AIDS/HIV | Truvada

Let's Talk About PrEP: The Silence Of Gay Men On Truvada

Truvada

In a lengthy piece at Out.com, Tim Murphy dives into the controversy and silence that pervades gay male culture about taking the HIV medication Truvada as a pre-exposure prophylaxis, or "PrEP." One of the people Tim interviewed, a doctor who is referred to anonymously as "Dr. John", said of the attitudes around the medication:

Gay men talking about not using condoms is really stigmatized. Most of us have never known sex without condoms or without threat of a ‘deadly disease.’ [But] I think it’s a lot to ask an entire generation of gay men to use condoms forever.

Despite being FDA-approved, 99% effective when taken as directed, and covered widely by health plans, comparatively few gay men are on the drug. Even though condoms are lauded as the ideal, studies have been taken since the 1980s that show that gay men as a whole consistently only use condoms about half the time, and the HIV transmission rates have increased by 22% in recent years. Jim Pickett of the AIDS Foundation of Chicago notes:

If condoms were so wonderful and a part of human nature, we wouldn’t have a problem with rising infections.

The biggest concerns seem to be that PrEP would provide a false sense of security and invite reckless barebacking, which is the stance of Los Angeles' AIDS Healthcare Foundation. A valid concern since though PrEP would dramatically reduce the likelihood of HIV transmission, it would do nothing against other forms of STDs such as Hep A-C, syphilis, and gonorrhea, the latter of which has started showing up in drug-resistant strains. 

What PrEP advocates and activists want men to understand is that the use of the drug is another tool in HIV prevention, not a panacea that will flawlessly protect people from everything. Said Darius Mooring, a 34-year-old bookkeeper in Pennsylvania:

If I go on PrEP, will I be condomless in all my sexual encounters? I don’t think so. But I’m not going to live in fairy tale where I tell myself I use condoms all the time. PrEP will be adding another strategy to my HIV prevention.

Previous Towleroad coverage of PrEP can be found here, here, here, and here

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Comments

  1. "I’m not going to live in fairy tale where I tell myself I use condoms all the time. PrEP will be adding another strategy to my HIV prevention."

    What is so freaking hard about using a condom?! I'm 23 and I despair of the example that older gay men - who witnessed the horrors of the AIDS crisis firsthand - set for my generation. Use a condom AND take the damn pill.

    Posted by: kennedy | Sep 11, 2013 3:48:56 PM


  2. Judging from all of the comments on that article, it seems that, some of us at least, are not ready or willing to talk about PrEP.

    Posted by: David | Sep 11, 2013 3:55:05 PM


  3. I echo Kennedy's comment. When I was single, I had ZERO problem using a condom 100% of the time. No exceptions. I don't understand what's so hard about it (no pun intended). It's always a bit shocking every time I'm reminded that I seem to be in the minority on this.

    Posted by: Rich | Sep 11, 2013 3:57:08 PM


  4. How many people who can't be bothered to use a condom for across the board STD protection would really be willing to keep up with a daily pill regimine?

    Posted by: JMC | Sep 11, 2013 4:01:21 PM


  5. Kennedy and Rich,
    Congratulations to you both for being the most perfect people in the world.

    Posted by: David | Sep 11, 2013 4:05:40 PM


  6. Below is a link to a far more thoughtful article by Sean Strub, founder of POZ Magazine and now executive director of The SERO Project, which questions, in many respects, the advisability of PrEP. Some key quotes from this article:

    "I think it's the wrong way to address HIV prevention. It's a topic of discussion and debate whether the message is being driven by a drug company pushing to expand its markets, and public health officials whose traditional HIV prevention tools--sex education, community-based HIV prevention, highly-targeted prevention messaging, etc.--have been gutted. They're desperate to find whatever way they can to reduce HIV transmission, even if it is a short-term strategy with unknown or risky long-term consequences or that puts other priorities in jeopardy."

    "PrEP risks ruining a very effective anti-retroviral by facilitating development of resistant virus, making the epidemic more complicated and more difficult to end."

    "I question the morality of spending scarce government resources providing treatment for those who don't have an immediate medical need while others are dying for lack of treatment."

    http://blogs.poz.com/sean/archives/2012/11/treatment_as_prevention.html

    Posted by: Douglas | Sep 11, 2013 4:10:10 PM


  7. Truvada really begs the question: Why would a healthy person bother to take a drug that we don't even know what it's going to do to your body over the long-term?

    Posted by: Sean Maloney | Sep 11, 2013 4:11:11 PM


  8. There will always be a sub-segment of MSM who choose to take unnecessary risks. It should not surprise the researchers that the same men who could easily choose other safety strategies BUT DON'T are not going to be interested in PrEP.
    There seems to be a naive assumption by the spokespeople that anyone who is not using condoms could be protected by PrEP. One quote says "gay men as a whole consistently use condoms only half the time."
    Okay, but a very high percentage of the time, there is no risk for which a condom would be needed. If a man is finding strange men in the park to have anal sex behind his wife's back, then he needs condoms; If a disease-free man is monogamous with his disease-free husband and they are engaging in mutual masturbation, condoms are irrelevant (unless they just enjoy wearing them.).
    Some people don't wear condoms at all because they are never at risk, and some wear them 50% of the time because that's how often they are engaging in something that requires them.
    The problem occurs only with those who need them for what they're doing but won't use them.

    Posted by: GregV | Sep 11, 2013 4:15:25 PM


  9. I'd call basic survival skills a low measure of 'perfection', David.

    Posted by: kennedy | Sep 11, 2013 4:30:57 PM


  10. @Kennedy, basically it wears on some people. I am 31 and it hasn't yet on me but who knows? I don't love condoms but it's not even in my mind as an option to not use one on a rando.

    I'm a tad confused, when do you use this? If you use condoms you don't need this, if you use this you don't need condoms, but you still need condoms if your are doing a rando as they might have syphilis.

    And like, a pill every time you have sex is crazy excessive, it makes sex too dangerous, what if you eat a food and get drunk and it like weakens it. I know that that is fear vs science, a bad fight to have. Im gonna get some from my dr. as a "man this sketch dude is hot, lets have sex" scenario.

    Posted by: Fenrox | Sep 11, 2013 4:43:04 PM


  11. "I'm a tad confused, when do you use this? If you use condoms you don't need this, if you use this you don't need condoms..."

    No, that's a dangerous assumption that they are afraid some people may make. The people who take PrEP due to their reckless sex habits still SHOULD be using condoms. The medicine will just help decrease (but will not eliminate) the chance of contracting one type of virus.

    Posted by: GregV | Sep 11, 2013 5:19:49 PM


  12. How about showing some moral restraint by not engaging in unfettered sexual activity with total strangers? Stop being perverts, basically.

    Posted by: Bob | Sep 11, 2013 5:21:42 PM


  13. People using both PrEP AND condoms ?

    Really ?

    Not. Buying. It.

    There's NO reason to use both.

    PrEP is just another marketing scam to distract us from the goal we should be shooting for. Reduction of HIV infections AND ALL STD's.

    People using PrEP are not people who are using condoms. People who are NOT using condoms are people who don't care about STD's in general.

    Let's be up-front and honest about this.

    It's a fact.

    Posted by: Buckie | Sep 11, 2013 5:24:02 PM


  14. We should be thankful to have PrEP.
    Many docs I know have it on hand in case of needle prick and I have taken it before and the % of not sero-conv is very high.
    I don't practice unsafe sex but accidents do happen re broken condoms etc.

    Posted by: Matteo | Sep 11, 2013 5:28:07 PM


  15. "PrEP risks ruining a very effective anti-retroviral by facilitating development of resistant virus, making the epidemic more complicated and more difficult to end."

    THIS ! The INTENTION is to accomplish this, because the drug companies make money with NEW combos, not with old ones that are effective but become generic !

    And then there's that HUGE elephant in the room, the fact that HIV is far from the only STD. Every STD, and the ensuing treatment you need, impact health negatively. And the more of them you collect, and the more frequently you need to be treated, the less healthy you are over time.

    It complicates HIV treatment; it arguably shortens your life even without HIV; it's the thing nobody wants to talk about.

    Because we're a target market and we're being sold something that is bad, any way that you look at it, it's a horrible thing to be pushing on the community, and I question the motives and intelligence of anybody that's pushing PrEP.

    Let's see some full financial discloser from those writing these articles encouraging PrEP use. These people, they are not our friends and they are NOT to be trusted !

    Posted by: Franklin Black | Sep 11, 2013 5:30:48 PM


  16. @FENROX and GREGV: Gilead, the manufacturer of Truvada, specifically instructs that it is to be used as PrEP in combination with the use of condoms.

    As quoted from Truvada's website: "If you are prescribed Truvada for PrEP...you must always practice safer sex. Use a condom, know your HIV status and that of your partner(s), get tested for other sexually transmitted infections (like syphilis and gonorrhea) and take action to limit your contact with body fluids."

    That's not to say that this instruction is consistent with what those in the bareback brigade have in mind, but it is nonetheless clearly specified by the manufacturer of Truvada.

    Posted by: Douglas | Sep 11, 2013 5:34:34 PM


  17. It only protects against HIV (not other infections) and it only costs $14,000 a year! Clearly a perfect substitute for condoms.

    [Obviously it's the right choice for some people. High-risk individuals should consider every option they can, and should be using them cumulatively -- PrEP *and* condoms, not PrEP *or* condoms.]

    Posted by: BABH | Sep 11, 2013 5:36:20 PM


  18. MATTEO :

    Then market it as such, and stop the lying and fake promotional stuff masquerading as real people that actually believe PrEP doesn't exist purely to do harm to the community.

    I'm sick of the obvious drug company viral marketing fakes conning us. PrEP is NOT for people who use condoms, it's NOT for "accidents", it's being viral marketed to us as a SUBSTITUTE for condoms.

    Fraud and lies are just that, and shame on anyone that's pushing this.

    If PrEP is just for emergency use, let's see some indication that there's any effort to prevent it from being used like Viagra !

    Posted by: Buckie | Sep 11, 2013 5:38:05 PM


  19. @MATTEO: To be clear, the type of scenario you are describing would require the use of PEP (post-exposure prophylaxis), which is a weeks-long regimen of HIV medications that are prescribed following exposure to the virus in order to prevent, if possible, sero-conversion from occurring. PEP is different from PrEP (or pre-exposure prophylaxis) which is the subject of this article.

    Posted by: Douglas | Sep 11, 2013 5:40:34 PM


  20. "PrEP AND condoms, PrEP and condoms.

    I call BS.

    Posted by: Hardiee | Sep 11, 2013 5:42:58 PM


  21. After reading the entire article, I just can't help wondering, how could anybody look at PrEP, at HIV research, at how some people in the community accept being drugged and being guinea pigs for new "rectal microbicides" (anyone remember what a DISASTER nonoxynol-9 was ? No ? How easily we're conned into forgetting) and I wonder, what kind of freak show am I missing out on ?

    Is it worth it ?

    I'm seriously asking those with HIV. Was it worth it ? What COULD have been said to you that would have mattered ? Is a life of constant medical intervention what you had in mind ?

    Pushing 50, and not needing any prescription drugs, simply because I made choices based on the facts, I feel like I've somehow missed-out !

    Posted by: Delicious | Sep 11, 2013 6:02:20 PM


  22. The problem with gay men is that you have confirmed all the Right Wing's prejudices about you. You are hedonists looking for a druggie quick-fix. Your holy grail is promiscuity.

    Posted by: Bob | Sep 11, 2013 6:10:40 PM


  23. Some of this comments remind me of what was said of the birth control pill.

    It's another tool. With birth control, it's suggested for people to use two methods. This would be a good way of using two methods for HIV prevention if you're at risk.

    Posted by: Fiveht | Sep 11, 2013 6:16:40 PM


  24. "When I was single, I had ZERO problem using a condom 100% of the time. No exceptions."

    When you were single? Over two thirds of new infections occur when people bareback IN RELATIONSHIPS.

    Posted by: MGC | Sep 11, 2013 6:17:28 PM


  25. MGC,

    The problem is promiscuity, not bareback. Why don't straight guys refrain from bareback with women?

    Posted by: Bob | Sep 11, 2013 6:22:58 PM


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