AIDS/HIV | Truvada

AIDS Healthcare Foundation: CDC Is 'Ill-Advised' To Promote PrEP


Hot on the heels of the medical specialists at the Centers for Disease Control and Prevention administering guidelines for PrEP as an HIV preventive the AIDS Healthcare Foundation released a statement calling the CDC's promotion of pre-exposure prophylaxis as a method of HIV prevention "ill-advised." AHF President Michael Weinstein said on their website:

This is a position I fear the CDC will come to regret. By recommending widespread use of PrEP for HIV prevention despite research studies amply chronicling the inability to take it as directed, and showing a limited preventive effect at best, the CDC has abandoned a science-driven, public health approach to disease prevention—a move that will likely have catastrophic consequences in the fight against AIDS in this country.

He then brings up concerns about other STDs and insists that an uptake of PrEP will lead to a surge in condomless sex and therefore a rise in other STDs; however, the CDC made their decisions after analyzing the results of actual scientific studies. Weinstein's assertion about increased condomless sex, on the other hand, is pure speculation and actually runs counter to observations from the iPrEx study that noted no decrease in condom usage by participants on PrEP.

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  1. "no decrease in condom usage by participants on PrEP"

    Probably because, among early PrEP users, it was pretty low to begin with. But promoting PrEP further will probably compel some men to stop using condoms.

    Posted by: Eugene | May 16, 2014 9:10:26 AM

  2. PrEP is not refusing to put on the condom - the person is.

    The CDC never encouraged or inferenced PrEP as a substitute for condoms.

    Condemning PrEP wholesale for those that play Russian Roulette with its dosage and like it bareback is so short-sighted it's not only depressing in this day and age of information about AIDS, it's infuriating.

    If the last three decades of this battle are any indication, those that want condomless sex aren't changing their minds no matter the health directive.

    Posted by: Leo | May 16, 2014 9:13:46 AM

  3. I"m on PrEP and one of my doctor's stipulations is a battery of STD testing every three months. My behaviors haven't changed, but I'd be lying if I said I've used a condom every damn time I've had sex for the past twenty years.

    I view PrEP like any other preventive measure. I get a flu shot in the fall because I live in a major metropolitan area. I take antihistamines in the spring for pollen related allergies. I didn't suddenly run out and start taking loads at the bath-house because I started PrEP.

    Weinstein is the real AIDS whore. He profits from people who are HIV positive and he and the AIDS Healthcare Foundation need more HIV positive people to stay in business.

    Posted by: Scott | May 16, 2014 9:16:52 AM

  4. Living in San Francisco, PreP is heavily promoted. About 95 percent of the guys I have met on it go bareback. I've also had more people tell me that they have contracted syphilis and gonorrhea. Related? I'm not a scientist, but people are not using condoms with PreP. It does seem to work for HIV prevention, but now Antibiotic resistant STI's are the new thing to be afraid of. Does it ever end?

    Posted by: Mike | May 16, 2014 9:55:29 AM

  5. Once people actually have confidence that PrEP prevents the acquisition of HIV, those condoms will never leave the bedside drawer.

    And for those that do use sex clubs, it's gonna be wild.

    I see how it makes sense for mixed-status couples, but beyond that, sincerely without judgement, it seems reckless.

    Posted by: pete n sfo | May 16, 2014 10:07:53 AM

  6. CDC=highly trained staff of thousands professionals with peer review.

    AHF=one demented crank that thinks he’s omnipotent.

    Posted by: KevinSF | May 16, 2014 10:20:35 AM

  7. @Leo

    What exactly is the point of PrEP if you're wearing condoms every time? So there's no need to promote PrEP specifically as a substitute for condoms - it's implied anyway.

    Posted by: Eugene | May 16, 2014 10:44:22 AM

  8. This guy sounds like he opposes any drug that reduces the pool of victims he can drain of money.

    Posted by: Justin | May 16, 2014 11:10:17 AM

  9. @ Eugene

    Who implied PrEP was a substitute for condoms?!? Not the CDC.

    There are people that wear condoms every time that also use PrEP every time - willing to pay up and go through the side effects for the added protection.

    Yes, they are a minority but they're being completely erased by Weinstein to bolster his misconstrued argument.

    Posted by: Leo | May 16, 2014 11:20:20 AM

  10. To be fair, the CDC has not in its recommendation for PrEP recommended continued use of condoms. I think all of this would be fixed if they just publicly say that PrEP is most effective when used with condoms. It would do them well to make sure that people know that PrEP does NOT protect from syphilis, chlamydia, etc.


    when discussing public health issues, the minority that happens to be very good about preventative measures is often not the focus. Obviously, the problem becomes how to address the majority that are not being as safe. I don't agree with Weinstein's complete dismissal of PrEP but there needs to be more effort to educate people in that PrEP is not a suitable substitute for a condom, just an extra layer of protection. They haven't really done that.

    Posted by: Patrick | May 16, 2014 11:32:18 AM

  11. WTF... Weinstein has to go. The AIDS Heathcare Foundation should be jubilant about this breakthrough but it is beginning to appear that they aren't interested in finding a cure since that would impact their funding and put them out of business. PrEP will save lives and prevent the spread of the disease. I'm not giving them another cent.

    Posted by: Gerry | May 16, 2014 12:08:44 PM

  12. Weinstein is nuts, however, anyone in this world who wants to argue that condom usage will not plummet as PrEP becomes more common is living in Fantasyland. PrEP is going to give gay man a sense of invincibility (which may actually be mostly accurate, as it pertains to HIV), and of COURSE they're going to have more condomless sex. I just can't fathom anyone arguing otherwise. Perhaps the use of condoms stayed pretty steady in earlier observations of guys trying PrEP out because it was new and they still had fear in them. But seriously, most guys who are going on PrEP now are for sure going to at least use condoms less frequently, if not skip them altogether, emboldened by encouraging stats that show PrEP to be so effective.

    Posted by: Matthew Rettenmund | May 16, 2014 12:17:29 PM

  13. Gerry, that's idiotic.

    PrEP will not save the lives of the people who don't use condoms, they'll still spread HIV and other STD's, if you can't be bothered to use a condom every time, you are hardly going to remember to not miss any PrEP doses.

    And make no mistake here, skipping your PrEP dose renders PrEP less effective than wearing a rubber.

    It's time for the community to grow the f*ck up, HIV is not the only thing to worry about, self destructive behaviour and using people with no regard for yourself or each other is what spreads HIV and other STD's.

    HIV and other multiple STD's are not killing people, your stupidity is.

    Posted by: Buckie | May 16, 2014 12:22:00 PM

  14. JUSTIN: and you sound like somebody that can't wait to push expensive drugs on people that have problems far more serious that a drug can't solve.

    Great for drug company profits, terrible for the community.

    Posted by: Buckie | May 16, 2014 12:24:12 PM

  15. GERRY:

    You are an idiot if you think PrEP is going to somehow make HIV suddenly disappear.

    Seriously, I see you and the attitude and misinformation people like you spread as THE real problem.

    Congratulations, you ARE why HIV will never be controlled.

    Posted by: Buckie | May 16, 2014 12:25:51 PM

  16. It seems to me that AHF exists because there are people that do not use condoms every time.

    It also seems to me that the spread of HIV is not significant among people who are being consistent about practicing safe sex.

    It also seems to me that everyone posting here has made interesting points, coming from different perspectives.

    But let's face it - PrEP is being promoted heavily, even in posts here, as some sort of potential cure for the spread of HIV. When people do this, it entirely justifies the unpopular stand Weinstein has made; you've made his point for him.

    PrEP is not for me or anyone that is in a stable relationship and has no interest in sex with people we do not know that has no issue with using a condom every time.

    For everybody else, I can see where the confusion and controversy lies.

    I have to be honest and admit that I don't understand the risks so many people are willing to take. At 50 I've managed to be consistent and free of HIV without missing out on life. All I can say to everyone else is good luck; you are going to have to live with your choices just like everyone else does...

    Posted by: WayOutWest | May 16, 2014 12:44:04 PM

  17. Okay everybody open your ears, PreP is not a goddamn substitute for condoms PreP does not prevent STI's for a full spectrum protection against both HIV and STI's you should talk Prep and Wear a Condom. and at the very least people should take prep or wear a condom one or the other or both.

    Posted by: josh | May 16, 2014 12:48:07 PM

  18. Buckie,

    I don't understand your comment "if you can't be bothered to use a condom every time, you are hardly going to remember to not miss any PrEP doses" at all. How does one flow from the other? Perhaps in your mind its because both show irresponsibility?

    In my estimate, they're totally different situations. The usage of a condom happens in a emotion and hormoned filled moment, sometimes further clouded by alcohol or more. Will you use it 100% of the time, who knows? HOpefully you will, but PrEP seems to provide a back-up for when you don't.

    Taking a pill every morning when you wake up, as part of your morning routine, like putting on contacts: a totally differnt set of circumstances and clear mindedness.

    I would venture to guess that taking a pill before brushing your teeth would have a much higher compliance rate than using a rubber during the heat of passion.

    Still thinking it through, but these are my initial thoughts.

    Posted by: Gerald | May 16, 2014 12:48:42 PM

  19. @Buckie, I usually don't feed the trolls but I'll state the obvious here... the CDC are the experts - their agenda is to save lives. You can rant and rave all you want, but the bottom line is you are wrong. For you others that are saying that not using a condom will spread other diseases that is another argument. PrEP has nothing to do with the other STIs. It's sole purpose is to keep people from getting HIV. It is a valuable weapon in this war and it should be welcomed. The AHF is being irresponsible by trying to prevent its usage. Apparently, the AHF's agenda is to keep AIDS thriving so they continue their fear mongering gravy train.

    Posted by: Gerry | May 16, 2014 1:23:29 PM

  20. "...anyone in this world who wants to argue that condom usage will not plummet..."

    Um, comdom usage has already plummeted. I guess you weren't aware that HIV infection rates are increasing?? DUH. Go back to your crappy blog.

    Posted by: John | May 16, 2014 1:32:38 PM

  21. The CDC does say that condoms are still always the best route. It instructs practitioners on page 47 of the report to work with their patients to encourage condom use.

    I think that AHF should say. "Sure, if you meet the guidelines for PrEP, go on it. But we're still going to go after those promoting/validating barebacking, as that constitutes the number one health risk to the Gay community, PrEP or not."

    Calling out the bareback porn studios, bareback sex commercial venues, and advocates of barebacking is not 'fear mongering'. It is a responsible position for a public health person to take. Actually, its the ONLY responsible position to take IMHO.

    Some of us that are a bit older have how this plays out.

    1) Peoplestop using condoms
    2) Idiots try to discredit those that advocate condom usage
    3) Barebacking increases
    4) STI's start to increase
    5) STI's start to mutate
    6) Public health problems develop. It might not be another HIV. But its coming, and it isn't going to be pleasant.

    I'd like to say that we can stop this from happening. But in many places, especially California, it already has. Weinstein is terrified that its going to get much, much, worse. I share his concern. I wouldn't go after PrEP, but rather the barebackers, who are placing their sexual gratification above all else including the own health and the health of their community.

    PrEP instead of a condom? No.
    Validation for bareback porn studios. No.
    Validation of bareback advocacy. No.
    Validation for condom free commercial sex venues. No.

    Posted by: Tom in Lazybrook | May 16, 2014 2:00:22 PM

  22. @TOMINLAZYBROOK - people don't like censorship. Barebacking is not evil. There are people who bareback and are STI/AIDS free. Barebacking in films doesn't encourage that behavior any more that violence in movies encourages that behavior. It's not that the people who bareback are waging an anti-condom campaign... it's the inverse. There are some pro-condom people who treat those who choose not to use condoms as evil incarnate or stupid. The "you have to use condom message" isn't working because the simple fact is that people don't like to use them. Blaming it on "the barebackers" and trying to shame people into using condoms doesn't work. It just pisses people off and they tune you out. That is what has been happening. The AHF instead of creating the barebacker boogie man should be welcoming any treatment that can prevent HIV. They should encourage Condom usage but not try to cram it down everyone's throat via laws and regulation. That is just going to backfire.

    Posted by: Mike | May 16, 2014 2:37:57 PM

  23. @ Mike

    "now Antibiotic resistant STI's are the new thing to be afraid of. Does it ever end?"

    Yes, stop having anal sex. There's plenty of other things to do in bed, that don't involve spreading feces and pathogens everywhere.

    Posted by: Pandion | May 16, 2014 2:54:30 PM

  24. Pandion, oral sex spreads STIs too. In fact, much of the uptick in syphilis is oral cases. I know very few people that advocate for condoms and dental dams for oral sex. I imagine most people posting here don't use condoms or dental dams for oral, either.

    Please note, that doesn't mean I'm advocating no condoms for anal or vaginal sex. PrEP won't prevent STIs other than HIV. But to receive PrEP, one must be tested for STIs every 3 to 6 months, a vast improvement over the typical testing patterns for folks not on the drug.

    Posted by: Jody | May 16, 2014 3:02:37 PM

  25. @PANDION - Let's just give up can get food poisoning that way... wait, don't drive a car, you could get in a car wreak, don't kiss, you could get encephalitis. I could go on and on...

    Posted by: Mike | May 16, 2014 3:03:23 PM

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