Why The Argument About PrEP While 50k New Cases Pop-up?

It’s rare that I get pissed off about a debate playing out in our community, but I am pissed now and getting angrier every day. I sometimes walk to work and go over the facts in my head and mutter to myself in angry tones.

“It’s insane,” I say, before putting my phone to my mouth to pretend I am talking to someone.

Here’s the deal: studies, including the iPrEx study led by Gladstone Institutes senior investigator Dr Robert Grant, show that taking Truvada, a drug commonly used in a cocktail taken by people with HIV, can be used as a pre-exposure prophylaxis (aka PrEP).

Take one Truvada a day and your chances of contracting HIV from condomless sex are reduced by 99 percent. As a result of his work, Grant was named one of Time magazine’s 100 most influential people in 2012.

In the United States, the Food and Drug Administration approved PrEP as an HIV-prevention tool back in 2012.

Wonderful — right? Not so fast. Do yourself a favour and check out our four-part video series above that addresses the debate around PrEP. We blew our budget on it because we think this issue is so important.

The bottom line is that PrEP seems to work for guys who are barebacking (having sex without condoms). Wear a condom and take PrEP and you are even more protected. A broken condom is no longer the anxiety-producing experience it used to be.

Yet, gay men are not embracing the drug. Even those who are riding without condoms are forgoing this seemingly logical choice.  

What is stopping them? Misinformation and shaming seem to be part of the answer. A recent Associated Press article (subsequently picked up by media outlets across North America) quotes Michael Weinstein, president of the AIDS Healthcare Foundation: “If something comes along that’s better than condoms, I’m all for it, but Truvada is not that. Let’s be honest: it’s a party drug.”

Weinstein and the AIDS Healthcare Foundation have more concerns. And Weinstein is not the only person who harbours the sentiment that gay men running wild are taking PrEP just so they can party and fuck all night without contracting HIV.

But, I ask, what is the problem? Why this associated shame? Condom usage is down. So, god bless the party boy who has enough foresight and self-awareness to take his daily dose of Truvada.

Since the article’s publication, Michael Lucas, a porn producer and PrEP advocate, has called for Weinstein to be fired. We interviewed Lucas back in late 2013 about his use of PrEP as a safety net for occasional “slips.” Now he is going whole hog — dating an HIV-positive man and forgoing condom usage. Lucas also broke his long-standing ban on starring in and producing bareback porn. 

Does Lucas fit Weinstein’s idea of someone taking PrEP as a party drug?

Lucas wasn’t the only one outraged by Weinstein’s comments. An online petition on change.org calling for Weinstein’s head is making the rounds. But Weinstein isn’t backing down.

“In the last few days, in terms of the people who have been yelling the loudest about this, they’ve all been associated with bareback porn,” he says in an interview with BuzzFeed. “Which kind of makes my point that it’s a party drug.”

But Weinstein’s “party drug” comment is nothing. How about this quote attributed to the University of Ottawa’s Dr Mark Tyndall: “If a gay man tells me that he will never use a condom and he will continue to have unprotected sex with anonymous partners, it seems counter-intuitive to me to give him a pill. He already has highly effective tools at hand to prevent exposure and we need to focus on removing the barriers that prevent him from using these tools.” (Here is the full article: http://www.catie.ca/pif/spring-2011/views-front-lines-pre-exposure-prophylaxis.)

Good god.                                                                 

We have been bad, bad boys for not following doctor’s orders, and now we must pay the price. And if you don’t do as I say, you kind of had it coming to you. Has this doctor ever used a condom? This quote was from 2011, so maybe he has seen the light since then.

Or how about the argument that a firestorm of sexually transmitted disease will follow when gay men start using PrEP and abandon condoms? Visions of flaming chlamydia and cancerous warts fill my mind.

Another issue often mentioned is cost. “For me, the expense of this drug alone makes it a non-starter: it costs a tremendous amount of money that eventually everybody will pay for either in the form of more expensive insurance or further burdening of our healthcare system,” (Dan Falkenham)

I get it — to a point. Drugs fail and have unforeseen side effects. We have been burned before on the pharmaceutical front in our fight against HIV/AIDS.

Damon Jacobs is a New Yorker who actively promotes PrEP education. He is not involved in the porn industry and he’s been taking Truvada since July 2011. He’s more of a bottom and has been on the receiving end with HIV-positive guys. He remains negative.

He wrote about his experiences on the My PrEP Experience blog. He describes the online debate as “unusually unscientific” and sees sides in the debate being drawn along generational lines with first-wave survivors of the AIDS pandemic being the most ardent in their rejection of PrEP as a prevention tool.

He sees these guys as married to the condom-every-time mantra. Often they are “furious” when debating. Me too.

Thank god we are finally becoming furious, because about 50,000 new HIV infections are popping up in the US every year. Lives are affected, ruined and cut short. Whether you are a party boy or an older man and whether you bareback or not, you deserve protection and information.
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