Shaming Prevention: Is PrEP a “Risky” Approach?

Commentary by Nina Brennan

Today is World AIDS Day. This morning, Michigan Public Radio reported a rising incidence of HIV diagnoses, with approximately 800 new cases per year. Complacent and/or apathetic attitudes which spanned the last decade appear to have placed HIV/AIDS awareness and prevention to the side; but advocates are urging public discussion about the pervasive rising incidence of diagnoses, indicating there is still a battle to be fought.

In mid-November, the New York Times published a spotlight on the controversial divisiveness between proponents of Truvada, an FDA-approved (2012) pre-exposure prophylactic (PrEP) which has been shown to significantly reduce the chance of contracting HIV, and one lone (or, at least, vocal) opponent: Michael Weinstein, president of the AIDS Healthcare Foundation.

In the article, Weinstein implied the push for Truvada is financially backed by “bareback porn” executives, and lambasted the drug as a “party drug.” He did not negate the effectiveness of the drug, however, and in fact, Truvada is prescribed to “at-risk” patients by the AIDS Healthcare Foundation. Yet, he implied the drug may serve as a false panacea: allowing for a deception of security which will undermine the importance of safe sex initiatives and condom culture. Proponents of Truvada counter that the use of condoms is markedly low in the clinical trial sample, and Truvada should be used for preventative health in lieu of total absence of protection – although, their use in conjunction is preferable. Additionally, there has been a long-standing stigma associated with HIV/AIDS, and some critics, including Daniel O’Neil, a physician and LGBT health advocate who wrote in the Huffington Post, argue that the opposition to PrEP is placing yet another layer of stigma on an already heavily stigmatized community:

“The ultimate concern is not that gay men would be unable to adhere faithfully to the daily dosing regimen and otherwise use PrEP as it was intended under a health provider’s care. Rather, it is a fear that some of us — for one reason or another — simply will not do so, and that some might indeed use Truvada as a ‘party drug,’ taken like candy before crystal meth binges or indiscriminate bareback sex parties. That said, it is clear that many responsible gay men already take PrEP because they are in a serodiscordant relationship or some other ‘high-risk’ situation, know the risks associated, agree to the regular checkups and lab work, and have made a conscious decision with their provider.” Indeed, the implications that Truvada is or will be used as a fail-safe in an effort to allow for risky sexual behavior reeks heavily of the same “slut-shaming” techniques, hurdles, and indictments women faced regarding their use of oral contraceptives, or other accusations of “improper” behavior which requires the HPV vaccine. In short, the assumptions that these preventative medications and vaccines are used as alternative to safe sex, that they are gateways to promiscuity, and the judgements about the people who use responsibly use them are dangerous and derogatory.

Weinstein alleged he is not the sole opponent of “over-prescription” of Truvada, but insists other high-ranking officials are scared into silence because of the economic control that Gilead, the manufacturer of Truvada, has on the non-profit AIDS organizations. While Michael Weinstein does appear to be the strongest opponent, his opposition to its use merits an interesting debate: Are researchers and activists favoring passive prevention methods? Michael Weinstein argued the reliance on Truvada negates decades of education and awareness, and the hard work to establish condom culture. Proponents argued that the condom culture which Weinstein is lauding, is clearly not as established as he thinks.

Full text references:

http://mobile.nytimes.com/2014/11/17/upshot/aids-group-wages-lonely-fight-against-pill-to-prevent-hiv.html?emc=edit_th_20141117&nl=todaysheadlines&nlid=23238478&_r=3&abt=0002&abg=0&referrer=

http://www.huffingtonpost.com/daniel-oneill/prep-yourself-making-better-sense-of-the-pre-exposure-prophylaxis-debate_b_5203299.html

Global Study which resulted in FDA approval: http://www.niaid.nih.gov/news/QA/Pages/iPrExQA.aspx

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About Equality Research Center

The mission of the Equality Research Center is to promote, support, and disseminate research focused on Lesbian, Gay, Bisexual, and Transgender equality and human rights. The Center is dedicated to the advancement of Equality by connecting academic, evidence based research to community action, public policy, and curricular innovation.
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