“I was a teenager in the mid ’80s, just as AIDS was making headlines in the mainstream press,” Ben Patrick Johnson writes in a new essay published on HIVEqual.org. “I was part of a new group for whom sex and AIDS were linked from the get-go … For those even a year or two older than me, AIDS was something that blindsided them. It was a death sentence that attacked without warning and wiped out a broad swath of gay men.”
In July 2012, the FDA approved Truvada, also referred to as Pre-Exposure Prophylaxis (PrEP), a once-a-day antiviral drug that can prevent HIV infection. The pill contains two medicines that are also used to treat HIV. If a person takes PrEP and is exposed to HIV through sex or injection drug use, the medicines can work to keep the virus from taking hold in their body.
“Today’s approval marks an important milestone in our fight against HIV,” FDA Commissioner Margaret A. Hamburg, M.D. said at the time. “Every year, about 50,000 U.S. adults and adolescents are diagnosed with HIV infection, despite the availability of prevention methods and strategies to educate, test, and care for people living with the disease. New treatments as well as prevention methods are needed to fight the HIV epidemic in this country.”
But some folks aren’t convinced.
How about we take this to the next level?
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Earlier this year, Larry Kramer caused quite a stir when he voiced his opposition to the drug, telling an interviewer: “Anybody who voluntarily takes an antiviral every day has got to have rocks in their heads… There’s something to me cowardly about taking Truvada instead of using a condom. You’re taking a drug that is poison to you, and it has lessened your energy to fight, to get involved, to do anything.”
But Johnson doesn’t agree. In his essay, he accuses Kramer of being “hyperbolic,” using “dismissive and sometimes insulting language,” and exercising “deductive logic.”
“To me, Kramer is both wrong and off-key,” he writes. “Certainly, Kramer has never been one to mince words. But this quote begs the question of why a man so intelligent and thoughtfully educated on this issue would take such an extreme position.”
While we don’t agree or disagree with Kramer’s stance, perhaps his resistance to PrEP has less to do with being “extreme” and more to do with the fact that he witnessed countless gay men take antiviral cocktails every day not because they wanted to, but because their lives depended on it, and he saw the permanent havoc those drugs wreaked on their bodies.
According to Gilead Sciences, the company that manufactures Truvada, the new antivirals don’t have nearly the same harmful effect on the body as the old ones did, and are proven effective in reducing HIV infection, though there can be serious side effects. But considering the horrors Kramer has seen, we can sort of understand his resistance to men voluntarily taking a drug similar to the one his friends were forced to take, even if we don’t 100 percent agree with his viewpoint.
Johnson has a slightly different theory.
“I smell fear,” he writes. “I sense a distrust of new direction.”
He continues:
“If there are studies or statistics that support Mr. Kramer’s claim that Truvada lessens one’s energy to fight or causes apathy, I’ve not seen them. I suspect Mr. Kramer is engaging in deductive logic that skips important steps. Fear makes us do that sort of thing.”
We can think of a lot of words that describe Larry Kramer, but “fearful” isn’t one of them. He showed tremendous bravery during the initial onslaught of the AIDS crisis, after all. Still, Johnson has a very good point. We haven’t seen any statistics that say Truvada lessens a person’s “energy to fight” either. If anything, it’s done the opposite by protecting gay men and keeping them healthy.
Johnson goes on to say that he believes the root of the PrEP debate lies in a generational gap.
“Perhaps we can chalk that up to age and the skepticism with which older, battle-wearied warriors views [sic] those who’ve taken up the charge after them,” he writes.
“The best answer for all of us, and especially for those like me who reside in the HIV/AIDS generation gap, is to try and take the caution of the past and marry it with the enthusiasm and audacity of younger activists,” he continues.
“There must be a balance,” he urges. “While keeping an awareness of PrEP’s limitations, we should promote it as loudly and widely as we are able, and work to make it accessible and affordable for as many human beings on the planet as we can.”
He ends his essay on an optimistic note: “Through a marriage of older activists’ long-sightedness and younger activists’ fearlessness, we just might bring this epidemic to its knees.”
What do you think? Is the resistance to PrEP expressed by some members of the gay community merely the result of a generational gap? Or is it more complicated than that? Let us know your thoughts in the comments feed below.
robirob
It’s about trust (or lack thereof) and hope.
newfoundma
Kramer is a contrarian who sees himself as always under attack. He will argue with anyone, even if he’s wrong. Dismissing people on Truvada as cowards overlooks the myriad reasons for people to pursue PrEP. Condoms are effective at preventing HIV transmission, but abstinence is more effective. Why not call people who use condoms instead of abstinence cowards, Larry? I think there is a very clear generational gap. People my age have always conflated gay sex with HIV, and Larry has a different worldview. There are people his age who are more open minded and interested in all avenues for decreased transmission, but some are stuck fighting the same battle from three decades ago. If condoms were the panacea, HIV incidence amongst MSM wouldn’t be on the rise.
Disappointed but not surprised by queerty for clearly taking kramer’s side in this article without marking it an opinion piece. Disappointed but not surprised.
Nowuvedoneit
I think it’s all a matter of perspective. Larry witnessed first hand the carnage Aids did in the beginning and has that to fall back onto as his opinion. I don’t know Ben has seen but he’s also going off his own experiences. We need to keep educating people on the many ways to prevent getting HIV and the ways to treat it. It’s neither good or bad their viewpoints.
Cam
My issue is why would you daily take a pill that causes some pretty massive side-effects rather than just wrapping it up if you are not in a long term relationship?
I have no problem with people who want to do it, it just seems not only way more expensive but condoms don’t cause nausea and diarrhea. The only other concern is that if the people using this medication to not get AIDS are more of the party and play types get ready for a massive upswing in Herpes, Warts, and all the other old STD’s
robirob
@Cam: I guess in the not too distant future there’s a pill for everything and guys will take pills on a daily basis for every occasion and old fashioned STDs won’t be an issue anymore (because you keep taking pills to keep them away) … until new STDs show up and more costly pills are required.
ChiChi Man
@Cam: My issue is why would I take a pill at all if I don’t have to? Why not simply use an effective and cheaper method of protection – and one that protects against other STDs? Why line the pockets of the drug companies who should be finding a cure instead of keeping us on the hook for the rest of our lives?
Johnson is right about one thing: there IS a generational gap. Kramer comes from a generation when ordinary people made sacrifices to fight HIV. When people attended rallies, protested, picketed and didn’t think it was a big deal to sacrifice a little pleasure to be more responsible. Johnson, unfortunately grew up in an entitled age in which all problems can be handled via email, text or pill. I grew up in the same age, but thank god, I haven’t given over to it!
Ben Dover
Larry used to walk to school in the snow 10 miles each way. And it was uphill both ways!
lostsleep
@Cam @ChiChi Man @robirob I agree completely. Larry is correct. He’s not saying the drug will make loose energy really. He’s saying people who take the drug and think everything is fine, no longer feel the need to get up and fight and work towards something better. I can’t imagine taking a pill everyday for no reason. I can wrap it with a condom when I am having sex and not worry about what it’s doing to my body or if I’m building up a resistance to medication. We over-medicate for everything. A pill is NOT the answer.
Pitou
It is entirely a generational divide, but a very dangerous one IMO.
I was born in the beginning years of the AIDS crisis (85), and all sex-education I have ever received has always included information pertaining to safer sex with condoms, etc. But the danger lies in young people being told that it is “OK” to have bb sex, just as long as you take this pill.
I mean, look at current statistics, even pre-PREP. There is a huge increase in young people being diagnosed as HIV+, and I think a large part of that is due to our being raised knowing that it is no longer necessarily the guaranteed death sentence that Mr. Kramer, and countless others, lived through. We (younger people) didn’t watch many/most/all of our friends die a horribly tragic death. We didn’t experience ANYTHING even remotely like it first hand. Not even non-HIV related. There’s been no serious health outbreak in my lifetime, after HIV/AIDS, and like I said, everyone up to young 30-somethings sex education has always included being taught safer sex. So there’s no real-life experience with that in-your-face-fear. I personally can’t blame Mr. Kramer for being, well, Mr. Kramer and continuing to feel obviously very passionate about such an important issue.
That said, I am a proponent of live and let live. If you want to take PREP and have bb sex, then by all means please do so. I have had long-term boyfriends and I definitely see/feel/understand the enjoyment in real, skin-on-skin love, but I think it is incredibly dangerous to promote the widespread use of the drug as it only really see it acting as an encouragement to younger people to continue practicing unsafe sex. What happens when a new strand of HIV is immune to these pills?
I think this is a very important topic, probably long overdue for debate. Maybe there is no right or wrong answer or solution.. but it is an entirely unavoidable conversation in the least and I think it is owed to every living soul to have it.
Ihadtosayit
I personally have a problem with the term “Truvada Whore’…it implies something less than self-respectful and lends itself to stereotyping that once I take this pill I am FREE to engage in HIGH RISK sexual behaviors.
Yes, of course there are some generational divide and the TRUST that we now have in drug companies will probably never be fully embraced by Mr. Kramer and others his generation.
Lastly, there still needs to be MORE activism and MORE instance of reducing the shame and stigma that is rampant in the “gay community” towards those who are HIV+.
Ihadtosayit
I would also welcome MORE films that deal with HIV as it stands today and NOT going backwards to address in the deluge of movies that have come out lately.
Even here on Queerty there was a piece on Films and AIDS but this is seriously not the issue any longer it is HIV and managing the disease and living with it…sadly as Tom Hanks said so well in the Celluiod Closet …”the hero dies at the end whether on screen or it is implied”…
http://www.queerty.com/and-the-films-played-on-16-essential-movies-about-aids-20131201
Gay men are living with HIV and that needs to be the next revolution to bring about awareness and change
Polaro
@Cam: I’ve been taking it for 5 months with no obvious side effects. If there were I would not take it. I’m getting regular blood work to track any other possible issues and will make a determination at 6 months if I want to continue it. There is a pill that prevents HIV…I take it.
Wilberforce
This Ben Johnson person sounds like one of the many self-destructive ghetto queens I’ve listened to over the last thirty years, with a million excuses and distractions to confuse some very simple issues.
1) Pills cost money and cause side effects, and anti-virals have unpredictable effects.
2) Condoms work and are cheap and used responsibly would stop hiv in this community. Period, end of sentence.
3) We haven’t stopped the spread of hiv because the ghetto crowd have fought us on every issue, instead of helping us set responsible standards in the community.
4) Here we go again with the endless nonsense of the self-destructive crowd. It’s been ten whole minutes since their last crazy-fest.
Ihadtosayit
@Polaro: That is awesome…I am pleased that you have made a decision for yourself but remember that sex is a two person activity…I surely do not think you are taking it for solo performances…that being said you do not know the other person’s efficacy of taking the drug…BE CAREFUL while you are trusting another person…
Also since you are on PrEP; are you open to dating HIV+ men; I mean what a blessing it would be if he is undetectable and you are on PrEP…this is what needs to be the next conversation in my opinion…releasing some of the stigma from the men who are HIV+
There are gay men taking PrEP and there are MANY gay men with undetectable viral loads so this should be a no brainier….right???
Ihadtosayit
@Wilberforce: your points are valid but made less so with name calling there are enough people who enact laws and other systemic measures that yours are not needed or appreciated…unless you are trying to STEAL the thread with hyperbolic language
Now with that said, there does need to be a conversation and but the MOST IMPORTANT conversation needs to happen when you are “hooking up”, “dating’ or in a relationship…how are WE going to be sexually active and keep one another disease free/
Kenover
BPJ has a lot more faith in the pharmaceutical industry than I do. Anti-virals are powerful medications that should only be taken as a last resort — not a first line of prevention. I’ve seen the side-effects of drug therapy on HIV+ men over the years. The idea of taking an anti-viral daily as prophylaxis seems nuts to me, unless you work in the sex trade or the porn industry. I’m with Larry Kramer.
jar
Is this idiot being paid by the pharmaceutical industry? Or is he just a self-absorbed moron? If one looks at the pharma industry’s track record over the past 20 years, one sees that drugs are rushed to market without sufficient trials and many are often withdrawn because of their deleterious, sometimes fatal, side effects. Furthermore, it should be simple common sense that one should refrain from taking drugs unless absolutely necessary. The body is not designed to process these foreign chemicals and the long term effects on vital organs/systems, such as the liver, kidneys, bladder, are usually not good.
I agree wholeheartedly with Larry, but a point that his quote does not drive home is that the pharma industry is focused upon containing illnesses and diseases, not curing them, for the obvious economic reason. The former approach creates a lifelong customer (like the simple-minded Johnson), whereas the cure is a one-off that would eventually eradicate the market for all of the current HIV-related drugs. That is the real danger with embracing this prophylactic approach. PReP will forestall the hope for a real cure as it disincentives finding one.
Lvng1tor
@Cam: It’s HIV not AIDS. It comes down to choice and if someone is educated and knows the possible side effects then at least they are taking a steps in protecting themselves. If ya wanna use condoms use condoms, if ya wanna use prep use prep. Judgement’s like Kramer’s stop people from discussing. It’s slut shaming plain and simple. Btw there are a host of std’s you can get with a condom. I’m not judging and neither should anyone else. protect yourself your way and let others do the same.
TO
I feel Ben made some very eloquent points in his article but it feels presumptive. I am younger than both Ben and Larry and a lot of younger gay men I know will use this an excuse to have bareback sex whether in a monogamous relationship or not. Plus, it’s not a cure all and we need the support and efforts of the younger generation in all aspects of HIV/AIDS issues. Many, not all, younger gay guys don’t do their homework or know their history. They will use diatribes like this as the reason to have BB sex, take Truvada and not give it another thought when they are not positive to begin with. I feel this will take a lot of education and planning now or it will cause many new problems and health risks.
Throbert McGee
The first line of defense against HIV should always, always, ALWAYS be:
“Let’s not do anal tonight, dude — let’s do oral sex and frot(tage) instead.”
Condoms are important, TasP is important, quick-result HIV tests and sero-sorting can be helpful — but “let’s save anal sex for another night” is the most important, because it doesn’t cost money and is available even when the drugstores are closed and even when government health services are “sequestered.”
Stache99
@TO: “I know will use this an excuse to have bareback sex whether in a monogamous relationship or not.”.
No shit. Hear I thought they were just taking it for better health. You learn something every day;)
Stache99
@Throbert McGee: Frottage just sounds so fun!!..if you’re 10 years old.
ghoop
My boyfriend of 2 years is HIV+ and I am not. We have a very fulfilling sex life and we do not use condoms. I am tested regularly every 2 months and am still HIV-. I talked to my doctor about starting PrEP, but I have not made the decision to start it because it’s been 2 years and nothing has changed. I’m not saying that I will not want to in the future. People are ridiculous if they think that it is only party boys or whatever taking this. PrEP, I believe, can help remove the stigma of people living with HIV.
Heyguy
Honestly, if I decide to taking prep in daily, I would be considered myself no difference from hiv positive/undetectable people who taking pills in daily as well… except $$$ due to my insurance not cover that in compared to them. That’s my thought.
DarkZephyr
@Throbert McGee: “Let’s not do anal tonight, dude — let’s do oral sex and frot(tage) instead.” Seriously? *This* is how you speak to someone you are potentially going to have such an intimate encounter with?
Oh G*D how I despise when a man that is attracted to me and is trying to entice me out of my pants calls me “dude” like we are a pair of frat brothers playing a 2 player game on the Xbox.
Tackle
@Throbert McGee: What??? You can’t be serious?
Mykaels
For the first time in my life, I agree with Kramer. I am not Poz, but I will not take Truvada just so I can bareback. I will use a condom or I will not have sex. I am not afraid of having sex with poz people, but I will not bareback with them or any stranger. I know people who are on antivirals, and though they are happy to be taking them to stay alive, if they had their choice, they would not be taking them at all due to the side effects. I can relate and understand. I was told my cholesterol was too elevated. I could choose to continue to eat like I had always eaten and take a statin or I could change my diet. I chose to change my diet and my numbers are good. Prevention without medicine is better (for those with high cholesterol due to genetics, this does not apply to you).
If someone is going to give the finger to condoms, then yes, I would prefer they take the PReP, but ultimately I would rather they use the condom.
Polaro
@Ihadtosayit I try not to have sex with condescending pricks – I just argue with them here. Otherwise, the drug protects me and those I have sex with regardless of their status. Since you can never know another person’s status the drug is perfect. But, you seem to miss the entire point.
Cam
@Lvng1tor: said…
“” It’s HIV not AIDS. It comes down to choice and if someone is educated and knows the possible side effects then at least they are taking a steps in protecting themselves. If ya wanna use condoms use condoms, if ya wanna use prep use prep. Judgement’s like Kramer’s stop people from discussing. It’s slut shaming plain and simple.””
_________________________________
No, please point out anywhere in my post where I “Judged” people for having sex. I stated simply that I thought it sounded much more complicated to take a pill that could cause some really uncomfortable side-effects and is very expensive (Although Polaro just said he hasn’t experienced side-effects which is good news). As for your comment that there are STD’s you can get even if you are using condoms, OF COURSE there are, but lets not pretend that they don’t stop a hell of a lot of them.
If what Polaro says about the side-effects is widespread then that is great news and would make the medication much more attractive.
barkomatic
Kramer is dead wrong on this issue. He’s done a lot for our community and I’m grateful to him but there is no rational basis not to take a drug that could save your life if you engage in risky behavior. None.
You can say “just use a condom” or “remain abstinent” — and these options have always been available yet HIV is still spreading. That’s because a lot of people being judgy about barebacking secretly do it themselves after they get drunk and meet a hot guy one night at the bar. This drug is for them.
Kieru
@felipec: Most of the side-effects you’ve mentioned are alleviated by taking your pill with food, so I’m not surprised you’ve (thankfully) not had to deal with them. The real issues are what most ART pills suffer from: prolonged use can result in damage to the liver and kidney functions.
Now as to whether PrEP is ‘good’ or ‘bad’ well… both?
If PrEP leads to people seeing HIV as a less serious disease; then PrEP is a terrible idea. Children growing up in a post-ART world already have a VERY different view of HIV than those of us born in the 80s – and as a result infection rates are going up. Our community especially is seeing a rise in infection rates. People aren’t terrified anymore and they are taking risks.
From what I’ve read you see PrEP much as I do – an added defense in your arsenal against HIV. That’s fine, but it’s not how a lot of blogs are promoting Truvada. They cite how when ‘taken correctly’ Truvada is actually more effective at preventing HIV transmission than condoms.
There are two important caveats here:
1.) “Taken Correctly” means taken every day without fail, and within roughly the same timeframe.
2.) “HIV” means specifically HIV-1. Yes HIV-2 is less prevalent but it exists.
I think opponents are rushing to judge because they are TERRIFIED that a pill could completely derail the progress that has been made. If people mistakingly think that a single pill will keep them from ever getting HIV no matter how unsafe they are… well… like I said; infection rates were already going up before Truvada.
EdgarCarpenter
There are lots of different opinions about whether or not to take Truvada – but surely that should be a personal decision.
If you don’t want to take it, don’t take it – like if you don’t like gay marriage, don’t get gay-married. But I wish old and young anti-Truvada vocal “activists” (and there are many of all ages) would just shut up and let people look at the facts and decide for themselves.
I am not taking Truvada, and don’t intend to. But that’s my choice for myself. It’s not my choice for anyone else, and I’m happy to support anyone else’s decision to take it.
Lvng1tor
@Cam: Show me where I said you judge people? Also I made the comment about condoms and people getting stds still not as a pro prep anti condom statement but to remind people that you still need regular testing even if you use a condom. Many people don’t understand this. As for me saying I’m not judging and neither should others as long as they are educated and taking precautions, I stand by that. The way Kramer stated his opposition to Prep is slut shaming. Never said you bud!
Lvng1tor
@Cam: Oh and it is HIV not AIDS!
Bull Winkle
I smell a different kind of fear. Folks like Kramer fear that more gay men will abandon condoms and continue to have numerous partners, opening themselves up to Hep C and a host of other diseases. Like Kramer, Ben is also intelligent & thoughtful but admits to abandoning condoms, thanks to Truvada. Kramer’s fear is that many other bright, and not-so-bright, gay men will do the same & we may end up with another epidemic, begging for attention and help w/o taking responsibility for the choice to abandon condoms in the first place. We could have sex w/o condoms in the 70s… until AIDS came along. We can return to that practice, in risks of something else coming along. We know better now. It’s not like this is a hypothetical. This is where the rubber meets the road. Can you imagine how disgusted some of our lesbians sisters, who were there for us back in the day, would be to hear folks like Johnson practicing condomless sex simply because the pill stops HIV? Should another epidemic surface, will Johnson expect them to care? Gay men lie in wait to clutch their pearls at one who would encroach on their “sexual freedom”. Well, with freedom comes responsibility. So I wouldn’t dismiss Kramer as just some old, unhip man who is scared of change. That’s unfair. He sounds like a man who is rightly concerned about the ‘freedom’ to have condomless sex introducing new epidemics, drug resistance & side effects. HIV isn’t the only disease to protect oneself from. It’s no surprise that younger folks embrace Truvada, but this article doesn’t explore why. It’s not simply that they’re forward-thinking and fresh whilst Kramer is just an old guy. That’s simplistic and biased. Young ones are ignorant of what a deadly epidemic looks like. They are less mature. Young folks tend to feel invincible. Young folks see plenty of gay men living with HIV who are in excellent shape and are doing well. We want to believe there can never be another HIV, so we don’t need condoms. We want to have real sex. I know it’s cool to side with youth, but none of these reasons are as compelling as Kramer’s. Finally, Gilead is a business. Its priority is the bottom line. If Gilead could sell a sugar pill for $1,000, it would. At first we were to take meds at a certain T-cell count. Then they raised it & got more customers. It was raised once again & even more customers came. Stockholders were happy. More recently, they started doling out the meds to folks who just contracted HIV & had good numbers. Still more profit came. Any company’s goal is to get as many folks using their product as possible. Now, HIV-negative folks are taking it on general principle & shouting it from the rooftops. Gilead needn’t invest a dime in advertising. Brilliant business model. . …but I take PrEP, too.
brucers
Resistance to this new HIV prevention option is not just generational. I was born in the 80s and didn’t see first-hand what many older gay men saw during the AIDS epidemic and how it took the lives of so many gay men. I saw the movies and documentaries but experiencing it was life changing, I’m sure. And while Mr. Johnson may be right about Mr. Kramer’s reason for resistance, it doesn’t sum it up for all of us.
This drug has an extremely high efficacy rate according to many articles I’ve read, including the CDC’s own article about PrEP. This drug is not an easy one to take–an individual on PrEP must take it every day at the same time, forever. And it has to be taken for a specific period of time before enough of the drug is in the blood for it to be effective. If the person taking the drug is not following directions they run the risk of catching HIV if they are not using condoms and even worse, risk HIV infection that is drug resistant.
All that aside. What bothers me most is that more and more profiles on the various gay geo apps (Grindr, Scruff, Jack’d) are advertising PrEP as a free pass for irresponsible behavior. But what about all the other STIs that exist that this drug does NOT protect against? I’m all for using this option to further protect yourself but I’m not for it as a replacement for condoms and responsible behavior.