Opinion: Advance on AIDS or Give Up on Gay Men?

AHF President Michael Weinstein Opinion Editorial Published
Today in San Jose Mercury News

Recent headlines that heralded taking medication as a means of preventing transmission of HIV among gay men were applauded by many AIDS experts. The news came in a study of nearly 2,500 men in six countries that found that an average man taking the medication was 44 percent less likely to become infected than a control group taking a placebo.

How very sad that we have come to this point. The applause for this approach shows just how disposable we consider the lives of gay men.

If we were talking about protecting the general population with a treatment that was only 44 percent effective, would we be celebrating? Yet that is how the media and most of the public interpreted this study.

First, 100 real live men got infected with HIV while on this study. This is a tragedy. Thirty-six were infected while receiving the pre-exposure drugs.

The 44 percent who received a benefit were also intensively counseled monthly. Blood was drawn five times in the first six months, and there were frequent tests for all manner of sexual infections. This is in no way representative of any real-world situation, in which the efficacy rate would likely be even lower.
And the patients did not know whether they were receiving the drug or not, so the risk of infection was high. In effect, half the chambers in the gun were loaded.

Why would anyone willingly subject themselves to such drug therapy if they had any intention of using condoms? If someone tells almost any man that it is reasonably safe to have sex without a condom, as this study may suggest, he will likely do so.

Kevin Fenton, chief of HIV/AIDS for the Centers for Disease Control and Prevention, said: "Some studies suggest that even a small increase in risk behavior due to a false sense of security about the pills' effectiveness could actually increase HIV infections, an outcome we cannot afford."

Given that a large percentage of patients infected with HIV do not take their medications, how likely are healthy men to take pills every day for the rest of their lives? And if the pre-exposure medication is not at therapeutic levels in their system before they have sex, they will not be protected.

The potential use of this drug is based on the premise that we cannot succeed in getting gay men to use condoms. Have we really made a wholehearted effort to do this? Are condoms readily available in bars, bathhouses and other meeting spots? Are they advertised on TV? Do our political, religious and community leaders speak out for protecting gay men from HIV? The answer in each case is no.

The rates of HIV infection in tolerant places in the world, like Holland, are one-sixth what they are in the U.S. Partner reduction, delay of sexual debut, faithfulness and condom use, combined with political will, have brought HIV rates down in such diverse places as Cambodia, Brazil, Northern Europe and Senegal.

Another question: Who will pay for this pre-exposure treatment? Today, almost 5,000 Americans who are already HIV-positive are on waiting lists for lifesaving medications. The minimum these new drugs will cost in the U.S. market is $10,000 per person per year. Will insurance companies cover them for preventive use? Will they cover HIV medications when the preventive drug fails?

I applaud efforts to find new ways to prevent HIV transmission. However, far too often baby steps forward are interpreted as huge leaps in scientific knowledge. We must consider this if we are going to offer up hundreds of thousands of gay men for this misguided experiment.


MICHAEL WEINSTEIN is president of the AIDS Healthcare Foundation. He wrote this article for this newspaper.


-end-