Factually Deficient Screed on PrEP Harms Efforts to Prevent New Infections
BY Todd Heywood
April 29 2014 4:00 AM ET
To say Robert Brandon Sandor gets PrEP completely wrong in his Gay San Diego editorial is an understatement.
He blatantly misrepresents PrEP and the science of HIV prevention and transmission.
So, let's deconstruct his claims, and get all the facts out there.
Claim Number One:
Years of published articles and scientific reports stating that PrEP failed to gain national support are based on factual evidence; PrEP is simply not practical.
The issue of PrEP uptake, or rather the lack of uptake, has much more to do with the two things.
First, PrEP uptake is seriously hampered by public health and other medical officials who are unwilling to write PrEP scripts because the science is not strong enough, in their opinions, for its use. See my report on HIV prevention efforts in Michigan, wherein a top HIV prevention official for the state of Michigan opines, "We've had internal discussions, we've had background discussions. We're interested in the science and the outcomes," [Jane] Duframe said of the intervention that has been approved by the FDA for all high-risk groups in the US, including MSM, IVDUs and women who have HIV-positive partners. "I think it's an exciting possibility for the future."
One might also note that Gilead, to date, has done no advertising to promote Truvada for PrEP and prevention. This is a business decision by Gilead. From a New Yorker report in October of 2013: "According to Jim Rooney, Gilead’s vice-president of medical affairs, the company 'spends several million dollars' on educational initiatives related to PrEP, delivered through third-party groups, but it 'does not view PrEP as a commercial opportunity.' Truvada is already a blockbuster drug for Gilead; it earned the company more than three billion dollars in global sales in 2012."
The New Yorker report also demonstrates a clear reluctance of doctors to be "the first out of the gate" in new medical options. But that hasn't stopped Medi-Cal and the State of Washington from creating direct access to PrEP.
Second, knowledge of the intervention is ridicuously low. How low? In a 2012 public poll from the Kaiser Family Foundation, only 17 percent of respondents responded "yes" to the question: "As far as you know, can the drugs used to treat HIV be used by people who are HIV-negative to lower their risk of getting HIV, or not?"
Is there any wonder that The National AIDS Treatment Advocacy Program reports that early uptake of PrEP (those getting prescriptions for the drug) was only 1,774 people, almost half of them high risk women?
Claim Number Two:
The supporters of PrEP state the HIV-negative community is required to take PrEP daily for life, and wear condoms 100 percent of the time. Which begs one to ask the question: Is it the condom keeping you HIV-negative or PrEP?
That fringe group Project Inform certainly does not make that claim. In their booklet on PrEP, here's what they have to say about condom use and PrEP: "If you rarely — or never — use regular or female condoms for riskier sex, PrEP is still a great option to lower your risk for HIV. It won't protect you from most other STDs but it might strongly reduce your risk of HIV compared to not using it at all."
PrEP failed because it is harmful.PrEP is Truvada and according to its own website, Truvada.com, there are serious side effects: "Too much lactic acid in your blood (lactic acidosis), which is a serious medical emergency. Serious liver problems. Your liver may become large and tender, and you may develop fat in your liver. You may be more likely to get lactic acidosis or serious liver problems if you are female, very overweight (obese), or have been taking Truvada for a long time. Worsening of hepatitis B (HBV) infection. If you also have HBV and take Truvada, your hepatitus may become worse if you stop taking Truvada."
PrEP failed because there is no need to take expensive medications with harmful side effects for something HIV-negative gay youth are doing now for free.One example is the national popularity of the disease and drug free revolution. This unique, community-driven, harm-reduction, HIV prevention strategy has been accepted since it was first introduced to the public back in the mid-1990s, with the formation of the nation's first HIV-negatve safe-sex environment, called "Boy Toys — NY"; a private sex party exclusively for HIV-negative gay young men, popularly known as "HIV-UB2/Safe Sex Serosorting."