Miscellaneous

PrEP and Slut-Shaming

When addressing proponents of Truvada as PrEP, Michael Weinstein, President of AIDS Healthcare Foundation, had this to say:

“In the last few days in terms of the people who have been yelling the loudest about Truvada, they’ve all been associated with bareback porn. They’re all associated with bareback porn, which kind of makes my point that it’s a party drug.”

First, Michael Weinstein’s claim is false. Let’s get that out of the way. I can start by pointing to the vast amount of literature over Truvada as PrEP available at TheBody.com, which is probably the best online HIV/AIDS resource available. Secondly, Weintstein’s claim is part of a larger ongoing public debate on Truvada as pre-exposure prophylaxis (PrEP) for HIV. For those of you unfamiliar with Truvada, it is a prescription drug consisting of a combination of two anti-retroviral drugs, tenofovir and emtricitabine, used for HIV treatment. On July 16, 2012, the Food and Drug Administration also approved Truvada for use as a pre-exposure prophylaxis, meaning the drug can be prescribed not only for the treatment of HIV, but also for the prevention of HIV.

Proponents of the drug argue that it could be a very effective tool in the fight against HIV, potentially achieving near-100% effectiveness in prevention when administered correctly, while opponents argue that it is too costly ($13,000 annually) and could encourage irresponsible sexual behavior.

I believe opponents’ first concern is legitimate, as the cost of Truvada has implications for its economic feasibility. However, most insurance plans, including Medicaid, cover Truvada. So, this should mitigate much of the first concern. Even cases in which Truvada is not covered under insurance, I don’t see this as sufficient reason for not enlisting Truvada as another weapon in our arsenal to combat the spread of HIV when we are able.

But the second concern of opponents is an argument I’m surprised to hear repeating itself. It is an argument that was first made against birth control. The argument goes that birth control is going to make people, especially women, more sexually irresponsible and thus should not be used and encouraged. This assertion goes largely unfounded, but more importantly it ignores that people are going to continue to have condomless sex regardless. Therefore, there is no reason we shouldn’t employ this demographic with a different means of contraception. Furthermore, it provides an additional safeguard for those who do use condoms consistently.

These arguments perfectly parallel the debate on PrEP. Replace “birth control” with “PrEP” and “contraception” with “protection”, and the argument is exactly the same. Whether or not we choose to endorse Truvada as PrEP, people will continue to have condomless sex. If our concern truly is the fight against HIV, then we will employ this demographic with a different means to combat HIV. And again, those who do use condoms consistently will have an additional safeguard.

Now, I want to address a darker sentiment I hear being expressed in this debate. In the birth control debate, it is expressed by slut shaming, misogynist conservatives; in the Truvada as PrEP debate, it is expressed by people such as Michael Weinstein, President of AIDS Healthcare Foundation, who seem to be no less engaged in slut shaming.

On the surface, I can sympathize with a medical industry professional expressing concern that people might disregard the dangers of STI’s other than HIV when using Truvada as PrEP. But we know from experience this concern doesn’t hold water. And we know that Weinstein’s claim is false, but assuming, for the sake of argument, that it is true: So, what? Like some arguments against birth control, his is one of slut shaming. There is no reason people associated with bareback porn should be denied an additional means of HIV prevention. His argument is one that implies HIV is a punishment, and those who do bareback rightly deserve HIV. A slut shaming, misogynist conservative argues that denying birth control will keep women from being sluts, because, you know, having lots of sex, especially bareback sex, makes someone a terrible person, I guess. And hell, we gays have all heard the argument from nut-jobs that HIV is a punishment for being gay. Weinstein’s sentiments aren’t much different, and they are very damaging to a group of people and to the mission of his organization.

Let’s take a step back for a second and see people who enjoy sex of any kind, whether filmed or within the privacy of their own bedroom, as actual people, deserving of a certain level of respect I believe should be afforded to any human being. And let’s also see if we can simply look at sex as a recreational activity like any other. That is to say let us try to clear our minds and wash away all the misconceptions and stigma regarding sex.

Almost everyone engages in sex at some point solely for the purpose of pleasure and not reproduction. And most of us engage in sex without the intent to harm another individual. (I make this point acknowledging that sex can be predatory, but this kind of sex, in comparison to the frequency of sex for pleasure that is not predatory, I think, is in the minority of cases overall and not here included in my definition of sex.) Therefore, sex can be seen as just another recreational activity in which people partake for the sake of their own enjoyment. Some people obviously enjoy sex more than others, and some people are more open about their sexuality than others. Nothing about sex per se is indicative of any moral culpability. When it is consensual, sex is a beautiful thing. There is no reason to shame people who engage in sex, or even those who have a lot of it or put it out there for the world to see.

What is implicit in Weinstein’s argument is very little a concern for sexual safety and more a concern for demonizing a lifestyle of which he disapproves. It is even more unfortunate the consequences of his sentiment go beyond affecting the people he is demonizing. They extend to other members of the population who are just looking for another tool in the fight against HIV.

ADDENDUM (17-June 2014): “Treatment with pre-exposure prophylaxis (PrEP) does not involve a significant risk of HIV drug resistance should seroconversion occur, results from the iPrEx study published in the online edition of the Journal of Infectious Diseases demonstrate”. Read more here.

3 comments

  1. I totally agree with everything you’ve said. It’s stupid to not take the precaution of using Truvada, even when using condoms, because they do break.
    As you can see from my name, I am a female and I am also in a long term monogamous relationship, therefore we don’t use condoms or any other kind of prophylaxis and never have. But, if something were to happen to my husband, I would most definitely get on Truvada, no ifs, ands or buts about it. It would be stupid of me not to, if I plan on having sex, which I know I would.
    HIV is not a gay person’s disease/viris, it is a human disease/virus. Anyone can get it and the better protected we are the better.
    This idiot, Weinstein, needs his head examined for saying the things he has. Does he truly think by denying this drug to healthy people is going to stop anyone from having sex, unprotected or not. It’s not going to change anyone into being more promiscuous, anymore than the pill did, all it’s going to do is make it safer for those who do.

  2. Well said! totally agree. It is bad when people try to impose their sense of morals and ideas on others yet such people often have little personal experience.
    Truvada medication is effective and even though Michael W may think $13000 is a lot it is still alot less than the 3 – 4 drug cocktail required for people who do get HIV plus lab-costs, doctors visits, increased risk of cancer not to mention the psychological cost.
    I have heard this argument before, the only way we should stop HIV is to give people condoms.
    Problem is that in the REAL world condoms, break, they slip or for various reasons cant be guaranteed to always be used.
    the fact HIV is still spreading like wild fire in many places proves condoms alone isn’t the only answer. Prep and PEP are great arsenals in the fight against HIV and to deny their use is stupid and dangerous.
    Condoms are great when complimented by these other defenses.
    If PrEP had been available just a few years back I know a number of mates who wouldn’t be HIV positive today.

  3. Thanks for this. In the early days of the epidemic, we looked for sex positive ways to stem it. I find it absurd that the head of an HIV organization would dismiss a powerful tool to reduce the spread of HIV and horrific that he would do so by sex negative, slut shaming. I am HIV- and legally married to an HIV + husband. I don’t need to be “slut shamed” as I consider the option of Truveda to stay healthy.

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