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PrEP Is Not The Problem, Perfection Is

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The Interplay is a special biweekly series exploring the intersections of sex, pop culture, and current events.

BY CHARLES PULLIAM-MOORE

Over the past few months Towleroad has extensively covered the development and deployment of pre-exposure prophylaxis (PrEP) and its use as an HIV preventative. The concept is fairly straightforward: If you’re HIV negative, you take a pill once a day that dramatically decreases your risk of contracting the virus. Like most drug treatments, PrEP is not 100% effective. Like most drug treatments, PrEP’s rate of efficacy is high enough to make it a legitimate guard against HIV infection.

12468795723_49cc5f73f7_zThere are times where explaining PrEP can feel repetitive, especially in writing. While the research and testing around newer versions of PrEP necessitate a fair amount of coverage, the core details of what the drugs do and how they work are the same. It’s easy to think that everyone understands PrEP, reads about it, and is talking about it with their doctors. It’s easy to think that Truvada opponents are overzealous fact-deniers that can’t be reasoned with. “Why bother engaging with them?”, one might ask. The thing is, though--walking away from an opportunity to talk about PrEP is almost as socially irresponsible as calling PrEP a threat to the gay community.

Figures like Zachary Quinto (most recently) and Larry Kramer (earlier this year) represent a side of the PrEP conversation that is couched in a very justifiable fear of sex. Hear me out: Regardless of who you are or how you do “it,” most every form of sex that we engage comes with a certain degree of risk. Part of being a sexually and socially responsible person is understanding that risk and making decisions with it in mind. For an entire generation of gay men, HIV/AIDS changed the way that people thought about that risk.

Experiencing a plague that spreads through sex brings the implicit danger associated with all sex acts into the sharpest relief. To that end, there’s a grain of truth to Larry Kramer’s ham-handed condemnation of today’s sexually active youth. I am a 24-year old millennial. Many of the men of my generation simply weren’t there for the initial outbreak. While the legacy of HIV/AIDS is a part of our collective cultural history, our generational relationships to it, and sex, are recognizably different. We are not so far removed from the early days of HIV/AIDS to have completely forgotten the lessons learned about safer gay sex. We are, however, primed for new, additional innovation.

CONTINUED, AFTER THE JUMP...

Continue reading "PrEP Is Not The Problem, Perfection Is" »


Zachary Quinto Responds to Controversy Surrounding His PrEP Remarks

Zachary Quinto has issued a follow-up to the response he's received from his interview in OUT magazine's OUT 100 issue where he had some stern words to say about pre-exposure prophylaxis (PrEP) and the gay community's "complacency" when it comes to the spread of HIV. 

QuintoSaid Quinto in the interview:

AIDS has lost the edge of horror it possessed when it swept through the world in the ’80s...Today’s generation sees it more as something to live with and something to be much less fearful of. And that comes with a sense of, dare I say, laziness...[On PrEP,] We need to be really vigilant and open about the fact that these drugs are not to be taken to increase our ability to have recreational sex...There’s an incredible underlying irresponsibility to that way of thinking…and we don’t yet know enough about this vein of medication to see where it’ll take us down the line.

Here's a portion of Quinto's follow-up, published over at The Huffington Post

I am a staunch advocate for the rights and well-being of the LGBT community. I have deep compassion and empathy for people living with HIV/AIDS. I am assuredly not internally homophobic or poz-phobic or willfully ignorant regarding this issue. I am a well-adjusted and well-educated gay man. I have read and understand the way PrEP works, and at least the most basic science behind its practical applications -- although I am always open to learning more. I support and encourage the amazing work done by HIV/AIDS awareness organizations -- as well as the many research and treatment organizations that exist across the country and the world. I did not intend to make generalizations about the LGBT community at large -- or people living with HIV/AIDS or people in love with someone living with HIV/AIDS.

What troubles me -- and what I was trying to speak to in my interview -- is an attitude among (some of) the younger generation of gay men -- that we can let our guard down against this still very real threat to our collective well-being. I have had numerous conversations in my travels with young gay people who see the threat of HIV as diminished to the point of near irrelevance. I have heard too many stories of young people taking PrEP as an insurance policy against their tendency toward unprotected non-monogamous sex. THAT is my only outrage.

How gay men have sex with each other was unilaterally redefined for nearly two generations as a result of AIDS. I was simply trying to assert my belief that we need to be especially vigilant and accountable to ourselves and one another at this moment in our evolution. It is a tremendous advancement in the fight against the disease that scientists have developed this particular medication. But it's still early -- that's all.

Read Quinto's full response here


Zachary Quinto Cautions Gay Community Against PrEP, HIV and 'Complacency'

Zachary Quinto is prominently featured in OUT magazine's OUT 100 issue, where he is listed with the honor of Artist of the Year.

QuintoIn one part of the profile for the issue, Quinto talks HIV and PrEP, and he has some stern words. Here is a condensed quote, via HuffPo:

AIDS has lost the edge of horror it possessed when it swept through the world in the ’80s...Today’s generation sees it more as something to live with and something to be much less fearful of. And that comes with a sense of, dare I say, laziness...[On PrEP,] We need to be really vigilant and open about the fact that these drugs are not to be taken to increase our ability to have recreational sex...There’s an incredible underlying irresponsibility to that way of thinking…and we don’t yet know enough about this vein of medication to see where it’ll take us down the line.

Check out the full text of the interview, over at OUT, where Quinto also talks Oscar Wilde and coming out. His comments might lead to some charged conversations, but as OUT points out, it's "disorienting" as well as thrilling "to hear a celebrity speak so passionately about divisive issues in the LGBT community"


Australian Obelisk Enveloped In A Giant Pink Condom to Help Promote HIV-Awareness


Screenshot 2014-11-09 20.42.45There are certain cities throughout the world that feature monuments whose construction lend themselves to...a particular kind of tourist photo. Paris, Pisa, and Washington are all homes to magnificent feats of human ingenuity whose shape tend to be co-opted for a giggle or two, and now Sydney, Australia can count itself amongst their ranks.

Last week the 157 year old obelisk located in Sydney’s Hyde Park found itself enveloped in what the AIDS Council of New South Wales (ACON) is calling  Australia’s largest condom as a part of their HIV/AIDS transmission campaign.

“ The need for gay men to ‘stay safe’ by using condoms is at the core of NSW’s strategy for eliminating HIV transmission by the end of the decade,” explained ACON’s CEO Nicolas Parkhill.

“We won’t be able to achieve this goal unless gay men use condoms when they’re having high-risk sex with casual
partners, particularly in situations where a partner’s HIV status isn’t known – it’s that simple. This installation is sure to create lots of interest as we’ve selected a very visible icon in a high traffic area. We’re hoping to turn lots of heads as well as raise a few eyebrows, not only here on the street but also on social media where the reach of the campaign will be expanded throughout NSW and beyond.”

According to Pink News the condom will remain in place for the next six days as a means of provoking conversation about safe sex policies.


Research on Injectable, Longer-Lasting PrEP Moving Forward

Studies focusing on injectible pre-exposure prophylaxis as a means of preventing the contraction of HIV is moving forward as researchers have seen higher rates of efficacy using certain drug combinations. Currently Truvada, produced by Gilead Sciences, is one of the only currently commercially available forms PrEP. The pill must be taken daily in order to be effective, and is actually a combination of the two antiretroviral drugs tenofovir and emtricitabine.

Screenshot 2014-11-07 12.24.50The results of testing trials presented earlier this year showed that the drug cabotegravir proved to be effective as remaining within the bloodstream and preventing HIV infection. Two doses of the drug, then known as GSK744LA, prevented all eight of the test subjects provided with doses from contracting HIV, while the control group not given the drug all became infected. Following the success of initial simian test groups, researchers are proceeding with human efficacy test trials.

The potential benefits to using integrase inhibitors like cabotegravir could be significant in the advancement of PrEP use. Unlike Truvada, cabotegavir proved to be effective being taken much less frequently.Opponents of Truvada often cite the need for a constant, regular dosage as a reason not to advertise he drug as the end all be all protection from HIV infection.  An 800mg dosage of the drug injected into the soft tissue remained in the bloodstream for up to 12 weeks, meaning that future iterations of PrEP would only need to be taken quarterly.

While cabotegavir has shown promise rilpivirine, another HIV drug being tested that has been shown to have much lower side effects in those taking it, was shown to have lost its efficacy after about 18-21 days.


Major HIV News: 'On-Demand' PrEP Study Appears Successful

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In major news in the fight against HIV, a second European study has concluded the "randomized" phase of its examination of the efficacy of pre-exposure prophylaxis (PrEP) due to the drug's high effectiveness at preventing HIV infection. All participants in this latest study--IPERGAY--including those who were previously receiving a placebo medication have now been given PrEP. What is perhaps most stunning about the new findings is that evidence seems to suggest that PrEP is effective not only when taken daily but when taken "on-demand", in other words, when sex is anticipated. AIDS Map reports:

6a00d8341c730253ef01a511e381fe970c-300wiThe investigators of the IPERGAY trial, which has six sites in France and one in Canada, announced today a “Significant breakthrough in the fight against HIV and AIDS” because IPERGAY had successfully demonstrated the effectiveness of its PrEP regimen.

IPERGAY’s early closure is significant not only because it adds confirmation that PrEP can be highly effective, but because it was testing an innovative, intermittent (“on-demand”) PrEP regimen. In this study, participants did not take PrEP daily, but only when they anticipated having sex. The regimen involved taking two pills of Truvada (tenofovir + emtricitabine) in the 24-hour period before anticipated sex and then, if sex happened, two separate one-pill doses in the two days following sex. This extends the versatility of PrEP and provides an alternative regimen to daily dosing.

The results from the IPERGAY trial mirrors those of a recent British trial, PROUD, which concluded its first phase early as well. The reports from both trials are still preliminary, however:

As with PROUD, no actual effectiveness figure or other quantitative data [from IPERGAY] were released, pending full analysis of the figures. The full results should be available early in 2015.

The trial will continue in non-randomised form for at least a year, as will PROUD, because of the need to demonstrate that “on demand” PrEP can have long-term benefit and to gather data on safety.

Principal investigator Professor Jean-Michel Molina said, "The biomedical concept of on-demand PrEP at the time of sexual exposure, in a broader prevention framework, is validated. We owe this to all trial volunteers without whom we could never have achieved these results". He adds that “condoms remain the cornerstone of HIV prevention. Combining all prevention tools that have proved to be effective will certainly allow us to better control the HIV epidemic.”

Professor Jean-François Delfraissy, Director of ANRS, commented, "This is a major breakthrough in the fight against HIV. The results of the ANRS IPERGAY trial should change national and international recommendations for HIV prevention".


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