Gay men divided over use of HIV prevention drug
Weinstein, the AIDS Healthcare Foundation leader, takes heart from the low usage figures, saying they bear out his reservations about Truvada. He says he's undeterred by criticism of his insistence that condomless sex — even in the Truvada era — should be discouraged among gay men with multiple partners.
"There's an element in the gay community that espouses 'anything goes,' that is for sexual freedom and not giving an inch," he said. "But demonizing me or AHF isn't going to shut us up."
Another Truvada skeptic is Richard Weinmeyer, a research associate with the American Medical Association's Ethics Group. In an article in February in Bioethics Forum, Weinmeyer — expressing his personal views — argued that preventive use of Truvada could encourage sexual irresponsibility.
"Personal responsibility for one's actions has simply been thrown out the window in a community in which we are too often concerned about stigma and moral judgment," he wrote. "We dare not speak against the reckless behavior of others because we wring our hands over the omnipresent worry that we will shame one another."
The article drew some harsh online criticism; readers called it "puritanical" and "fear-mongering." But Weinmeyer raised a topic that's a visceral part of the debate — the concept of gay-on-gay "shaming" in which men using Truvada as PrEP are stigmatized.
New York psychotherapist Damon Jacobs, an enthusiastic Truvada user since 2011, has encountered the shaming syndrome as he encourages more gay men to learn about the drug's preventive capabilities. Since co-founding an informational web site called PrEP-o-licious.org, Jacobs says he's heard from men distressed by reactions they faced after broaching the possibility of taking Truvada.
"They'd email me about the names they were called — the 'Truvada whore' syndrome," Jacobs said. "They'd talk with their friends about responsible condomless sex, and they'd get shamed. They'd get seen as a slut."
The U.S. Centers for Disease Control and Prevention offers extensive information about PrEP on its web site.
"Strong research evidence indicates that PrEP, when used consistently, is safe and effective for reducing the risk of acquiring HIV sexually," it says.
However, Jacobs says other wings of the medical establishment should be more active in disseminating that message, both to gay men and to doctors.
"A lot of doctors are still under the belief that if they give their patients PrEP, they'll go out and have condomless sex," Jacobs said. "What they don't understand is that gay men are already doing that."
At the Fenway Institute in Boston — which specializes in gay, lesbian and transgender health — many doctors initially had misgivings about PrEP, but have overcome them, according to Dr. Kenneth Mayer, the institute's medical research director.
"There definitely were apprehensions at the beginning — would it increase risk-taking behavior, would people take it regularly," Mayer said. "More recently, the questions are not whether it's a good idea, but the optimal way to provide it, and which patients are the best candidates."
"I don't have an issue with people voicing concerns about it, but we have proof it works," said Mayer, who hopes high-level federal officials get more involved in the public discussion.
Another challenge is raising awareness of PrEP in black communities with high HIV infection rates.
"We have young minority men becoming infected at disproportionately alarming rates, and now we have something that could avert this," said Lynnette Ford of GMHC, a New York City AIDS service organization. "But there's not a lot of information out there in communities that need it most."
Demetre Daskalakis, the Mount Sinai doctor, said the Truvada debate recalls the way birth control was viewed in some quarters in the 1960s — as an accessory to promiscuity.
"Anyone who takes Truvada, someone is looking at them and saying they're licentious," Daskalakis said. "When this becomes more normalized, we'll be fine."