Truvada A Party Drug? HIV Prevention Gets Complicated.

 

Truvadapill

 

There is a new little blue pill in town. Just as Viagra changed the landscape of American culture there is a possibility that this new drug may be more revolutionary and depending upon where you stand that may, or may not, be a good thing. The latest blue pill to shake up America is a combination of two HIV medications into a once daily dose that is usually taken by people with HIV in conjunction with other HIV drugs to suppress the virus. Sounds good so far right?

Well Truvada is that drug and it seems to do more than just keep HIV positive people healthy. It seems to work as a pre-exposure prophylaxis. Which means that after having intercourse, either with or without protection, an HIV negative person on this medication will reduce their chance of contracting HIV. The National Institutes of Health (NIH), in a worldwide study, found a ninety percent success rate in preventing the contraction of HIV when Truvada was taken as directed, at least four times a week.

Time magazine in 2010 gave Truvada its top spot in The Top Ten Everything list for that year.

Antiretroviral drugs have turned the AIDS epidemic around, by thwarting the virus in HIV-positive patients. But new research suggests that this powerful treatment may have another benefit ? as a weapon against infection in healthy individuals. Time, The Top Ten Everything 2010

The New Yorker did a story in October of 2013, “Why Is No One On The First Treatment To Prevent HIV?” In this article The New Yorker quotes the researchers of the NIH who say the drug is capable of “reduc(ing) the risk of contracting H.I.V. by more than ninety percent.”

The article then went on to quote Michael Weinstein, the CEO of AIDS?Healthcare Foundation, the largest AIDS?organization in the world, who is completely against using Truvada this way. Mister Weinstein in the San Jose Mercury News penned an editorial where he asked, “Why would anyone willingly subject themselves to such drug therapy if they had any intention of using condoms?” More recently in USA Today, he said this about Truvada, a drug that has now shown to be 95 percent effective in preventing HIV infection when used at least four times a week, “Let’s be honest: It’s a party drug.”

A “party drug.” In the gay community “party drug” is what they call crystal meth, GHB, and Ecstasy (although they now call Ecstasy, “Molly” for some reason). Gay neighborhoods around the country have been as devastated by addiction to party drugs, especially crystal meth, as AIDS. Seeing someone die of crystal meth addiction is much like seeing someone die of HIV infection. The person fades and wastes away. Sometimes quickly, sometimes slowly, but it is always heart wrenching.

Having lost people I love to both AIDS and drug addiction I decided to contact Michael Weinstein and ask him to clarify his quote in USA Today. He was kind enough to call me and we had a long conversation. During this talk he compared Viagra to Meth and said that he did think it possible there would be a new party drug cocktail of, “Meth, Truvada, and Viagra.” He claimed that people are taking Truvada only as a, “means of having unprotected sex.” Which most studies don’t support and most long term data shows gay men intermittently use condoms.

He rightly makes the claim that Truvada wasn’t intended to be used as risk substitution. He pointed out the very real concern that there are other STDs out there that Truvada won’t protect you from. On both those points he is absolutely correct.

When I pressed him on the “party drug” reference he said that, “If that grows the conversation then so much the better.” This is a bit of a cop out. If you are going to throw a verbal bomb claim it.

Mr. Weinstein feels that Truvada has been effective, “In the context of how it’s being used in the context of HIV+ people and black women. It (Truvada) is being used as a means to have bareback sex.” Later he added, “There is a portion of gay subculture that is reckless and that end of the spectrum is dangerous to the community as a whole.” Now I assume he means Truvada has helped HIV negative African American women stay negative so I’m not sure why he thinks gay men should not be offered that same “context.”

When I mentioned some of the people who disagree with him, like gay porn director Michael Lucas, he said, “The people making a fuss are a tiny non-representation of a group.”

For now, let’s look at one of the people who represent the “tiny non-representation” group, Michael Lucas. For those who don’t know Michael Lucas is a gay porn star, producer, director, and business person. He also “came out” recently as being HIV negative and as using Truvada to enjoy bareback sex. His company, Lucas Entertainment , recently started making bareback films. So when I was looking for someone to comment on the “Truvada is a party drug” quote I immediately thought of him. Here is what he had to say:

If every HIV-negative, sexually-active gay man were taking Truvada, than we could halt the spread of this disease. But if that were to happen, Mr. Weinstein would find himself out of a job. Since he’s more interested in protecting his own interests than the health of sexually-active gay men, I hope the directors of AHF use this as an opportunity to show him the door . It is wildly irresponsible, and grossly inaccurate for him to tell the national news media that Truvada is a “party drug.” The promotion of condom use has been an undeniable, and unmitigated failure. That is why we still have 50 000 infections a year. PreP works. And if gay men literally “party” with it, than so be it. At least they are protected. Shame is not a strategy, but that’s the bitter pill Mr. Weinstein is pushing on my community. Michael Lucas

So we have two viewpoints. On the one hand I strongly agree with Michael Lucas that anything we can do to reduce the risk of infection in the gay community is a good thing. I also think that some, not all, of gay men who use Truvada specifically to engage in bareback sex, are people who normally wouldn’t use condoms anyway. Every long-term study shows that condom use in sexually active gay men is inconsistent. If Truvada can pick up the slack for when people make mistakes, then I think it is a good idea. If people just throw condoms away and never look back? Well that will lead to other health disasters so I don’t think that position works.

Michael Weinstein has some good points: Nothing works better than condoms for preventing STDs including HIV. There has not been a trial specifically done to determine if Truvada can be used for anonymous sex, meaning multiple partners, without condoms and still be effective. For example, contracting another STD can weaken your immune system and make it more likely or possible that a person could become infected.

What makes sense to most people is somewhere in the middle of the two Michaels. If Truvada can reach those “reckless” people the director of AHF seems to dismiss, and prevent them from becoming infected I think it is worth making it available to them. We’ll know soon enough if it is effective or not, and these are people who likely would have become positive anyway. Why not offer them any chance to avoid that? Mister Lucas’s position is that we are “slut shaming” people for having more sex than we are having. There may be some truth to that. But I think it is also important to note that sex addiction is a real problem and that the real purpose of Truvada should be to minimize the risk of infection and not as an “open season” license.

Truvada is going to change gay culture very soon. We need to create a realistic framework for condom use and non-condom use. Lives are at stake and just saying “No” to Truvada isn’t going to work. There is a long hard conversation that the gay community needs to have. I hope they have it before we see another generation of young people become infected.

Source: Wehoville.com, USA Today

Edited/Published by: WG