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

Condoms

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.

Comments

  1. Eugene says

    “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.

  2. Leo says

    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.

  3. Scott says

    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.

  4. Mike says

    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?

  5. pete n sfo says

    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.

  6. Eugene says

    @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.

  7. Leo says

    @ 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.

  8. Patrick says

    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.

    @Leo

    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.

  9. Gerry says

    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.

  10. says

    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.

  11. Buckie says

    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.

  12. Buckie says

    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.

  13. Buckie says

    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.

  14. WayOutWest says

    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…

  15. josh says

    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.

  16. Gerald says

    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.

  17. Gerry says

    @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.

  18. John says

    “…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.

  19. Tom in Lazybrook says

    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.

  20. Mike says

    @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.

  21. Pandion says

    @ 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.

  22. says

    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.

  23. Mike says

    @PANDION – Let’s just give up eating…you 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…

  24. Tom in Lazybrook says

    Mike

    Barebackers put their own sexual gratification above all else, including their own health, the health of their partners, and the health of the community.

    There is not one single medical doctor that I can find that says that barebacking for casual sexual relations among men is ever medically acceptable. Not one.

    Yes, people engaging in bareback sex for commercial purposes should face consequences. Including OSHA fines, demands to post bonds to insulate the taxpayers for the actuarially predictable future costs of that act, and or penalties from public health departments.

    If someone wants to film themselves engaging in bareback sex, that’s their business. If they want to do so for profit, then that is the government’s business.

  25. Douglas says

    Sean Strub, founder of POZ Magazine and director of The SERO Project made a characteristically articulate online statement about this yesterday. He said it better than I could–and my position mirrors his–so here goes:

    “There is no question but that PrEP works to prevent HIV transmission on an individual basis. But whether or not that translates into efficacy on a community-wide basis is questionable, as is whether or not PrEP will ultimately facilitate development of resistant virus. I saw the statement today signed by a large group of community organizations stating that the evidence to date shows PrEP increasing condom use–if I read their statement correctly–and while I don’t doubt there might be some such evidence somewhere, it flies in the face of what I hear anecdotally and is counter to common sense. The people I know using PrEP are doing so in order to justify not using condoms; I only know one or two who say they’re using PrEP in addition to condoms. It is clear that syphilis rates among gay men have gone up dramatically in recent years, which is a function of lessened condom use. But how much of that lessened condom use is driven by an assumption that others will utilize biomedical prevention and therefore lessens the social contract that suggests we should care about the health of our partners and seek not to transmit diseases? What has been the opportunity cost in focusing so much community and government resources, time and attention on PrEP, at the expense of other prevention strategies? How come all these organizations so devoted to promoting PrEP haven’t been so out front in promoting PEP, post-exposure prophylaxis, which is an emergency intervention? I think PrEP is a godsend for those who won’t or can’t use condoms, for sex workers (where intercourse without condoms is an economic issue) and for passive partners in relationships with abusive or insensitive partners who won’t use condoms. I think everyone should have access to PrEP if they choose to use it. But I also fear we are making a huge mistake by putting so many eggs in the PrEP prevention basket and it may very well end up causing more new HIV transmissions, indirectly, than it prevents. We just don’t know. I wish the energy put into HIV-specific prevention strategies could be replicated in trying to promote sexual health decision-making across the board, understanding that one wants to avoid hepatitis, syphilis and all sorts of other things, as well as HIV.”

  26. Scott says

    So if you are using PrEP as directed and condoms properly . PrEP with condoms & condoms alone will get you in the upper 90% as far as protection . If you use condoms without PrEP you save close to $2000 a month and don’t subject your liver or the rest of your body to drug toxicities .

  27. Scott says

    Actually Scott,

    Truvada isn’t processed by the liver, rather by the kidneys. Leaving me to arrive rather quickly that you haven’t read the CDC’s guidance and are blindly projecting your opinion.

    Like I said earlier, I’d be lying (and I’m pretty sure so would most who read Towleroad) if I said I had used a condom every time I’d had sex over the past 20 years. Sometimes it was drunk hook up sex, sometimes it was lonely. Sometimes it was within a monogamous relationship.

    The thing about PrEP is that while I’m on it now, I can stop at any time. Can’t say the same after I’m living with HIV. It’s a decision I didn’t enter into lightly, but am glad that I did.

    You’re entitled to opinions, just make sure they are grounded in reality and facts.

    Another Scott

  28. andy says

    et tu Andy? “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.”
    PUH-LEEEEZE! It’s not pure speculation. Do a little experiment. Go to your favorite hookup sites and find some guys taking PrEP. Now ask if you can bb. If any one of them says no I’ll give you a million dollars.
    As far as the iPrex study, they specifically chose volunteers WHO DIDN’T USE CONDOMS! How could their condom use be any less?

  29. says

    To assert there are data that suggest PrEP has “a limited preventative effect” is a blatant falsehood and is downright dangerous. The data are clear that this can be an effective adjuvant to preventing HIV infection. And of course it must be taken appropriately in order to be efficacious. That is an obvious fact that holds true for all medication regimens.

  30. Robert M. says

    Condoms were never intended to be the answer to preventing HIV transmission. They were merely the only effective method of the time. It is anti-gay equality to say that gay men can only have sexual relations with each other by using condoms. It makes us second class citizens and diminishes our worth as human beings to “force” us to live with a method of HIV protection that is less than it could be. Until there is a vaccine, we must move to implement any and all effective methods of prevention. PREP works. It should be used widely.

  31. Really says

    PrEP is probably good for people who are destined, by their own poor choices, which everybody makes constant excuses for, going to become infected with HIV anyway.

    If you get drunk to the point that your judgement is impaired, and have sex, use PrEP.

    If you don’t use condoms because whatever, use PrEP, because it makes a drug company happy, though you’re going to have other STI’s that require treatment and are an example of exactly why gay guys need to be really selective about who they have sex with.

    It isn’t prudish or judgmental to filter out people from your sex life that are irresponsible and self destructive.

    My only objection to PrEP is that it’s just another example of a solution in a pill for an entirely avoidable problem.

    Well, that and the fact that everybody is intentionally using PrEP to change the entire dialogue from one of being responsible to one of reliance on a drug that is NOT going to do anything in the end to reduce HIV transmission.

    It will, however, create more mutations of HIV. Funny how that works, looks like the drug companies will make a fortune regardless, because some people can be relied upon to always choose to act stupid.

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