I’m slightly resistant to writing this piece, because it requires me to reveal some personal truths that have nothing to do with my politics (which I’m very used to expressing with little reservation). But a somewhat bizarre conversation is happening around a relatively new use for a not so new drug on the market. And much the same way as gay activists from Harvey Milk to Frank Kameny once proffered, coming out of the closet is the quickest and best way to turn a homophobic tide, it seems like there is a new tide, and a new closet from which to emerge.
Pre-exposure prophylaxis (PrEP) is a relatively new HIV prevention approach where HIV-negative individuals use anti-HIV medications to reduce their risk of becoming infected if they are exposed to the virus. In 2012, despite efforts to derail it, Truvada became the first and only medication approved by the Food and Drug Administration (FDA) for HIV prevention. Doctors had been prescribing it off label well before the FDA approved it, and for good reason.
The use of PrEP is being hailed by some, including physicians as one of the most promising new drugs in the reduction of new HIV infections, which now total about 50,000 a year in the U.S. according to a recent Associated Press story that focused on PrEP or its brand name, Truvada.
As the AP story put it, the remarkable efficacy of Truvada has led to a “rancorous debate among gay men, AIDS activists and health professionals over its potential for protecting uninfected men who engage in gay sex without using condoms.” And how remarkable exactly? In a 2010 clinical trial funded by the National Institutes of Health and published in the New England Journal of Medicine, even in those patients who didn’t adhere perfectly, their risk of contracting HIV still dropped by more than 90 percent. Yes, you read that correctly — 90 percent.
For those taking Truvada daily, as prescribed? A whopping 99 percent reduction.
The results of three successful PrEP studies, iPrEx, PARTNERS and TDF2 are pretty much incontrovertible. As Joe Biden would say, this is a big fucking deal.
The latest battle lines around PrEP have been simmering for a while already. And as expected, the usual suspects, like the divisive Andrew Sullivan, are front and center of the discussion. But a reckless quote in the AP story by Michael Weinstein of AIDS Healthcare Foundation, in which he called PrEP a “party drug” catapulted the issue into the spotlight, sparking appropriate outrage along with much needed conversation on the one hand, and petitions calling for Weinstein’s resignation on the other.*
One can appreciate the uphill struggle it has been to get youngsters to take HIV seriously, or view it as anything more than a mere inconvenience, when their only real reference to HIV and AIDS have been glossy magazine ads touting the latest HIV medications with visual depictions of gorgeous, healthy, perfectly sculpted men scaling mountains with bikes on one shoulder. Which, despite the confusion that can result from that kind of messaging, is infinitely better than the much-maligned poster campaign by STOP AIDS Project San Francisco, which included vivid images of some of the negative effects of AIDS, such as diarrhea, facial wasting, night sweats and crix belly.
Not to mention the extent to which negative portrayals of people with HIV unnecessarily offend and scare people who are living with the virus (particularly those who are asymptomatic), and even worse, scapegoat, isolate and denigrate an entire group of people who happen to be carrying a virus that does not discriminate.
Against that backdrop, are a slew of coming out of the PrEP closet stories by the likes of Lucas Films porn studio owner and actor Michael Lucas, (coupled with his decision to compete in the rapidly growing bareback porn market — and bareback porn star inventory — by ditching condoms once favored along with studios like Titan and Falcon). The latter continue to produce condom-only porn, but the appetite for bareback frustrates the efforts of current HIV prevention strategies, which continue to advocate for condoms or abstinence, despite their demonstrable limited overall effectiveness in reducing transmission.
Lucas’s porn star status, and financial incentive to promote the virtues of safer, guilt-free barebacking, dilutes his message and thus his potency as an appropriate PrEP poster man. Andrew Sullivan’s holier-than-thou sanctimony can be a royal pain in the ass to many people, but he is able to elevate a conversation that penetrates mainstream media. And although Sullivan is HIV-positive, (and thus not part of the constituency for whom PrEP is an available HIV prevention strategy), he has been touting preventative medication since 2006, and credit is due where credit is due.
SF AIDS Foundation strongly supports PrEP, and has teamed with a slew of other agencies to promote its use and make it available, including a blog featuring Jake Sobo, a pseudonymous, sexually promiscuous HIV negative man, who early on reclaimed the PrEP whore label. And while it’s great that Jake Sobo unashamedly documented his PrEP life, his anonymity inadvertently perpetuates the very thing he seeks to eliminate. That there is shame involved in using PrEP. Something to be hidden or unspoken.
But what really is going on here, and why Weinstein’s comments lit such a fuse of outrage, is that he attempted to demonize a potentially revolutionary HIV prevention tool rather than cop up to the abject failure of HIV prevention messaging. And his complicity in it. The failure of which, ironically, for better or worse, sustains his relevance and enables him to command six figure compensation packages. ($398,650 to be exact, according to some digging by activist Michael Petrelis). Without AIDS, who needs AHF? It has been an issue for AIDS, Inc. ever since HIV became a manageable disease and no longer a death sentence.
Michael Weinstein’s comments were not only idiotic and counter productive, they were designed to mock and humiliate people for making intelligent, and not necessarily easy, choices. Using, no less, the same tactics one would expect of the recently deceased Fred Phelps of the Westboro Baptist Church, not the head of an organization who receives much of its funding on the premise it will help eradicate AIDS, not attack and punish those acting in alignment with those goals and worse, preclude them from gaining access to tools that allow them to make the best possible health choices.
Weinstein sounds much like Rick Santorum talking about birth control. Or like Rush Limbaugh calling Sandra Fluke a slut. Party drugs evoke images of Molly and GHB cocktails, or crystal meth fueled circuit parties. If men responsibly taking Truvada tablets once a day with a glass of water constitutes a party, I shudder to think how fucking boring spending a night with Michael Weinstein must be.
There is no denying that the slut shaming tactics being employed AIDS Healthcare Foundation, the world’s largest AIDS organization, in addition to the shitloads of money they wasted trying unsuccessfully to get the FDA to reject PrEP, flies in the face of scientific evidence, and is morally reprehensible. Instead of marveling at the efficacy of PrEP, and shouting in joy from the rooftops, this moral scold told ABC news that he thinks “[PrEP] will be a catastrophe for HIV prevention in this country.” If the notorious homophobe Scott Lively wanted to do the most damage to gay men, he’d push for Michael Weinstein to helm AHF.
“Under the leadership of Commissioner Hamburg, the FDA has proven that it cannot be trusted with protecting the American public from unsafe and ineffective drugs,” Michael Weinstein chided in an all out attack on the FDA in 2012, irked that his demented, expensive and unsuccessful crusade to keep PrEP out of the hands of those for whom it could benefit enormously did not stop the FDA from approving PrEP. One of the key missions of AHF is to support decriminalization of HIV/AIDS, and so you’d think they would know a thing or two about the dangers of demonizing those with whom they disagree. The biggest question that should be asked right now is if the broader mission of the AHF is to rid the world of AIDS, why the fuck is Michael Weinstein still heading it?
There’s also finger pointing designed to induce guilt from those who would take Truvada to satisfy their voracious, reckless sexual appetites while so many in Africa are deprived the same life saving drugs, which is a ridiculous argument at its core, and would only make sense if there was a shortage of Truvada. The reasons for a lack of access to Truvada in Africa have nothing whatsoever to do with the access and availability here.
The slut shaming from the gay community, despite the demonization efforts perpetrated by Weinstein and his ilk, is quite difficult to wrap one’s head around. First off, there’s this notion that PrEP should only be available to men who are in sero-discordant relationships, where only one partner is HIV positive, and not for sluts, who deliberately bareback and eschew condoms altogether. It’s a moot point though. And once again, Rick Santorum is better suited to pontificate on what sex is acceptable.
Arguments from the right, predictably, view PrEP as nothing more than an open invitation for promiscuous gay men to continue fucking without having to compromise or give up anything. The same argument being pushed by AHF. As if gay sex is inherently sinful or hedonistic, and therefore has to have a price.
Regan Hofmann, former editor-in-chief of POZ wrote: “Unfortunately, PrEP will probably remain in the domain of the haves, not in that of the have-nots. Treatment as prevention is not going to be a reality for disenfranchised HIV-negative people at risk. PrEP will be for rich, HIV-negative people in the United States and other developed nations, gay and straight, who would rather take a pill and weather its side effects than use a condom.” To some extent, she may be right, but that isn’t a reason to not use it. Unfortunately, she didn’t leave it at that, she chose to contradict herself with a ridiculous dismissal of PrEP as a “profit-driven sex toy for rich Westerners.”
Coming from the gay community though, the hostility toward those taking PrEP is more complex, thanks in part to Weinstein’s shaming tactics, which mirror those that would sooner label a woman a slut than support her for making responsible birth control choices. And one more reason why I have decided to step out of the PrEP closet.
So, before further ado, let me say it loudly and clearly - Yep, I’m a Truvada whore.
With recent predictions that over half of gay men will contract HIV by the time they’re 55, being called a whore is a paltry price to pay.
I’m not ashamed of my decision. On the contrary, I feel good about myself for doing it. And hope my decision leads to many more people making the same choice, free of the misinformation and guilt intended to curtail this potentially revolutionary step in the fight against HIV and AIDS.
As a single, sexually active man with a candid and collaborative professional relationship with my primary care physician, I make it my business to take whatever steps are available to me to protect myself.
Last week I was vaccinated for meningitis, which my doctor recommended proactively based on a recent spate of cases in California and New York. Like hepatitis vaccinations, for men like me, the meningitis vaccination was a no-brainer.
So what about PrEP? I had read the latest literature on it, and of course, have been exposed to the latest debates. But despite my relatively active sex life, there were still some legitimate concerns I had, and areas of misinformation to contend with, before I made the decision to start taking PrEP.
First, aside from the litany of potential side effects pharmaceutical companies are required to list by the FDA, was the toll that taking medication has on one’s kidneys and other organs. Truvada is no exception. Taking Truvada is not as simple as popping a pill once a day, but requires also getting tested for HIV, screening for other sexually transmitted infections, and being monitored for kidney health four times a year. Not a problem for me, since I monitor my health in a similar manner anyway, but certainly a commitment nonetheless.
Second, I risk having it as a line of defense against another potential strain of HIV if my body builds a tolerance for it that reduces or eliminates its effectiveness for me.
And finally, and perhaps more challenging, was facing the fact that despite my ability to remain negative over a pretty active twenty-five year sex life, my sexual practices and preferences demand nothing less. I owe it to myself and I owe it to my sex partners. Because protecting myself is ultimately my responsibility, and mine alone. And to those who are going to resist having sex with me because I take PrEP, and must therefore be a promiscuous whore, the loss is yours. And shining some sunlight on PrEP use is worth far more than your judgmental sex.
As my doctor cautioned strongly, despite the extraordinary efficacy and success rate among those taking it in compliance with the prescription directives, it is not a fail-safe, one hundred percent guarantee against contracting HIV, and should not be viewed as an alternative to taking other precautions, including condoms, but rather as a complement.
As a doctor, that’s the advice I would want and expect. But there’s no denying, in the absence of condoms, it’s a fucking good alternative, pun intended. And one I am grateful for.
Before I am bombarded with comments, let’s face it, as a birth control measure, condoms are not a guarantee against pregnancy either, but we don’t see sex educators refraining from promoting it as a damn good start. And so with PrEP, why on earth wouldn’t I use it if I know that it’s acting as a powerful weapon in my protection arsenal?
Because despite car accidents, I still drive, and although seat belts aren’t guaranteed to save my life, I still wear them. And despite my best intentions, and embarrassing as this truth may be, when it comes to fucking, sometimes I’m still ruled by my dick instead of my brain. And in those unguarded moments, I am giving myself the best protection science currently has to offer. Stigma be damned.
At the end of the day, I’m sleeping a lot better at night than Michael Weinstein should. And I’d far rather be labeled a “Truvada whore” than be a reckless, self righteous obstructionist with unnecessary seroconverted blood on my hands.
* CORRECTION: This article originally attributed the origin of the term “Truvada Whore” to Michael Weinstein of AIDS Healthcare Foundation. In fact the term originated in a Huffington Post article by David Duran in November 2012, in which he acknowledged the value of PrEP for those in serodiscordant relationships, but lashed out at promiscuous men who would eschew condoms to engage in condomless sex. (Bareback used to refer to unprotected sex, but PrEP has required an alteration of that definition). Adam Zeboski, an HIV test counselor and recruiter for San Francisco AIDS Foundation appropriated the term as a way to take the sting out of the derogatory insult, much like the word queer, and transformed “Truvada Whore” into a pro PrEP information and education resource. It was in that spirit that I titled this article.
Michael Weinstein continues to stand by his ill-advised statement calling PrEP a “party drug,” and his attitude and efforts continue to violate the very mission of AHF by railroading access and stigmatizing those taking steps to prevent contracting HIV. David Duran has evolved since he coined the phrase “Truvada Whore” to align with Adam Zeboski’s reclamation, along with a growing group of brave, generous and outspoken people who are either taking PrEP or supporting its use.
PrEP Facts: Rethinking HIV Prevention and Sex is an open group of Facebook with almost 2,500 members is a formidable resource, along with the following resources:
Originally published by The New Civil Rights Movement.