THOUGHTS ABOUT PrEP AND WHY IT ISN’T THE ANSWER (YET)
So, there’s this thing that everyone is really excited about called PrEP (Pre-Exposure Prophylaxis), which is an HIV prevention treatment that consists of taking Truvada, an HIV treatment med. It’s really exciting, right? You could just take a…
I read Morgan’s article with interest, for several reasons:
1) I am queer and live in New York City, where I have many friends who are HIV+, sex workers, or both; as well as having many friends who are at risk for contracting HIV
2) As an HIV activist who has volunteered at organizations like ACT-UP NYC, the Sylvia Rivera Law Project, Gay Men’s Health Crisis and SAGE (Services and Advocacy for Gay Elders), these issues are very much being discussed among our constituencies, and
3) I like Morgan, consider her a personal friend, and am very interested in her ideas.
However, I take a different view than some of the opinions expressed in her article. Namely:
The jury is still out as to whether the consequences of non-adherence to and long-term use of PrEP are quite as dire as Morgan has characterized them. Truvada is already a medication used for the long-term treatment and management of HIV. It keeps viral loads down, which reduces the over-excitation of the body’s immune response, which it is hoped will prevent many of the inflammation diseases (dementia, heart disease) endemic to people who have been living with HIV/AIDS for a very long time (including seniors.) Truvada is a very good drug. And, of all the HIV drugs on the market, it has the lowest measured side-effect profile.
Many people living with HIV take Truvada every day. The official literature says that it requires 99% adherence (meaning, you can only skip one dose about every three months), but in clinical practice — ask any doctor who has many HIV+ clients, and they will tell you that this drug is more forgiving than its labeling would indicate. It is my suspicion that the extreme adherence requirements expressed on the drug’s labeling are a way of covering Gilead (the maker of the drug in the US)’s ass.
Speaking of which, it’s true: the price of HIV drugs are outrageous. But, they don’t have to be. In India and Thailand, for example, the public health ministries of these countries refused to issue patents for certain HIV drugs, citing their high cost and inaccessibility for their citizens. It is our job as activists to demand fair access to these drugs. A wise activist once taught me this fundamental rule of social change: ain’t nobody gonna give you nothin’ if you don’t ask for it.
Also, Morgan’s point about sex workers’ clients expecting them to be on PrEP and thus being more adept to demand unprotected sex is a valid one, especially for street-based sex workers. However, in my experience, I am not so sure this bears out in practice? A casual glance at Backpages.com lists dozens (if not hundreds) of girls advertising BBBJs and “no condoms needed.”
Morgan makes another good point in her article, too: THE COMPARISON TO PrEP TO BIRTH CONTROL IS AN APT ONE, but I’d like to explore this analogy a little further…
Lots of people fuck up taking all kinds of meds. I, myself, was conceived while my mother forgot to take the pill for a few days. It should also be considered that combined oral contraceptive pills were only legalized in the United States in 1960, and during that time, they contained a much higher dose of hormones than they do today — it was a matter of (frankly, unethical) experimental titration for toxicity that left many women with reproductive health issues for the rest of their lives. I have suspected that the higher doses of hormones used in the early days of the pill may have contributed to my own mother’s reproductive health issues later in life; and yet, using the pill gave her control over her own reproductive choices, which allowed her to graduate from college (despite being married at age 15), greatly increasing her socioeconomic life chances. Many life choices require risk evaluation. Sometimes, it’s a trade-off.
(It should also be noted that prior to 1960, these experiments were conducted in Puerto Rico in inhumane conditions that left many women permanently sterilized.)
The march of progress for allopathic medicine has at times been a long and cruel one, and has claimed many bodies, lives, and spirits. And yet, today, birth control has given women control over their bodies and the ability to plan their families in a way never before imagined in human history. And sure, people still fuck up! My mom, of course, being a perfect example, but then, had she not, I probably would not be writing this article. (And hey, depending on what research you chose to believe, were she not all pumped up with these exogenous neonatal estrogens, I might not even be trans. And wouldn’t that be a shame!)
And — this is the point on which I feel most passionately — though perhaps the long-term health consequences of PrEP are unknown, you know what is quite well known? The long-term health consequences of living with HIV/AIDS. If these can be prevented in any way, I say, go for it.
When I was at the Lambda Literary Retreat this summer, I spoke with a brilliant young queer femme queen of color who was debating going on PrEP. In the city where he lived, it was free. Though I am excited about the possibilities of PrEP and encouraged him to explore its possibilities, there’s certainly no way I can say what the right choice for him is.
At the end of the day, though, I’m glad the choice is his to make.