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The Real Casualties in the PrEP-Battle

May 6, 2014

I sit waiting at a coffee shop in the Central West End at the Washington University in St. Louis Medical School. This meeting, like most these days, are spent working on strategic planning for implementing PrEP (Pre-Exposure Prophylaxis), a one-pill-a-day drug regimen that has been shown to be up to 99% effective in preventing HIV infection. People slowly trickle into the working group and we start to address the task at hand. Who could benefit the most from access? Believe it or not, it is not those who are waging a moralistic attack on whether or not it should be used. For the most part, it is not even the people who will read this article or who are on social media. That is because the people who could benefit the most from PrEP are limited on resources. The young, black male who has sex with men or the Latino ages 13-24; that is who are falling casualty of this absurd power struggle.

PrEP provides added protection when used within a sero-discordant relationship. Recently released data from the PARTNER study showed that within a sero-discordant relationship that ensuring viral suppression of the positive partner's viral load protects the negative partner. So then who would the ideal person be that would consider utilizing PrEP? It would be those who are engaging in high-risk sexual behavior; if you are sexually active and HIV-negative then PrEP is indicated for you.

The real casualties are not the ones who are voicing their opinions in this battle of public perception that is being waged in the media and across social media. Interestingly enough, I do not see these same talking heads delivering the diagnosis to an 18 year old African American male who tests positive for HIV. I do not see Michael Weinstein working in an STD clinic consoling a young Latina who now must adjust to life as an HIV-positive woman. Although I want gay men to have access to PrEP, this is not something that should be exclusive to privileged white gay men. Thankfully, as a result of the Gilead patient assistance program (PAP), those who cannot afford the medication will get it provided to them. There is also assistance to help pay for physician co-pays for office visits.

PrEP clinics are springing up across the United States and I am proud to be working to organize the first one in St. Louis. Physicians can cure sexually transmitted infections such as syphilis with a dose of penicillin, HIV however cannot at this time be cured. We can, however, do more than simply sending a person away from clinic with a bag of condoms that may or may not be used. PrEP is included in a total risk reduction strategy which includes reducing risky behavior, regular STI/HIV screening, and as well as monitoring adherence to the medication.

As I sit in the working group I realize that the talking heads who are railing against PrEP are irrelevant, holdovers of a bygone era. The work that we are doing to provide PrEP to those who will benefit the most is marching on. You say "Michael Weinstein" and I say, "Michael Weinstein" who? My clients do not know who he is and conversely they do not care. We will continue to treat the real casualties of this PrEP battle, interestingly enough these are the same people that many seem to forget or let fall through the cracks. I am guessing that young black men and Latinos aged 13-24 weren't invited to that party.

This article was provided by TheBody.
See Also
Fact Sheet: HIV/AIDS and Young Men Who Have Sex With Men
Quiz: Are You at Risk for HIV?
10 Common Fears About HIV Transmission
More Personal Views on HIV Prevention for Gay Men

Reader Comments:

Comment by: Henry Smith (Dallas TX) Mon., May. 12, 2014 at 5:57 pm UTC
What concerns me most about Prep with Truvads is the great potential for drug resistance to Truvada. Seriously! There aren't many NRTI drugs in this class. I am partially resistant to the 3TC (lamivudine) type of component of Truvada (emtricitabine). This means that I have to also take an additional NRTI drug like AZT or Zerit (stavudine). My doctor finally had to take me off of stavudine because it is giving me hypothyroidism, and of course lipoatrophy. We are hoping that a double dose of Tivicay will allow me to stop taking stavudine forever. Resistance to Truvada is a real danger for hiv patients - leaving few options. I already have met a young black man (addicted to crystal meth and an IV drug user) who thought prep would allow him to share needles. Crystal meth addiction is a huge problem among HIV patients in Dallas.
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Comment by: HarleyMC Mon., May. 12, 2014 at 5:38 am UTC
It was interresting to see the tibalism by the AHF defending their own.
The AHF website doesn't even mention PreP as a possibility for reducing HIV transmission, nor do they acknowlege Treatment as Prevention. Denialism costs lives.

It isn't just pharma that have vested interests. Directors in community foundations also have vested interests.
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Comment by: Joey Terrill (Los Angeles) Tue., May. 6, 2014 at 4:02 pm UTC
What misplaced energy being spent vilifying Michael Weinstein and AHF's cautionary stance from a public health perspective regarding PrEP. Current PrEP regimens require taking medication daily. ALL PrEP studies have shown a significant problem with adherence based on daily dosing. This is fact, not opinion. Research studies that show limited success at the individual level cannot predict community-wide success. PrEP is appropriate for a very limited number of people under special circumstances like zero-discordant couples and poor sex workers. As a community wide public health strategy dependent on daily adherence it falls short. When a future drug regimen with better adherence rates among participants (like a monthly dosage or a shot on a quarterly basis) comes along, those of us concerned with HIV infection rates from a public health perspective will champion it's implementation.

As for Mr. Laxton's "not seeing" Mr. Weinstein delivering a "diagnosis to an 18 year old…" , that's so completely lame,it's almost "Palin-esque" and like Ms. Palin, it's not worth responding to. Singing the praises of Gilead…really? Come on we all deserve better than that.

Joey Terrill (HIV+ 34 years)
AHF Director of Community Partnerships
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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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