Pre-Exposure Prophylaxis for HIV

[FindingNamo]

Posted: 11/19/14 at 5:45pm

I felt like starting a thread about PrEP (a once a day pill that prevents the acquisition of the virus in confirmed HIV-negative people) that is, at least, initially not hinging on Larry Kramer's name and reactionary stance of a couple of months ago.

I have been following the coverage fairly closely and I would have to say that the American media obsession with having to have a voice from "the other side" on every story that is about the advancement of gay rights or the sex lives of gay men is terribly wearying.

A lot of the "other side" in the discussion of PrEP, or Truvada as Pre-Exposure Prophylaxis for HIV, has come from Michael Weinstein, whose billion-dollar AIDS Healthcare Foundation took out anti-PrEP ads in major papers, including in Washington DC. I can't quite get to the bottom of what his investment is in undermining this development of an effective HIV prevention tool to put in the arsenal of ways to stop HIV. The cynic in me wonders if he fears an end to new clients for his agency if the epidemic is stopped?

Anyway, in my travels on the topic today I found a GREAT article that looks at the phenomenon and the American myths it plays into. It really resonates with me.



PrEP and The Moralization of Calamity

Updated On: 11/19/14 at 05:45 PM

[haterobics]

Posted: 11/19/14 at 5:54pm

When I was a newspaper reporter, the very small gay community was just emerging and was putting on a small film festival on a college campus. I was writing the story for the newspaper, since I knew the organizers, and it was a puff piece anyway.

My boss read the piece and asked me why I didn't get a reaction from the local anti-gay mouth breather, and I said, "Because it's a gay film festival, so if you don't want to see gay films, you just don't buy a ticket?"

She wouldn't budge, so I said, "I'll quote him on one condition: I'm writing our story on Kwanzaa, and you're not allowed to remove the quotes I get from the opposition." The story ran as-is.

[FindingNamo]

Posted: 11/19/14 at 6:06pm

And that impulse has yet to change.

[haterobics]

Posted: 11/19/14 at 6:08pm

I refuse to take PrEP because my pill-to-sex ratio would be far too depressing.

[FindingNamo]

Posted: 11/19/14 at 6:16pm

Mine would be low if only anal counted. As for everything else, well, only I and a few dozen others per month know for sure. That's why this sentence really resonated for me:

"Science describes HIV infection as a matter of odds, which implies that many of those not infected engaged in some of the same behaviors we shame, and simply got lucky."

My repeated negative tests have reinforced a notion I can summarize as "I must be doing something right," which is correct but only as a far as I can admit it includes a great deal of luck. It's probably a relatively low number, but there's no way I haven't engaged with guys who have no idea they are in the earliest (and most highly "infectious") stage of HIV seroconversion.

[sabrelady]

Posted: 11/19/14 at 8:26pm

a few dozen others per month.

Is that a boast or a complaint?

[PalJoey]

Posted: 11/19/14 at 10:19pm

It's an in-polite-company understatement.

[HorseTears]

Posted: 11/19/14 at 10:36pm

I know this makes me sound like an anti-science tin foil hat wearing goob, but the idea of taking an elective medication that's fairly new to market for life makes me a tad anxious. I know that, at the end of the day, to maintain one's sanity, you have to put a certain amount of trust in the system. But seemingly every other year we learn of an investigation into big pharma being in bed with the FDA and manipulation of safety studies and long-denied life threatening side effects being covered up. I know all the current science tells us that it's safe, but unless my life depends upon it, I'd like to avoid taking a medication until it's been in the marketplace for, I dunno, 5-10 years. That's just my personal reason for rejecting it - for now. I in no way share Larry K's views, though and I see the development of PrEP as a very positive one.

BTW, I should know this, but because I have no interest in taking the drug, I haven't done much research. Is its cost partially covered by most insurance plans? If not, what are people paying out of pocket for it and, uh, what does that say about healthcare and socio-economic status. Probably the same thing as always.

[PalJoey]

Posted: 11/19/14 at 10:51pm

There's no answer to the evil profit that "Pharma" makes out of getting every gay boy in the United States (and then the world) to be taking this as a once-a-day like a vitamin. Whether insurance pays for it or mommy and daddy's trust fund pays for it or you make enough money to pay for it, the drug company gets between $8,000 and $12,000 per year per patient. That translates into gazillions of potential dollars.

That conversation goes nowhere except to cynicism and the same-old prevention strategies we've been hawking since poppers were ruled out.

And still the 20somethings get infected.

If you're going to talk about this at all, you really have to drop that cynicism and look at PrEP as a new paradigm of prevention strategy: X% of the number of people taking PrEP and following the protocol including the 4X yearly doctor visits will NEVER seroconvert.

Whether that number is 50% or 99.99&, it's probably way better than condoms.

Namo's heard me say this before, but I wish, I wish, I wish, that Pharma had come up with a cure or a onetime vaccination.

But this is what we got, and taken correctly, it can prevent infection.

What to do about the drug company's windfall profits?

I dunno. Buy Gilead.

Updated On: 11/20/14 at 10:51 PM

[SNAFU]

Posted: 11/19/14 at 11:04pm

I'm a bit skeptical. Do we know what long term use side effect this drug has? I guess I am with HorseTears here on this matter. As well as not trusting Big Pharma much.

[HorseTears]

Posted: 11/19/14 at 11:11pm

PJ - my personal reason for - currently - having no personal interest in PrEP is not so much about my reluctance to support the massive profits of big pharma, but about their shocking ability to get unsafe drugs approved and to then, years later, settle death and injury cases while still maintaining a healthy profit. I'm not a conspiracy nut. I don't believe big pharma is "evil" and out to get us. I'm sure, like most people, I know friends and family members who are alive and living better lives because of medical advances from the pharma industry. I'd just rather have other people be the guinea pigs for a few years before I'd consider taking it myself. A selfish, illogical, highly emotional reason? Sure.

[FindingNamo]

Posted: 11/19/14 at 11:55pm

"but the idea of taking an elective medication that's fairly new to market for life makes me a tad anxious."

The only people who *have* to take these meds for the rest of their lives are people who are HIV positive. If they want to stay alive.

The protocol for negative people is to get complete blood work every 3 months while they are on Truvada as PrEP to monitor kidney and liver functions as well as to make sure they are still negative and STI free. So people who are at significant enough risk of seronconverting and who chose to go on this form of PrEP (there are different things in the pipeline and if this is taken up by enough people obviously the market in this whole lousy stinking for-profit system will take notice) are in a way helping contribute to the knowledge of long-term efficacy and safety.

PJ, the letters L, O and L get tossed around a lot these days but I truly did all three when i read:

"It's an in-polite-company understatement."

[HorseTears]

Posted: 11/20/14 at 12:02am

I LOL'd too.

I'm not trying to make a point here about anything other than to offer my (unsolicited) reasoning for having no interest in Truvada at this time. In no way a moral judgment about those who choose this option. I think it's a wonderful advance and should be celebrated. And I may join in in a few years myself.

[FindingNamo]

Posted: 11/20/14 at 12:08am

Soon there may be a 1 injection every 3 months form of Truvada as PrEP.

I do think one thing to do that is helpful is to let people in our lives know that this exists, since a lot of people don't even know about it. Although, with the billion-dollar annual budget of the AIDS Healthcare Foundation placing ads designed to put doubt in the minds of everybody who sees it (like the Koch Brothers placing ads urging young people to opt out of the Affordable Care Act), I think it might be a lifesaver to some people we may actually know.

[haterobics]

Posted: 11/20/14 at 12:39pm

AHF seems to have a pretty weak rebuttal, that people may not take it every day and you still can get other STIs if you then go condomless?!

Seems pretty straightforward that if you don't take medication as prescribed, you wouldn't get the desired effect, and that a pill tat prevents one thing doesn't protect you from other things.

But the new world order seems to be if you can elevate your bull**** to a certain level, people have to discuss the "two sides" as though they have equal value.

[FindingNamo]

Posted: 11/20/14 at 12:56pm

Peter Staley says he heard from an insider that AIDS Healthcare Foundation spent 1.2 million dollars to place their anti-PrEP ads around the country. My Koch brothers analogy is feeling more apt.

[Phyllis Rogers Stone]

Posted: 11/20/14 at 2:06pm

It is astounding how obfuscated information about this seems to be. Around the time of the Larry Kramer thread, I was talking to a friend of mine who is a pharmacist about anti-virals being used prophylactically and she looked at me like I was crazy. I had to dig up that thread and show her that I wasn't just pulling this out of thin air.



Updated On: 11/20/14 at 02:06 PM

[FindingNamo]

Posted: 11/20/14 at 3:09pm

I don't know whatever happened to the idea of "cautious optimism". I would expect nothing but pessimism from Kramer, but why is AHF spending SO much money on getting negative talking points out there for what will be an unquantifiable number of people's first information on the topic?

[FindingNamo]

Posted: 1/9/15 at 2:18am

Yes, another old, white HIV+ gay man has something to say about PrEP (in this case it's Peter Staley, whom everybody loves and who isn't a blocker like Larry Kramer or Sean Strub or the exceedingly odious Michael Weinstein). It's a good article but I am really longing to hear from young HIV negative men and their thoughts about PrEP.


time for anti-science PrEP critics to "shut their traps"?