As pre-exposure prophylaxis (PrEP) becomes a more mainstream method used to reduce the risk of HIV infection, a new advocate for the HIV prevention strategy has emerged: San Francisco City Supervisor Scott Wiener.
In an essay picked up by The Huffington Post, Wiener explains why he's being so forthright about his decision to take Truvada (which is a combination of the two anti-HIV drugs tenofovir and emtricitabine) as PrEP, saying that he hopes "to contribute to a larger dialogue about our community's health." In particular, Wiener insists that his political position in San Francisco -- long-touted as America's gay mecca -- made "outing" his use of PrEP "hard but necessary."
The Huffington Post is the same news website where the term "Truvada Whores" first appeared in an op-ed that perpetuated the unsubstantiated belief that PrEP increases promiscuity. The term has since been taken back by those who support the use of Truvada in HIV prevention. Activist Adam Zeboski even turned it into an empowering hashtag, #TruvadaWhore -- which has made its way onto T-shirts -- for those who believe in the drug's importance.
While homegrown campaigns and activist movements have worked hard to raise PrEP awareness, Wiener's straightforward endorsement has drawn nationwide attention because of his political stature. To date, the San Francisco politician is the highest profile public official using PrEP to prevent HIV infection.
Wiener is also aware of the importance of adherence when taking PrEP. "Each morning, I take a pill called Truvada to protect me from becoming infected with HIV. [It] reduces the risk of HIV infection by up to 99 percent if the pill is taken once a day. This makes PrEP one of the most effective HIV-prevention measures in existence."
The latest research on PrEP demonstrated that, when PrEP was taken at least four times a week, HIV risk was reduced by 100%. That contrasts with 70% efficacy for condoms in a study by the U.S. Centers for Disease Control and Prevention (CDC) presented at the Conference on Retroviruses and Opportunistic Infections in 2013.
The CDC cautions that PrEP should not replace condoms as an HIV prevention strategy, because it does not protect against other sexually transmitted infections like gonorrhea and chlamydia. Moreover, when coupled with condom use, PrEP seems to reduce the possibility of HIV infection as completely as possible.
Many critics insist that PrEP encourages risky sex, though no study has seen any such correlation. Wiener credits those critics as part of the reason he's come out in favor of using PrEP to prevent HIV. "We still see enormous stigma, shame, and judgment around HIV, and around sexuality in general," Wiener writes, "that is precisely why I decided to be public about my choice."
The U.S. Food and Drug Administration approved Truvada as PrEP for those at high risk of acquiring HIV, including men who have sex with other men, in 2012. And, because of its effectiveness, PrEP seems to be one of the most promising new developments in HIV prevention for those who have access to it.
Currently, Wiener and his colleagues in San Francisco are considering an idea, floated by fellow City Supervisor David Campos, to distribute PrEP for free throughout the city. If enacted, San Francisco would be the only city in America with such a progressive policy toward HIV prevention.
Josh Kruger is an award-winning writer and commentator in Philadelphia. His work often focuses on HIV/AIDS, cultural stigmas and social problems. You can follow him on Twitter @jawshkruger.