(JOEL SAGET/AFP/GettyImages)

When the HIV drug Truvada was found to prevent infection in healthy people, it was lauded by public health experts as a way to protect those in high-risk groups, such as young gay men. But the drug hasn’t caught on in the gay community as fast as expected. Some critics of the drug say it may actually promote reckless behavior by reducing condom use.

Guests:
Jeff Sheehy, patient advocate HIV/AIDS and board member of the California Institute of Regenerative Medicine
Whitney Engeran, senior director of public health for the AIDS Healthcare Foundation, the largest provider of HIV/AIDS medical care in the U.S.
Oliver Bacon, attending physician, UCSF Division of HIV/AIDS; co-investigator on Demo Project
Dominika Seidman, Ob/Gyn at UCSF/SF General Hospital's Bay Area Perinatal AIDS center

  • Guest

    It sounds like Truvada is to sex what party buses are to drunkenness: An excuse for stupid risk taking, with repercussions.

    • Benjamin Patterson

      And we all know that people should not be having sex… it’s very dirty and unseemly

      • Bob Fry

        Who said that? But when a group’s behavior causes an epidemic, it becomes society’s right and responsibility to point that out and take measures to slow or stop the epidemic: drug research, behavioral changes via campaigns and shutting down gay bathhouses, needle exchange, and, yes, gay marriage in the hopes of more long-lasting relationships.

        • Honeymaid

          Maybe not everybody wants to be assimilated and forced into heteronormativity? Accept differences maybe?

          • thucy

            Honeymaid,
            I fully support your rejection of heteronorms, I simply question Gilead’s product and Gilead’s influence on the medical community.

          • Bob Fry

            And maybe society doesn’t want to be put at risk and financially support the voluntary choices of others.

          • Jason Orion

            We as a country spend billions of dollars on healthcare for smokers and people who love good food and end up with diabetes. That is ridiculous. We all put into the pot and should receive care regardless. We generally don’t have kids and yet pay taxes to support schools. It is societal responsibility.

    • Honeymaid

      Nice slut shaming.

  • Guest

    I am against Truvada use as PreP. Why? Because I’m HIV positive and take Truvada & Isentress everyday. I never imagined becoming positive in my 40’s after a life of safer sex. Thankfully my meds are paid for…there’re very expensive, $22K/year! Perhaps anyone considering using the pills to have unprotected sex, could have safe sex and donate the medication to those in need! This was a huge mistake to sell this as a prophylaxis!

    • Benjamin Patterson

      Jon, I’m surprised to hear you sound so judgmental of other people’s sex lives. Truvada is prescribed as a prophylaxis because there’s scientific evidence showing that it works. It will prevent new HIV infections when taken regularly. Unprotected sex is already happening. Guilt-tripping people about not using condoms often enough has proved to be a miserable failure. The proof is people are still getting infected — and sometimes even when they believe they’re practicing safer sex.

      I find your scarcity mentality argument a bit dubious. Other people getting a prescription for Prep does not necessarily mean other people who take Truvada for HIV treatment will be deprived.

      • Guest

        My comment was in no way to ‘guilt-trip’ or ‘slut-shame’ anyone concerning their sexual behavior. My point is, 1)Truvada used as a PrEP in the correct way may prevent HIV, however it is not preventative for any other sexually transmitted diseases, 2)10’s of thousands of people are positive and need care now, and 3)Gilead was irresponsible to market this drug in a way that is easily misunderstood! The forum discussion was very helpful! I do agree with it’s use in some instances mentioned in the forum.

        • red_donn

          Though it may not prevent other diseases, the prevention of the worst STD known to date should not be dismissed because there are other, more comprehensive methods to being safe. Responsible heterosexual couples very often utilize multiple forms of birth control simultaneously, to reduce the risk of pregnancy.
          There is no reason to think that condoms and Truvada exist in an either-or dynamic, which appears to be the ongoing argument leveled against the drug in the comments. I find it singularly unfortunate that the concerns raised are not “proper use, messaging, and awareness” but instead “refrain entirely from one of the two proven methods of preventing HIV.”

  • How does the AHF feel about the petition that asks for Michael Weinstein’s removal as a result of his Party Drug Comment and unwillingness to participate in dialogue with other organizations to find common ground and move forward together in offering accurate information free of stigma and discrimination? https://www.change.org/petitions/ahf-remove-weinstein#

  • Why does Weinstein call HIV PrEP a “Party Drug” as he called Viagra the same in 2007? How are those two medications related?

  • Does the AHF plan a campaign to educate people on the effects of actual “Party Drugs” to not highlight the importance of informing the public of the risks of actual drugs like cocaine, meth, heroine, GHB etc?

  • Do you think that condoms offer 100% protection from all STI at all times? Can STIs like gonorrhea and chlamydia be contracted by a person through contact not involving vaginal/anal intercourse?

    • johnqeniac

      I’d just like you to go on record as asserting that sex with a stranger who you have no idea what STDs he or she might have, is ‘safe sex’ as long as you’re on truvada. Thanks.

  • How do you, Whitney Engeran, think we will prevent 50000 seroconversions per year in the US?

  • People that ask about PrEP in AHF clinics have been repeatedly shunned and misinformed – how does the AHF plan to change this and how will the public be informed about PrEP in the future?

  • Is the AHF planning an Anti-PrEP campaign in Europe as the PROUD study is bringing forward very promising data, even in its early stages?

  • Not thinking of the LGBT community – where else is HIV PrEP useful?

    • Hello Eric – Great question! Please see the links above to the BAPAC (Bay Area Perinatal AIDS Center) program with information for HIV+ male/HIV- female couples their reproductive and sexual health, including PrEP for conception.

      • thucy

        Shannon,
        If overprescription/overuse of Truvada leads to greater viral resistance, then of what use will Truvada be in the perinatal AIDS Center?

        • Thucy, this is actually only a potential option and not proven. A potential resistance would in this case not only occur in HIV- but also in HIV+ people – a resistance can only be developed when the medication is not administered properly. hence it is all the more important to educate people on how to take it properly – like antibiotics.

          • @ericpaulleue:disqus @thuck:disqus: people who take Truvada run the risk of developing drug resistance if they are infected with HIV and continue to take PrEP, or they take PrEP inconsistently and become infected. That’s why monitoring with frequent HIV testing and doctor visits is really important. Also there are other drugs, like maraviroc, that they’re studying to see if there are other potential PrEP options for people to take.

          • @megancanon:disqus @thuck:disqus – If they take their pill once a day, an HIV transmission with a drug-blood level of 90% is prevented with 99% efficacy on Truvada. This is about educating people, checking drug levels and making sure the person is HIV- before commencing PrEP. It’s exactly what I asked AHF to support and they said No. The studies about other HIV PrEP medications are all promising, as well as monthly/quarterly injections/vaccines. Opposing dialogue and insulting peoples intelligence by calling it “a party drug” underlines that Weinstein is unfit to lead the AHF.

          • thucy

            I agree that Weinstein calling Truvada a “party drug” was irresponsible, at best.
            It would have been much more accurate to describe it as a “poison pill” – something that promises to make you well, but which in reality, and in the words of its own maker, Gilead Sciences, has the potential to create greater viral resistance. In effect, a soi-disant “preventive cure” that will build a stronger virus.

          • johnqeniac

            Define ‘party drug’. Thanks

          • thucy

            Eric,
            You make a fair point, but one need only look at hospital admissions for MRSA infections to understand that antibiotics have been overprescribed and taken incompletely to the point that we now have a very, very significant problem with antiobiotic resistance.
            If a population that cannot practice safe sex properly (and I include the vast majority of straight people under that banner) moves to Truvada, how well will they adhere to the once-daily Truvada regimen?
            Answer: they won’t, and despite the financial gain for Gilead, we’ll simply end up with a stronger HIV virus.

      • thucy

        Hi Shannon,
        Why is it that neither you nor Eric have acknowledged AHF’s key legal victory in forcing the FDA to turn over documents showing collusion between the FDA and Gilead Sciences?

        http://www.businesswire.com/news/home/20130807006114/en/AHF%C2%A0Wins-Major-Ruling-FDA-Gilead-Prevention-Pill#.U1AyfmS9LTo

  • Nasir

    People should welcome any prevention from any dısease. and stıll before thıs many dont stıck to safe sex

  • Sam Bartos

    My friend and I in New York started a HIV/AIDS awareness campaign centered around raising awareness of Truvada and trying to encourage it’s PreP use to end the spread of HIV/AIDS

  • thucy

    It’s too easy to be judgmental about higher levels of sexual activity among gay men. The reality is that men (gay and straight) have higher sex drives, and that without the “generally” moderating influence of a female partners, men are likely to have more sex and take on more sexual partners.
    But taking Truvada prophylactically sounds risky at best; what are the (known) side effects for the patient? More urgently: as with all the “wonderful” drugs foisted upon us by PhRMA, what is the cumulative effect of all these meds exiting human systems and ending up in the bay? There are already studies showing that vast amounts of Prozac being flushed into the waters are harming marine life.
    http://www.uottawa.ca/media/media-release-2800.html

    My criticism isn’t of gay men, but of the human folly of ignoring that our appetites (gustatory, sexual and consumerist) are killing the planet. As Lou Reed wrote, “I wish I hadn’t wasted all my time… on so much human and so much less divine.”

  • thucy

    NY Times on Truvada and resistance:

    “Already, though, there are reports that the drug is being prescribed to men who may not fit these criteria. Little is known about how consistently they are taking it. And that raises a big worry: viral resistance.
    Although Truvada alone can prevent an H.I.V. infection, it cannot control one that has already taken hold. If an H.I.V.-positive patient were to take Truvada alone, or if a user were to become infected while taking it, the H.I.V. strains they carry could become drug-resistant. The infection would be hard to treat, and it could spread to other people.
    To prevent drug resistance, people who want to use Truvada for prevention first would have to make sure they were H.I.V.-negative and then be retested regularly, every few months, because it is possible, though unlikely, to become infected while taking the drug. But experts testifying before the panel on Thursday acknowledged that there is no way to ensure that people taking the drug receive frequent H.I.V. tests.
    Then there is the question of adherence. Skipping doses or using Truvada on occasion, as if it were a party drug, would invite both infection and the emergence of drug-resistant strains. But research shows that people are not good at sticking to the required daily regimen. In one major study, only 10 percent of the participants took Truvada as directed.”

  • Cheryl

    I have many friends in the LGBT community and I’ve heard how very difficult it is to get a prescription for this life saving drug. One friend had to threaten his doctor with the possibility of a lawsuit if he were to come down with HIV in order to get his doctor to prescribe it for him. I had no idea this drug even existed until a friend told me about it. Why are doctors not discussing this with their patients? It’s this concept that it will encourage risky behavior that is keeping these important discussions from happening with their patients. And it reminds me of the birth control pill discussions in the 70s or the Plan B discussions in the 90s. Stop being judgmental and making assumptions of how I am going to behave when taking a specific drug and save my life instead. Is not that what doctors are supposed to be doing?

    • thucy

      Cheryl,
      the comparison to birth control isn’t valid – there’s no risk of developing viral resistance to HIV with ortho-tricyclics.

      • Cheryl

        That’s not what is being debated. I’m not arguing that point. Per the pre-show summary above, the argument is that “Some critics of the drug say it may actually promote reckless behavior by reducing condom use.” That’s it. Reckless behavior was the only thing mentioned. My point stands.

        • thucy

          Whether your point stands is probably irrelevant to the fact that Gilead itself acknowledges that its product, Truvada, has the potential to create greater viral resistance.

          That is the elephant in the room and the fact that it was only briefly discussed on-air raises some interesting questions about the relationship of two of the guests to Gilead Sciences.

    • Cheryl – Many are sharing their experiences accessing and taking PrEP on this blog: http://myprepexperience.blogspot.com/ This blog has also helped folks with accessing care and reimbursement.

  • Chemist150

    While I’m on the side of letting people use it, it should be used with other protection and not used alone for “safe” sex.

    Not being an expert in HIV, my concern would be specific transmission of drug resistant virus. Someone who is positive and on medication may have higher levels of resistant virus that might make transmission more likely despite the use of Truvada. That is a double threat to the newly infected. Hopefully, the resistant strain is a high energy mutation that is not selected for in wild type. But the resistant strain may be the pathway to infection.

  • Ethan

    AHF is involved in a concerted campaign of misinformation, ignoring the results of extensive research on PrEP.

    For instance, these results show there is not risk compensation based on use of PrEP.

    “Belief in receiving FTC/TDF was not associated with an increase in receptive anal intercourse with no condom (ncRAI) from baseline through follow-up…”

    “There was no evidence of sexual risk compensation in iPrEx. Participants believing they were receiving FTC/TDF had more partners prior to initiating drug, suggesting that risk behavior was not a consequence of PrEP use.”

    http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0081997

  • MoistPup

    I know plenty of smart people who have started taking PrEP, and have stopped using condoms because they believe PrEP is enough of a shield against HIV. These are people I know that practiced safe sex with condoms, but now feel they don’t need to use condoms anymore. The studies which show “condom usage doesn’t change when people are on PrEP” undoubtedly were using a placebo group, something that participants would be aware of (the possibility they were on a Placebo.) I can only imagine how knowing 100% for certain you are on PrEP vs. the uncertainty of a study with a control group (in which you are informed you are possibly on a placebo) results in different outcomes for condom usage.

    • Ethan

      This study looked at the difference between people who believe they are on Truvada versus the placebo. http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0081997

      • MoistPup

        There is a HUGE difference between believing and knowing you are on a drug when it comes to the possibility of contracting a potentially terminal illness.

        • Honeymaid

          Belief and Know are different in hindsight or with more information but essentially the same. Many people “KNOW” there is a God, when in reality that is only a belief, but the actions taken on belief/knowledge are effectively the same. Or do you not understand how the double blind studies are made?

          • MoistPup

            I understand. I have my degree in psychology thanks, which included how to run experiments, and understanding things like confounding factors. The difference between belief, and knowing, in something as serious as potentially getting HIV is a pretty big gap if you ask me, and definitely a confounding factor. In your example the difference between believing and knowing there is a God doesn’t matter: the outcome is the same either way for the believer and the knower.

            ON the other hand, with a Truvada study where you told beforehand that you MIGHT be on a placebo, you might BELIEVE you are Truvada, but is that belief the same thing as the certainty of KNOWING you are on Truvada? Especially when the consequence of being wrong is potentially cutting 20 years off your life, costly daily drug regimens, and an end of life that is fraught with frequent illnesses (over the last few years as your immune system finally fails.)

  • Astrid Vogel

    Sometimes I don’t have a choice about the condom. PeEP allows me to protect myself.

    • thucy

      But for how long? And if Truvada, as its maker warns, has the potential to create greater viral resistance, then is it really allowing you to “protect yourself”?

  • Martin E. Glass

    The “elephant in the room” I rarely hear acknowledged in the PrEP debate for gay men is that, absent of sexually transmitted diseases, virtually nobody would use a condom. Let’s face it. Condoms do NOT enhance sex. I have straight friends who have experienced accidental pregnancy and it is greeted with a shrug. Straight people have condomless sex all the time and there is never such “slut-shaming” of straight people as there is of gay men who have condomless sex. In the anti-PrEP debate, there seems to be an attitude that gay men deserve to have to wear condoms. With PrEP, it is an out-dated attitude from an era when condoms were the only protection against HIV.

    • thucy

      The real elephant in the room is the potential for Truvada to create greater viral resistance. That’s not being discussed. Why?

      • Martin E. Glass

        Linky-lou to the studies that show this potential for creating greater viral resistance?

        • thucy

          What is linky-lou?
          Studies aee being undertaken, as the guest discussed. The issue has been raised by the NYT:
          NY Times on Truvada and resistance:

          “Already, though, there are reports that the drug is being prescribed to men who may not fit these criteria. Little is known about how consistently they are taking it. And that raises a big worry: viral resistance.
          Although Truvada alone can prevent an H.I.V. infection, it cannot control one that has already taken hold. If an H.I.V.-positive patient were to take Truvada alone, or if a user were to become infected while taking it, the H.I.V. strains they carry could become drug-resistant. The infection would be hard to treat, and it could spread to other people.
          To prevent drug resistance, people who want to use Truvada for prevention first would have to make sure they were H.I.V.-negative and then be retested regularly, every few months, because it is possible, though unlikely, to become infected while taking the drug. But experts testifying before the panel on Thursday acknowledged that there is no way to ensure that people taking the drug receive frequent H.I.V. tests.
          Then there is the question of adherence. Skipping doses or using Truvada on occasion, as if it were a party drug, would invite both infection and the emergence of drug-resistant strains. But research shows that people are not good at sticking to the required daily regimen. In one major study, only 10 percent of the participants took Truvada as directed.”

          • red_donn

            The NYT is not, in any sense, a reliable source for scientific news, based on the quality of their “analysis” offered in articles pertaining to nutrition and exercise. I’ve read more than my share of scientific journals on those topics, and consistently found that the NYT science section has no comprehension of how to investigate claims or concerns – they simply spit back whatever they were told by some source and throw in a dash of Grandma’s truisms.
            Considering that Truvada has been used on HIV positive populations for years now, with no evidence being produced of these mutations. What is the point of concern then? That someone who becomes infected while on Truvada will produce an altogether new strain? Let’s be precise with our concerns, rather than suggesting that any drug leads to a new supervirus – since the concerns raised so far could be applied to any drug for any infection.
            Furthermore, let’s address the statement that there is no way to make sure people get HIV tested. There are many drugs which doctors will not prescribe without certain preconditions – if there is real evidence that mutation is a risk this could be put in place.

      • Phoenix

        Martin, I fully agree with you. Nobody is discussing the fact that, ultimately, nobody wants to wear condoms. It decreases the enjoyment of the experience and takes some of the joy and closeness out of sex. Bareback sex is hotter. A growing number of people simply refuse to wear condoms, given that HIV is no longer considered the death sentence it used to be and the consequences of contracting a different STD are considered much less severe, and more manageable. Why is nobody discussing the reality that people are already having condomless sex. They always have, and they always will. The condom campaign has failed.

  • Andrew Coile

    Why does AHF assume that people will be on Truvada erratically? They keep harping on how it has to be taken daily….okay, so I take it with my cholesterol pill. Is there actual data that people are doing the start-stop, or is just a fear tactic on AHF’s part?

    • thucy

      Have you ever had to monitor patient drug adherence? Even the most disciplined patients don’t adhere to regimens 100%.

      • Andrew Coile

        But it’s been pointed out that adherence rates in a double-blind study where you don’t even know if you are getting the drug are a lot lower than if you *know* you have the drug, and the advantages it provides. Plus, Truvada lasts 72 hours at therapeutic levels, so missing one day is not catastrophic. I just don’t get why AHF is claiming that Truvada provides _no_ benefit, because they assume _no one_ takes it regularly. That seems like quite a stretch without real-world data from doctors on adherence levels.

        • thucy

          I can’t speak for AHF, but I do think that in the real world, imperfect adherence is not going to look like “missing one day.” And that non-adherence will, as Gilead warns, lead to greater viral resistance.
          Which will be great for Gilead, because then they’ll have to develop and market a new drug. And the whole cycle can continue… and it’s not as if Gilead itself didn’t warn you. Sigh.

          I’m sorry, but working at UCSF made me profoundly skeptical about the relationships between pharmaceutical companies and the medical community. Bear in mind that health care in the US is a for-profit system. And that means that much of what even UCSF touts as “safe” is anything but.
          Ask hard questions. Hold these people accountable. Not just for yourself, but for the larger group.

  • Michael

    HIV is not just a sexually-transmitted disease. It is also an occupational hazard for healthcare providers. I have been a physician for 11 years, and I have been stuck with a hollow-bore needle used on an HIV positive patient twice. Both times it has caused me considerable distress, but fortunately I did not acquire the disease. I have been stuck by non-HIV needles on several other occasions. I wonder if PrEP may be useful for healthcare workers at risk of acquiring the disease through needle-sticks?

    • thucy

      You really think the risk is great enough to force your staff to take a new drug every day? Get a grip, doc, please.
      Isn’t it strange that a doctor doesn’t acknowledge post-exposure anti-virals for just that sort of exposure?

      • Thucy, I agree with Michael – but remember this is about giving people the option and knowledge not to force them. We are not Weinstein, we are not dogmatizing people to do as we say, we want to make options and accurate information free of stigma and discrimination available. #removeWeinstein https://www.change.org/petitions/ahf-remove-weinstein#

        • thucy

          Eric,
          What astounds me is that you seem to be more agitated by Weinstein’s lack of political correct language than by what AHF’s legal victory against the FDA re collusion with Gilead means in terms of the drug’s safety.

          http://www.businesswire.com/news/home/20130807006114/en/AHF%C2%A0Wins-Major-Ruling-FDA-Gilead-Prevention-Pill#.U1AyfmS9LTo

          • Honeymaid

            Nice Ad Hominem attack, @thucy.

          • thucy

            How is that, in any way, an ad hominem attack? If anything, Eric’s attacks on Weinstein are ad hominem, while ignoring the substance of his legal victory re: FDA collusion with Gilead on Truvada.

          • “So, I don’t know Michael Weinstein personally and have never had any professional interactions with him, so I am going to refrain from making any personal comments. However, I can say that his statements seem to ignore reams of new data on prevention, not just PrEP. I cannot fathom why he would say that condoms are the “best way” to prevent HIV, when, AS A PUBLIC HEALTH MEASURE, they are only about 70-80% effective, max (and that’s old data in heterosexuals).

            PrEP is not an issue of “this OR that;” it’s one of “this AND that.” We should be using every tool we have to prevent new infections and fight stigma, especially ones that take the decision about prevention out of the “heat of the moment” and allow people to take precautions when they are ostensibly thinking more clearly.

            It is also clear that PrEP is not for everyone. Some people don’t need it, and others are just bad candidates. Poor adherence carries potential public health risks in the form of resistance, so close follow up with frequent testing is essential if we are going to be able to keep using Truvada in the future. I urge everyone who is on it or thinking about being on it to get fully educated and get the appropriate follow up. Contrary to what Weinstein is suggesting, PrEP should INCREASE personal responsibility, not decrease it.

            David Holland, MD, MHS
            Division of Infectious Diseases and International Health
            Duke University School of Medicine”

  • pdjmoo

    Sex is getting very expensive. Perhaps it is time to restrain our sensual appetites a little.
    But what I wish to address is the billions of dollars BigPharma is generating from this. They will cry the cost of research, but this could be offset by all their other $trillions being made (imagine their goldmine from the Affordable Care Act). I think the cost of these lifesaving HIV drugs is outrageous and the drug industry should be called to account for capitalizing on HIV worldwide. Seems capitalism is well at work here, but it must be addressed, particularly as the cost is coming out of taxpayer pockets through Medicare, Medicaid.

    • Honeymaid

      That’s big pharma as a whole and is hardly restrained to only antiretrovirals… but I have to agree, the way we treat instead of cure/prevent is silly, we need more drugs like Truvada, prevention and cures, not palliatives.

  • Jay

    One of the biggest failures of HIV prevention has been the lack of technological advances beyond the condom. If in fact, as the studies show, daily Truvada use is at a minimum, as effective as condom use, then we finally do have something beyond the condom in our prevention toolkit.
    We need to change our language around protection and risk in this context. For HIV prevention, sex while on PrEP is just as protected as sex while using a condom is.

    • thucy

      Except… we don’t really understand the long-term effects of Truvada, including its potential for creating greater viral resistance.
      Condoms aren’t perfect, either, but they don’t have to risks of Truvada.

      • Honeymaid

        However we still have 50 THOUSAND seroconversions a year on condoms alone and ACTUALLY WE DO know the risks of truvada considering it’s been in use for HIV+ people for many years.

        • thucy

          I agree that condoms are not enough, however, that doesn’t mean we understand the long-term effects of Truvada. “Many years” usage does not really tell us that much.

          • Honeymaid

            Uh, yeah, many years == long term, actually.

          • thucy

            No, that’s medium-term, at best. Long-term looks at effects a decade later and longer.
            Look, I know it’s an emotional subject, it should be. But don’t go running into the arms of Gilead before asking some tough questions about this drug’s approval and its long-term effects.

          • @thucy: Truvada has been used to treat HIV-positive people since 2004 so we have significant data on the safety of Truvada for HIV-positive people and it’s deemed safe for long-term use. While long-term side effects on HIV-negative people are unknown, if someone is concerned about it, then they don’t have to take it.

          • thucy

            But Megan, if Truvada is creating greater viral resistance, then it is going to affect even those who don’t use it. Gilead is merely building a stronger virus.

          • Jay

            You keep talking about resistance, but there is no evidence for it at this point. If someone were to seroconvert while on Truvada, the possibility exists, but there’s no documentation at this point.

  • Honeymaid

    Graham from Phoenix, AZ here:

    Engeran’s response to my question COMPLETELY ignored the fact that condoms alone still result in 50k seroconversions a year.

    • Jon Gold

      Hello, I couldn’t find another way to reply to your ‘slut shaming’ claim. I’m sorry you misunderstood me. I posted a new comment to Benjamin with my perspective.

  • Jonathan Van Nuys

    Thank you for discussing PrEP and having such thoughtful guests like Dominkia Seidman, MD and Oliver Bacon, MD to dispel some of the myths around this prevention tool. As a Nurse Practitioner who is the primary clinician and prescriber on the CRUSH project at East Bay AIDS Center, a PrEP demo project and sexual health services clinic for youth in the East Bay, I have many young patients who feel that PrEP allows them intimacy without fear and empowers them to take care of and talk about their sexual health. I have youth who are HIV negative with HIV + partners who see PrEP as a way to have greater intimacy with their partners. I have youth who use PrEP alongside condoms as a prevention tool to take care of their sexual health at increased times of risk and I have youth who chose not to take PrEP, who decide other prevention strategies work for them. As Dr. Bacon said, it is not an either/or equation, but another effective tool we have to prevent HIV transmission. Let me also please remind you and some of your guests to stop using Physician and Dr. As a proxy for Primary Care Provider. I am probably currently one of the primary PrEP prescribers in the East Bay and just one of many patient centered, educated and competent Nurse Practitioners working as a primary care provider in HIV and in primary care in general. Thank you to Oliver Bacon, MD for being conscious about using the the term primary care provider.

    • Jonathan – Thank you for your good work. If someone wants more info about PrEP and lives in the East Bay, how can they be in touch with you?

      • Jonathan Van Nuys

        They can contact me directly at jonathan.vannuys@ucsf.edu
        or, if interested in enrolling in CRUSH–whether for sexual health services, STI tx and dx, PrEP, PEP or HIV primary care–they can also call the CRUSH (Connecting Resources for Urban Sexual Health) line at 510-863-0021

  • thucy

    From The New Yorker Magazine:

    “The medical community’s reluctance to prescribe Truvada—and patients’ reluctance to request it—also stems from a bitter fight over the treatment. Critics have questioned PrEP’s safety, efficacy, and cost, and have accused the government of colluding with the drug manufacturer at the expense of public health. Regan Hofmann, the former editor-in-chief of Poz, a magazine for people living with AIDS, called PrEP a “profit-driven sex toy for rich Westerners.” Michael Weinstein, the head of the AIDS Healthcare Foundation (A.H.F.), the world’s largest AIDS organization and the primary-care provider for more than two hundred thousand patients around the world, predicted a public-health catastrophe. “The applause for this approach shows just how disposable we consider the lives of gay men,” he wrote. When I interviewed Weinstein, he claimed the studies were “rigged” and that PrEP was essentially a plot by Gilead to force young people into buying unnecessary medication, and that it was going badly because A.H.F. wasn’t letting the company get away with it.”

  • thucy

    Is it true that one of Truvada’s proponents as PrEP, the AIDS Foundation of Chicago, led by Jim Pickett, is heavily funded by Gilead, the maker of this drug?
    Is it also true that AHF just won a court case forcing Gilead to turn over correspondence indicating that the FDA and Gilead skewed testing results for Truvada as PrEP?

  • thucy

    I missed the first half hour of the program. Was the AHF court case (which they won) against the FDA re Truvada approval discussed?

    http://www.businesswire.com/news/home/20130807006114/en/AHF%C2%A0Wins-Major-Ruling-FDA-Gilead-Prevention-Pill#.U1AyfmS9LTo

    WASHINGTON–(BUSINESS WIRE)–AIDS Healthcare Foundation (AHF) won a key legal victory today in a push for drug safety as well as increased government transparency when a federal court ruled that the Food and Drug Administration (FDA) illegally blocked Freedom of Information Act (FOIA) requests tendered by AHF regarding correspondence between the FDA and Gilead Sciences. The description of the documents in the court ruling also implies collusion, suggesting the FDA worked with Gilead on what to say to get their unfavorable drug trial results spun in such a way that the FDA deemed them sufficient to approve the drug for expanded use of Truvada as an HIV prevention pill for pre-exposure prophylaxis (PrEP) in uninfected individuals.

  • Troy

    PreP is a weapon in the tool box of fighting HIV transmission. I think it is irresponsible of service organization to stigmatize something that could help reduce HIV rates ALONG WITH reducing community viral load, risk counseling, condom use, and any other method that has a proven effect. It’s an all of the above strategy! I have followed this very closely over the last couple years and I have never heard any proponent of PreP say it is the magic bullet.

  • Please see medical commentary below, and you may also want to see the below video at 11:30min https://www.youtube.com/watch?v=9Zp5F1lelt8

    “So, I don’t know Michael Weinstein personally and have never had any professional interactions with him, so I am going to refrain from making any personal comments. However, I can say that his statements seem to ignore reams of new data on prevention, not just PrEP. I cannot fathom why he would say that condoms are the “best way” to prevent HIV, when, AS A PUBLIC HEALTH MEASURE, they are only about 70-80% effective, max (and that’s old data in heterosexuals).

    PrEP is not an issue of “this OR that;” it’s one of “this AND that.” We should be using every tool we have to prevent new infections and fight stigma, especially ones that take the decision about prevention out of the “heat of the moment” and allow people to take precautions when they are ostensibly thinking more clearly.

    It is also clear that PrEP is not for everyone. Some people don’t need it, and others are just bad candidates. Poor adherence carries potential public health risks in the form of resistance, so close follow up with frequent testing is essential if we are going to be able to keep using Truvada in the future. I urge everyone who is on it or thinking about being on it to get fully educated and get the appropriate follow up. Contrary to what Weinstein is suggesting, PrEP should INCREASE personal responsibility, not decrease it.

    David Holland, MD, MHS
    Division of Infectious Diseases and International Health
    Duke University School of Medicine”

  • Eddie Hamilton

    This petition now has jeopardized the use of PrEP. With all of the screaming back and forth, you have now elevated this drug to the national radar and you now run the likely risk that Congress will decertify this drug being paid for under the ACA and Medicaid unless a person is already positive in a position similar to benZos and Viagra.Also, if this drug is so good, redirect all of the CDCs prevention funding to PrEP. That won’t happen because it’s all about the money. If this much energy and dramatic resources were devoted to lower drug prices , we all would have been better off!

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