debate.

Comment by: Jim Pickett (Chicago) Mon., Apr. 21, 2014 at 2:18 pm UTC
Just to remind us all..... Lots of gay/bi POZ men have been in support of PrEP since before the FDA approved Truvada for prevention in July 2012. Here is a link to the petition we circulated, with signatures in the first half of 2012.
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Comment by: Len (Los Angeles, CA) Mon., Apr. 21, 2014 at 1:00 pm UTC
I wholeheartedly agree, and I am an HIV-negative man currently in a PrEP study at LA County-USC Medical Center.

There are too many gay men who are engaging in slut-shaming and acting as though they secretly HOPE that anyone whose behavior doesn't match their prescription of propriety will seroconvert as punishment for their "sins". It is not far from what we saw right-wing extremists saying at the beginning of the epidemic.
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Comment by: Rosso (Illinois ) Mon., Apr. 21, 2014 at 12:28 pm UTC
Agreed on the importance of reading the data, but shrilly scolding PrEP skeptics isn't helpful. And conflating PrEP skepticism with opposition to birth control is polemic B.S. A lot of PrEP skeptics are people traumatized by years of AIDS deaths (many of which occurred since the last magic cure-all was introduced in the mid 1990s) so they're going to need a lot more persuading that PrEP is as good as—or better than—condoms before they’re convinced. Condoms ARE very effective at preventing HIV transmission when they’re used properly, so for many people, PrEP seems like a flashy newcomer competing with a proven, simple, easily-available, decades-old method. And that’s essentially a PR problem. 25 years ago, AIDS activists developed effective advertising campaigns to encourage condom use among gay men; rather than deriding the lasting effectiveness of these arguments, perhaps PrEP advocates should take a seat and learn from these campaigns about how to persuade skeptics to change their minds and their behavior. And as far as birth control goes, the structural power imbalances that make it harder for women to demand condom us from men isn’t the same dynamic that’s preventing consistent condom use among gay men. And the organized, sexist attack on women’s rights isn’t the same thing as PrEP skepticism. Don’t mix your metaphors.
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Comment by: tom craig (Paris, France) Mon., Apr. 21, 2014 at 12:04 pm UTC
Dear Aaron- You said all trhe things that I didn't dare say outloud. Congratulations, someone had to do it.
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Comment by: Jim Pickett (Chicago) Mon., Apr. 21, 2014 at 12:02 pm UTC
Thank you for this succinct, punchy, smart, and right on piece. Condoms aren't enough. PrEP isn't enough, either. We need an array of choices for people to protect themselves from HIV. I am grateful for Truvada, and look forward to new versions of PrEP coming down the road.
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Comment by: Michael Kaplan (Little Rock, AR) Mon., Apr. 21, 2014 at 11:57 am UTC
Mark...thanks for your witty banter, but you're missing to point of the article. Congrats on the freedom to choose your own pre-exposure prophylaxis and I am happy that you feel you don't need Truvada as prevention. It isn't for everyone.

It can be tough on the system and requires blood tests to ensure liver function and the rest of the body remain well.

Clearly, however, you've lost your mind when it comes to civility. The author's health status has no bearing on this argument. It is folks like you that perpetuate stigma in our community.

I'm guessing that this editorial arises from recent news stories regarding the President of the AHF regarding Truvada as a party drug, stigmatizing those that choose to use it for it's FDA approved PrEP therapy.

Like all medication, use as directed. Just like condoms, use as directed. It's not hard, and could save a life.
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Comment by: Andy (New York City) Mon., Apr. 21, 2014 at 11:33 am UTC
"Since when does being an HIV-positive gay man give us authority over those who are negative and the things that can keep them healthy?"
Oh the irony. Look in the mirror and say that.
And just who are these poz people knocking the bottles of truvada out of neg guys' hands? All I ever see is poz people like yourself, King, Staley, Kruger, et al who also promote bbing, pushing PrEP. Hasn't that ship sailed for you? It's almost as if you had ulterior motives, hmmm.
So yes, I agree wholeheartedly with your title. Let us decide. I hardly see how those that failed at staying neg and have no medical expertise have a dog in this fight.
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Comment by: Jim Pickett (Chicago) Mon., Apr. 21, 2014 at 2:16 pm UTC
137 gay/bi POZ leaders stood up in support of PrEP before FDA approval in mid 2012. Here is a link to the petition signed by 137 poz gay/bi men.
Comment by: Aaron M. Laxton (St. Louis) Mon., Apr. 21, 2014 at 4:58 pm UTC
Hmmmm who is knocking the bottles out of neg hands? Try Michael Weinstein and the AIDS Healthcare Foundation. If Michael has his way then Truvada would never be made available. Regarding your thought that I promote bb'ing, that is not true. I accept the fact that people are having condom-less sex. When we accept what people are doing then we can create effective strategies. That is what myself, King, Staley and Kruger seek to do. Thanks for your viewpoint though. You rock!

Comment by: Damon L. Jacobs (New York, NY ) Mon., Apr. 21, 2014 at 11:22 am UTC
Thank you Aaron for another astute and perceptive piece. It has also been surprising to me that some (though certainly not all) of the moral opposition against PrEP comes from people who themselves would have taken it if they had had the chance.

The only arguments against PrEP that they still have are the moral ones. The science has been shown to be reliable and validated. Insurance is paying for it. Adherence is strong in real-world settings (, and side-effects have been rare (and reversible).

So what do we have left? Paternalism: "The policy or practice on the part of people in positions of authority of restricting the freedom and responsibilities of those subordinate to them in the subordinates' supposed best interest."

Is Paternalism really what the fight against HIV/AIDS has come to? I know my brothers and sisters who died from AIDS would never have stigmatized others for accessing prevention medication. They would have been there right in line with them!
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Comment by: Andy (New York City) Mon., Apr. 21, 2014 at 3:13 pm UTC
"Adherence is strong in real-world settings" I wonder if anyone called your bluff and actually looked at that link. In case they didn't here's what it says. The blood levels consistant with daily dosing San Fran 52%, DC 35% and Miami 13.5%. THAT'S TERRIBLE!! You call that "strong"? In addition, inconsistent use can cause drug resistant strains of HIV. These are valid concerns that have nothing to do with moralizing. (And when did saying have sex with a condom become anti-sex?)But all you and your PrEP cult ever do is scream "slut shaming" instead of addressing it.

Comment by: Mark Adnum (Sydney) Mon., Apr. 21, 2014 at 10:42 am UTC
"Let HIV-Negative People Decide Their Own Prevention!" --- Thank you so much for finally giving me permission to do what I've been doing for the past 23 years. I'm so happy to know that the decisions about my own sexual health that have absolutely nothing to do with anyone else and which effect nobody but me have finally been handed over to me, and by you - thanks so much! I'm especially greatful that you've granted me permission to be disinterested in PrEP, since I've not needed it thus far and can see no use for it, for me, in the future and the last time I checked it's my choice to access or ignore whatever medications I decide are right for me. What would us clueless HIV Negative men do without infected men like yourself telling us how to stay Negative, since clearly we don't know how to do that, and you do. That makes perfect sense, clearly. With much respect for your insight and generosity, Mark x
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Comment by: Douglas (Miami Beach, FL) Mon., Apr. 21, 2014 at 11:10 am UTC
Right on, Mark. Indeed, if the author's point is to encourage poz folks to pipe down and allow HIV-negative men to make their own prevention choices, doesn't it logically follow that he--and many other poz men like him--should cease vocalizing their support for PrEP? Or is he only concerned about poz men who oppose its use?
Comment by: Georger (Ontario, Canada) Mon., Apr. 21, 2014 at 11:19 am UTC
I believe the author is arguing for his right to use PrEP, not against your right not too.
Comment by: Aaron M. Laxton (St. Louis, Mo.) Mon., Apr. 21, 2014 at 5:41 pm UTC
You are absolutely right Mark. It isn't anyone else's decision or right to say what you can/cannot access. I wasn't granting negative individuals the right to choose but rather reaffirming my belief that it is there choice. I do not tell people what to do. I simply share my story and insight in hopes of empowering people to make their own choices. Thanks for taking the time to comment. I always love to hear from the Down Under.

Comment by: Lovinglife101 (Florida) Sun., Apr. 20, 2014 at 6:06 pm UTC
An effective tool used incorrectly or inconsistently is reduced to an ineffective tool. The data presented by Gilead Sciences objectively document that most persons enrolled in the 2 pivotal efficacy trials on which the PrEP approval indication is based did not use the Truvada “tool” consistently or correctly, thereby substantially limiting its potential efficacy and overall utility in preventing HIV infection.
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Comment by: Georger (Ontario, Canada) Mon., Apr. 21, 2014 at 11:13 am UTC
So then penalize the guys who do use it correctly?
Comment by: Jeremy (Boston, MA) Mon., Apr. 21, 2014 at 11:59 am UTC
If your conclusion was correct, the efficacy of all oral medications would also be challenged. All medications face adherence challenges, but this doesn't prevent us from applying them to treat and prevent a range of illnesses. For example, adherence to HAART for those infected with HIV and AIDS has been historically challenging. The answer wasn't to abandon HAART as an effective treatment for HIV. The solution was to improve adherence.
Comment by: tom craig (Paris, France) Mon., Apr. 21, 2014 at 12:16 pm UTC
Yes, you are right. That is where the "44 % effectiveness" quote comes from, from the IPREX trials It includes those who took the pills and those that did not, or were taking the placebo. But if you excluded them from the statitistics, you would get over 90% effectiveness with those who took the pills. Current trials are now studying the effectiveness of new injectable long itme acting ARV's, that may be a solutioin for those who weren't adherent. We will have to wait until another 2-3 years for the results. In the meantime adherence is the key. "Ineffective tool" can also be included condoms, or we wouldn't have 50,000 new infectioins each and every year in the U.S. alone. By using both, as well as other tools, we would have a better chance of ending the epidemic.

Comment by: SolentPAC (Portsmouth United Kingdom) Sun., Apr. 20, 2014 at 4:42 pm UTC
Good argument.

PrEP also has other uses that are not apparent.
It adds a layer of protection either on its own or in addition to condoms. Condoms can break.

Failure to use condoms can be many reasons. Notable ones being it dulls the moment. Being off ones head on drink or drugs to even being in a relationship where one person has more or less control. Add in that failure can happen with condoms this provides extra prevention.

However like mr latex it has limitations. It does give you an extra defence if you are aware for whatever reason you may not later have total control over condom use. Eg drug or drink or sex work or violent controlling relationship but its only protection if you want to use it.

On a personal note I feel that some but not all infections are carried out as a result of self harm due to low self esteem or depression or other psycological issues. This small group of people are not helped by condoms or PrEP or PEP as they dont care at the moment. Maybe a few get worried after and use PEP but how many dont?

With that in mind I believe that where possible people like me who are lucky enough to have free access to antivirals should consider accessing treatment and getting themselves to an undetectable viral load. That way we can all reduce the risk to others and for the most part do our bit to give others a chance to avoid infection when they themselves may not be able to make a proper decision. And on top of it enjoying the sex we want to have.

Get Tested Get Treated Get Undetectable LIVE!

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Comment by: Aaron M. Laxton (St. Louis) Mon., Apr. 21, 2014 at 5:38 pm UTC
The name is Laxton however you were so clever and found the similarity with laxatives. I have never heard that before... You are kind of preaching to the choir, we know that it adds additional levels of protection. That is why I encourage those who are on PrEP to use safer-sex practices. I do not have the time or energy to address your flawed hypothesis regarding self esteem however thanks for taking the time to comment.

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My HIV Journey

Aaron Laxton

Aaron Laxton

I am simply a guy who on June 6, 2011, received the news that over 33 million people have received: I am HIV positive. I decided in that split moment to record the journey that I was embarking on so that I might help others as they receive that news.

I am not a doctor and I do not endorse any agenda other than simply living a healthy life. I am an activist and advocate and simply want to make the world a better place. I hold a degree in sociology and psychology. I am a product of the Missouri Foster System and this is one of my main passions, second only to the work I do with HIV/AIDS outreach and prevention.

I embrace a sex-positive model. People are going to have sex; it is a natural part of who we are. However we need to make sure that it is safe. I can be found on weekends throughout St. Louis, Missouri, passing out condoms and safe-sex kits.

I am now an M.S.W. student at Saint Louis University's College of Public Health and Social Justice and the School of Social Work.

Whether in St. Louis, D.C. or around the nation, I always jump at the chance to help change not only policies to better serve those that need help but to also change the landscape of the society that we live in.

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