Scott Wiener sits on the San Francisco Board of Supervisors, and this week he made an unprecedented announcement: he’s on PrEP.
More specifically, he takes Truvada, a daily pill that’s been shown to cut the risk of HIV infection by upwards of 90 percent.
Wiener represents the same Castro-based district that Harvey Milk did, and wants to fight PrEP stigma head on, starting with his own personal disclosure.
Wiener said in an interview:
How about we take this to the next level?
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“A much larger segment of gay men should be taking a close look at PrEP. I hope that my being public about my use of PrEP can help people take a second look at it.”
We first read about it in the New York Times’ “Upshot,” a recently added online section that is largely data-driven, breaking down otherwise confusing stories involving complex science or numbers into more digestible media.
The author of the piece, titled San Francisco Official Says He Takes Truvada to Prevent H.I.V., and More Gay Men Should, Too, Josh Barro, writes:
“Taking the pills is a practice known as pre-exposure prophylaxis, or PrEP, and some researchers believe it may reduce the risk of infection by 99 percent if patients take their medication daily as prescribed.”
Interestingly, he doesn’t mention that almost exactly two months ago, he wrote another article for the Upshot titled Is Truvada, the Pill to Prevent H.I.V., 99 Percent Effective? Don’t Be So Sure.
In that piece, Barro say’s of the “99 percent” claim:
“This is a claim I hear thrown around a lot among gay men in New York. And it’s wrong. The 99 percent figure isn’t a study finding; it’s a statistical estimate, based on a number of assumptions that are reasonable, but debatable.”
Which is to say nothing of Wiener’s plan to get more San Franciscans on the drug, but it did strike us as an odd bit of reporting.
Wiener and another gay city supervisor, David Campos, are holding a hearing today to address ways to combat the “educational and affordability issues” of Truvada.
SportGuy
Well this should be interesting.
frshmn
Is coming out as negative the new coming out as straight?
Dakotahgeo
Coming out negative can only be a good, errr, GREAT thing, and has nothing to do with GLBT or straight! I commend these fine young politicians who are leading the way for the rest of their generation to follow. Good going, guys!
damon459
Shit I’m sick of these uppity gays who think we are rich enough to afford all these “magic” pills! I can get condoms anywhere for free, but being a disabled gay man I simply can not afford $1,300.00 for a pill just so I can feel “safer” fucking in the baths! If you want to be a slave to the drug companies that’s you business I guess, but I can find better ways to spend that kind of cash on a monthly basis.
vive
@damon459, PrEP is covered by Medicaid and Medicare in a number of states. It is also covered by most health insurance policies. For the uninsured and under-insured, there is a copay assistance program offered by the company.
damon459
@vive: Medicaid covers it and Medi-cal covers it. Medicare however does not pay for pre-exposer usage. I’m not on medicaid only medicare since the teabillys in my state decided the expansion would be bad for Montana. But it’s not just the cost there is also the long term risks on taking these drugs, even HIV patients are warned of the long term risks of using these drugs. Co-pay assistance means little to someone on a fixed income. As I said condoms are much cheaper, and there are no long term risks from condom usage. It’s not like condoms will fry my kidneys or liver. Truvada has a risk for liver damage when used long term, and considering the alcohol consumption of many (not all) gay men I would think this would be a concern.
tardis
Correct me if I’m wrong…okay, so in order for this to work, you need to be on it everyday, right? So, does that mean that you’re having sex everyday or do people go on this in intervals where they’re off sex for a month and then they start to cycle again? And I read that this hurts your liver, is that right?
Chris
This is another tool in the ever-growing arsenal to halt the spread of HIV. Yes, there are side effects; yes, the numbers are estimates; and yes, it is very costly. But every med (as well as condoms) has side effects (for condoms it’s the loss of sensation for some men); all odds and other numbers are estimates; and the cost of getting HIV is itself higher than the costs of avoiding it. So while some people may opt out for very good reasons, I do not think we should be shamming or dissing people who chose this option.
passingthru
@Chris: It seems that with this drug, people have another option to help reduce the possibility of becoming positive. I’m not sure why someone would be so angry and make judgements in reference to “uppity gays” and bathhouses. People become positive in many ways (even using condoms) and it is a horrible thing. HIV is a very serious threat to everyone. I, for one, am very happy with any new option that people have even if I don’t choose it for myself. It’s great when information like this is shared and people have the ability to research and make decisions for themselves.
passingthru
@Chris: Sorry Chris, that was meant for damon459.
Billy Budd
I will never ever, ever, buy or take this pill. I will always resort to condoms.
SportGuy
@Billy Budd:
Condoms for me too. No side effects, cheaper, and a whole lot cleaner.
Billy Budd
I must add that I DO lose sensation due to the use of condoms and that I very rarely -almost never- reach orgasm while topping with condoms. But I would rather have these side effects than the side effects of dangerous drugs such as truvada.
If in the years to come I become partially or totally impotent because of the use of condoms, I will take C***is or Viag** to boost my performance, and CONTINUE using condoms. the side effects of viag** are very mild and there are generic versions available.
Billy Budd
The only thing that could make me stop wearing condoms would be the discovery of an efficient vaccine for preventing HIV infection. Nothing else will ever make me change my choice.
Realityis
Personally, I don’t understand why a negative person would want to take meds that are comparable to chemo. What a shock it would be if we see a new generation of lipodystrophy in the next 5-10 years. Wouldn’t that be a hoot. What if Truvada actually will cause it in 5-10 years. Then what? A big OPP’s from the Pharmas and their lobbyists? Disgusting.
I started taking the medications cus I wanted to live. Unfortunately “no one” knew about the side effects they caused. I didn’t see anything for the first 4-5 years and then it hit me all at once.
Chris
@passingthru: I just thought you were agreeing with me! 🙂
michael mellor
Scott Wiener appears to be a dick-head.
trelin
Another dude being paid to speak the sacred word of PreP. They seriously are trying to market it like vitamins. Live your life and be safe. If you want to bang without a condom, then talk to your doctor. But stop trying to press this on us like we’re all tramps and are destined to get HIV.
passingthru
It seems that several of the negative comments here are about a decision to replace condoms. However, I don’t see anything in this article that mentions taking this instead of condoms. Rather, it’s information about options. Although I would never take this instead of using condoms, I would consider taking it in addition to using condoms. What is wrong with options and having information? Nobody is forcing anybody to do anything.
Black Pegasus
@damon459: LMAO!! @ “Shit I’m sick of these uppity gays”.
Damon, I know you didn’t mean to be funny with your comment, but I nearly spat my beer all over my iPad while reading that little blurb 🙂
queerT
Another Gilead shill posting a press release designed to empty the coffers into Big Pharms’s hands. We’ve seen it all before,the exact same talking points, the exact same concerns glossed over, the exact same deceptive manipulation of stats.
seaguy
@damon459: Medicare is usually for people 65+ who are retired and it’s drug coverage is different than medicaid so most of the PrEP taking population won’t be using medicare. But you should contact Gilead to ask about patient assistance for those without insurance drug companies often have programs that will pay for the entire cost of the drug if your income is low enough.
seaguy
@tardis: Few people have experienced side effects that involve the liver but most have no side effects. If you do you can always stop taking it. You take it daily for it to be the most effective if you miss a dose it will be less effective because there is less of the drug in your bloodstream. It’s not something you take for sex you take it daily like it were the pill that females take for birth control.
seaguy
@michael mellor: How original.
seaguy
I think it is great that he came out publicly about this. PrEP is another tool poeple can use to prevent themselves from getting HIV because even when you use condoms they are not 100% effective they break, especially during rough anal sex. And we all know that condoms are not being used 100% of the time by everyone because new HIV infections continue. Some additional protection is better than nothing.
Saint Law
@seaguy: True though.
Even a stopped clock tells the right time twice a day.
Geoff B
@michael mellor: Please do elaborate. Your viewpoints are always so illuminating. I for one simply must know more about your fascinating point of view on this topic.
buffnightwing
My Doctor, whom has been treating HIV patients for 20 years now, says that Truvada as PREP is very safe. She monitors my blood work every four months. If this prevents someone from getting shingles, and bells palsy, and other HIV related conditions, then it’s worth it.
buffnightwing
@Realityis: The NEW drugs have so little side effects now. I’m sorry about your lipodystrophy, but you come on here bashing everyone with your argument, which doesn’t hold water anymore.
As one HIV person to another, you need to go talk to somebody so you aren’t so angry anymore. You are alive, but you sound like you don’t want to be.
Go get some help.
Realityis
@buffnightwing: Thanks for the advice. Before I take it, can you tell me where you got your psychology degree and where you’re licensed to practice?
1. I have CHOSEN to live for 20 years with HIV and during that time competed in sports and taught fitness in NYC. So I do want to live.
2. You are HIV +, so you’re choice is different from someone who is not positive. You’re choice is to live and I commend you on that.
3. Not everyone who has taken the first generation of meds has lipodystrophy. So who knows what long term side effects will be. My doctor never will put me on something until there has been 5 years of study minimum.
I am not bashing anyone here. A choice is a choice and I respect that. I am only telling my side of my story and I wouldn’t want others to have to follow this road.
If Truvada doesn’t cause any side effects in the long run, then great. I love that there are new things on the market to help prevent this horrible disease but they need to find a cure and not make it so everyone will have to give mone to BIG PHARMA in order to survive!
onthemark
@Black Pegasus: “LMAO!! @ ‘Shit I’m sick of these uppity gays’.”
Yeah – personally I prefer sex with the uppity gays. They’re just better at it.
And as I’m sure you know, Black Pegasus, the uppity black gays are even better!
bnard620
The sad thing is there is no cure. But HIV infections among gay men are on the rise compared with the general population. But there is this little blue pill that could keep a person from contracting HIV. SHouldn’t it be used. You’re right there could be serious side effects but the reality is that condoms aren’t always enough. Not everyone uses them 100% of the time. There always seems to be that one time it wasn’t worn.
vive
@damon459, @tardis, no, Truvada is not associated with liver damage. There is a small risk of kidney function changes (that are reversible upon cessation), so part of the regimen is a kidney function test every 3 months.
vive
@Realityis, lipodystrophy is not well understood, but it is mostly associated with protease inhibitors, and two of the older nucleoside reverse transcriptase inhibitors (older NRTIs).
Truvada doesn’t contain any protease inhibitors or any older NRTIs.
Also, in HIV-negative people Truvada can be stopped quickly if even the slightest side effects are noticed, and it will be eliminated by the body in a few days.
vive
@tardis, you can go on and off Truvada as circumstances change, but you have to be on it for a certain number of days before and after any possible exposure for the fullest protection.
vive
@bnard620, true, only 1 in 6 men even use condoms consistently, but even if condoms are used all the time they are not 100% protective.
Here is a study by the CDC reporting that condoms are only about 70% effective for HIV prevention even if they are used consistently:
http://www.aidsmap.com/Consistent-condom-use-in-anal-sex-stops-70-of-HIV-infections-study-finds/page/2586976/
Bauhaus
Both condoms and Truvada are extremely effective.
The problem is that people fail to use both consistently. Truvada must be taken daily, without fail. Condoms must be used every time.
People aren’t perfect, obviously. Condoms break, we trust people and they lie to us about their status, people cheat, we have a lapse of judgement, a moment of passion, an unpleasant side-effect from a medication, whatever.
Buying condoms was once stigmatized, as was the Pill. The message should not be Truvada replacing condoms, but potentially adding it for some people. That way one would be “covered” if there was an oops on either the Truvada, or the condom use.
Cam
If you read articles or see movies like “And The Band Played One”, some of the negative reactions to this pill seem to be similar to the reactions that gays had when it was suggested that they start using condoms.
Not sure where all the anger is, if people want to take it, they can take it, if people don’t want to take it and use Condoms, then do that. Why all the manufactured outrage?
Black Swan
Making a joke at our expense? This Truvada bullshit is a complete insult to all HIV-positive gay men. Thanks queers for being the main attackers of HIV-positive gay men just to announce that your own sexual practices are really just as shameful as anyones. Not a cure, but a relief to the HIV-negative sect.
And are you laughing at all the HIV-positive gay men to their faces while you’re having your unprotected sex with them like, “Ha ha ha! I lied when I persecuted all of you for not being responsible enough to use condoms 100% of the time, but I got away with it! Don’t die laughing at our little joke!”
For the first time I’m not interested in the sex lives of gay men. Disgusting. Coming out as negative you called it? More like coming clean as hypocrites. You owe all of us an apology!
JennyFromdabloc
Guessing a drug company made a donation to his reelection campaign? I do not cosign on Truvada or PrEP drugs. It is absolutely leading to risky behavior and is only making big pharma richer. Use a damn condom!
How can anyone intelligently debate whether Truvada results in liver, kidney, or other organ damage? Studies are a years old, not decades old.
Merv
The people who would benefit most from Truvada are those not disciplined enough to follow safer sex guidelines consistently, which means they are probably not disciplined enough to get a prescription, take their pill every day, and refill their prescription before it runs out.
The people who are disciplined enough to already be following safer sex guidelines, are most likely to get Truvada, and least likely to benefit.
vive
@Black Swan, I really have no idea what you are trying to say.
He was “coming out” not as “being negative” but as using PrEP, something that takes some courage in the face of all the derision heaped upon gay men who make that choice. Nobody was deriding poz men.
vive
@Merv, “The people who are disciplined enough to already be following safer sex guidelines, are most likely to get Truvada, and least likely to benefit.”
This is not the case. Here is a counterexample. I got on Truvada because I wasn’t always using condoms, for various reasons that had little to do with discipline. And I haven’t missed a single dose in the entire year I’ve been on it.
Merv
@vive: That’s good, but what was stopping you from using condoms? Was it just that you don’t like them because they’re less pleasurable? Nobody likes them. Latex allergy?
damon459
@vive: Side effects are listed on their website for all to see, here is some of it. TRUVADA can cause serious side effects:
Too much lactic acid in your blood (lactic acidosis), which is a serious medical emergency. Symptoms of lactic acidosis include weakness or being more tired than usual, unusual muscle pain, being short of breath or fast breathing, nausea, vomiting, stomach-area pain, cold or blue hands and feet, feeling dizzy or lightheaded, and/or fast or abnormal heartbeats.
Serious liver problems. Your liver may become large and tender, and you may develop fat in your liver. Symptoms of liver problems include your skin or the white part of your eyes turns yellow, dark “tea-colored” urine, light-colored stools, loss of appetite for several days or longer, nausea, and/or stomach-area pain.
You may be more likely to get lactic acidosis or serious liver problems if you are female, very overweight (obese), or have been taking TRUVADA for a long time. In some cases, these serious conditions have led to death. Call your healthcare provider right away if you have any symptoms of these conditions.
Worsening of hepatitis B (HBV) infection. If you also have HBV and take TRUVADA, your hepatitis may become worse if you stop taking TRUVADA. Do not stop taking TRUVADA without first talking to your healthcare provider. If your healthcare provider tells you to stop taking TRUVADA, they will need to watch you closely for several months to monitor your health. TRUVADA is not approved for the treatment of HBV. So yeah there are risks of liver damage for people using this drug longterm!
Black Pegasus
@onthemark: lol… Touché’ ????
Realityis
@damon459: And these side effects (on their website) under the Other Serious Side Effects tab:
Serious side effects of TRUVADA may also include:
New or worsening kidney problems, including kidney failure. Your healthcare provider may do blood tests to check your kidneys before and during treatment with TRUVADA. If you develop kidney problems, your healthcare provider may tell you to take TRUVADA less often, or to stop taking TRUVADA.
Bone problems, including bone pain or bones getting soft or thin, which may lead to fractures. Your healthcare provider may do tests to check your bones.
Changes in body fat can happen in people taking HIV-1 medicines.
Changes in your immune system. If you have HIV-1 infection and start taking HIV-1 medicines, your immune system may get stronger and begin to fight infections. This may cause minor symptoms such as fever, but can also lead to serious problems. Tell your healthcare provider if you have any new symptoms after you start taking TRUVADA.
damon459
@Realityis: Exactly which is why I would think very carefully about taking this pill daily for most of your life. I mean what’s the worst side effect of a condom, lack of sensation? I just saw the other day they have a new synthetic rubber condom (no allergy known issues) and they are supper thin and supper strong. We need to educate people on all their options rather then pushing this drug as some miracle pill that’s somehow as life changing for gay men as the birth control pill was/is for straight women.
stranded
@passingthru: Exactly. I feel like the first argument against it is to slut shame users. Since the moment i heard about it, I immediately thought with this pill AND condoms sex can be safer. I think part of this misconception about abandoning condoms has to do with porn. Those in porn who promote Truvada and PrEP are also doing bareback porn, and i do think that’s sending the wrong message. Like any other medication it will have an individual effect. I’m more cautious about long term effects. The argument regarding this being a product the drug companies can take to the bank. Well there’s some truth in that, but it’s entirely too pessimistic to be treated as reason to be against it. Currently, i have no problems with just condoms. I’m not that sexually active that I have multiple partners weekly or monthly. So part of me thinks, i really don’t need it.
rhino79
I’m sorry (and I’m sure I’ll be accused of “slut-shaming”), but why are gay men having so much unprotected sex with strangers that they require daily antiviral drugs to prevent HIV? It’s not difficult to avoid HIV infection. First of all, maybe don’t have unprotected anal sex so much. Are gay men so addicted to stranger sex that they can’t even consider the possibility of modifying their behavior or reducing their sexual activity? If you are having multiple unprotected sexual partners on a regular basis, maybe you should start asking yourself why you are engaging in this behavior. This is like an alcoholic saying, “Well, I know my drinking is dangerous and injurious to my health, so… instead of reducing my alcohol intake, I’m going to take a pill that supports my liver health.” I mean really… do you know how ridiculous this sounds to straight people?
damon459
@rhino79: I don’t care personally what straight people think, have you see how they act? You think they’re all a bunch of monogamous saints? Watch a little tv or head to the local watering hole breeders hookup all the time, heck their craigslist ads are scarier then the gay ones.
vive
@damon459, @Realityis,
Most of the side effects that you list were observed in HIV-positive individuals on c*cktails that included other m*dications. Since in those cases it is impossible to identify which side effects were due just to Truvada and which were due to the other m*dications (or to HIV itself), they have to assume the worst for legal and ethical reasons and list the entire c*cktail side effects for each individual m*dication. Also, in the last paragraph quoted, note that that liver damage was the case only for people with chronic hepatitis-B infection who STOP Truvada, since Truvada is actually protective against chronic Hep-B.
But when HIV- people have taken just Truvada in PrEP trials, liver damage has simply not been seen. True, the trials have not been long-term; however, in trials with large numbers of patients, even if they are short-term, you would expect at least SOME patients to show signs of liver damage much sooner than average, so there are usually signals of long term side eff*cts in short term trials as long as the number of participants is large enough. There has been no such signal.
(Sorry if this is hard to read – trying to get this past autofilter.)
Finally, the reality for most guys will NOT be lifelong continuous PrEP use, but intermittent use during spells when they are single.
damon459
@vive: Sorry but there is no way in hell any doctor is going to let you just stop and start this drug during spells when you are single, doing so risks creating further drug resistance making this drug worthless and defeating the entire purpose of PrEP. Taking directly from the CDC, “When taken consistently, PrEP has been shown to reduce the risk of HIV infection in people who are at high risk by up to 92%. PrEP is much less effective if it is not taken consistently. PrEP is a powerful HIV prevention tool and can be combined with condoms and other prevention methods to provide even greater protection than when used alone. But people who use PrEP must commit to taking the drug every day and seeing their health care provider for follow-up every 3 months.”
vive
@stranded, @rhino79, “I’m not that sexually active that I have multiple partners weekly or monthly. So part of me thinks, i really don’t need it,” and “…why are gay men having so much unprotected sex with strangers that they require daily antiviral drugs to prevent HIV”
The reality is that about 60% of cases of HIV are caught from boyfriends, not strangers. You can easily google the relevant study.
damon459
@vive: Wait didn’t you already claim this would only be used when people were in there “single spells” a you call them? Now you want to state that 60% cases come from partners? So which is it? Frankly you’re talking out of both sides of your mouth and you can’t even keep your story “straight”!
vive
@damon459, “Wait didn’t you already claim this would only be used when people were in there “single spells” a you call them? Now you want to state that 60% cases come from partners?”
Well, you are right. I do suspect, though I admit without proof, that a lot of the “partners” referred to in that study were the kind of serial relationships that last a season or so that is quite typical for gay men, and in which many gay men abandon condoms (assuming they even use them initially) – of course PrEP should be continued in such relationships. But I really don’t see people continuing PrEP in long term seroconcordant relationships. And there should be no need as long as certain conditions are satisfied, which we are all familiar with.
vive
@damon459, “Sorry but there is no way in h*ll any d*ctor is going to let you just stop and start this dr*g during spells when you are single…”
Of course they are going to let you stop. I recently started d*ting a n*gative guy and my d*ctor asked me if I wanted to stop PrEP.
You may know this, but just in case someone else doesn’t, let me just say that “people” don’t devel*p a r*sistance to Truvada if they st*p and restart. The vir*s may develop a resist*nce, but only if you are already inf*cted with it.
(Sorry for the edits – d*mn autofilter.)
vive
I swear this last comment was autoflagged three times before I was able to mutilate enough words to pass the filter. This is ridiculous.
Matt
What is it about that last name? The dude’s a pig. To actually tell the world what prescription he’s on says little about his character. He likes breeding and seeding. That’s nothing to be proud of in this day and age.
onthemark
@vive: “But I really don’t see people continuing PrEP in long term seroconcordant relationships.”
Why not? It seems perfect for them.
@vive: “And there should be no need as long as certain conditions are satisfied, which we are all familiar with.”
??? – No idea what you mean here.
vive
@Matt, “What is it about that last name? The dude’s a pig.”
You know that’s a REALLY antisemitic remark.
vive
@onthemark, “@vive: “But I really don’t see people continuing PrEP in long term seroconcordant relationships.” Why not? It seems perfect for them.”
That was -concordant, not -discordant. You may have misunderstood me.
onthemark
@vive: Yes.
Realityis
@vive: Look. Take the medication. I hope and wish nothing but the best for you.
I am only trying to make people aware of the devastating side effect known as lipodystropy, which according to the Truvada website, can happen. Believe me, it’s something you don’t want. It has devastated my social life and self esteem, as well as, countless others who suffer from it. The gay community views it the same way the straight community does. Not a lot of compassion there.
Lipodystrophy is non-treatable right now and research for a cure has all but halted. I have spent thousands trying to correct it.
I really hope it works without the side effects, but again, we need a cure. We need to stop making Big Pharma richer at our expense.
Geeker
So will this guy be the new “Milky Loads” now that Andrew Sullivan is off the market? He’s an idea,Don’t let strange men dump their loads in your ass.
Geeker
@rhino79: I must be a bad gay because I’ve never had multiple partners in a week or engaged in bareback sex.
vive
@Geeker, HIV transmission does not require ejaculation, and if you think that’s what it takes, you may have a nasty surprise coming, so please inform yourself better.
stranded
@vive: You bring up a really good point, which i thought about later. I will admit, I’ve had 2 long term relationships and after a while we inconsistent with our condom use. You put on the rose colored glasses and never suspect the person you love and trust can cheat on you, but it’s a possibility.
Geeker
@vive: I use condoms so that helps.
Geeker
Folsom must have been Truvada central,I wonder if they sponsored the bareback gangbang tent.
misterhollywood
I am seeing more and more public figures disclosing that they are using PREP. I do wonder if politicians are getting $ for doing this with the drug companies? Just thinking out loud but I would not be shocked.
vive
@misterhollywood, the same insinuations are made for people who try to popularize the Gardasil anti-cancer vaccine.
Some people would rather prefer that their daughters get cancer one day than pay a dime to the drug companies.
Maybe some public figures are just trying to lead by example to improve people’s health. But I know nothing anyone can say will satisfy the conspiracy theorists.
Geeker
Their slogan should be Truvada it’s not just for dirty whores anymore.lol
Jeton Ademaj
Bravo! Truvada is not a dangerous drug to the vaaast majority of users, it is more effective than condoms are for blocking HIV at any given adherence level, and it is vastly more forgiving of missed uses than condoms are. 60% (4 days out of 7) adherence to Truvada-PrEP = 96-100% risk reduction.
meanwhile, using condoms 4 out of every 7 sexual encounters provides almost no risk reduction at all.
guys resent PrEP because they pathologically feel that their sexual sacrifices are being mocked, and somebody else might be having a better sex life than they.
they’re right of course…raw feels better. THAT’s why they’re wrong to fight PrEP…because HIV is more of an existential threat to Queers now than at any point before.
shame is for those who think spreading disease is a worthy price for their own sexual sanctimony toward others.
use whatever HIV prevention works for YOU. PrEP is a choice, not a debate.
Matt
@Geeker: hope that’s working out for you. Gay men are the laughing stock of the world.