HIV+ gay and bi men! Sign-on letter supporting an informed debate about PrEP based on facts, not misinformation

Published: July 28, 2011

The release of data from the iPrEx study of pre-exposure prophylaxis (PrEP) for HIV prevention in gay and bisexual men and transgender women has led to a good deal of debate about whether and how PrEP should be used. Unfortunately, some of that debate has been fueled by misrepresentations of the study data and, perhaps more alarmingly, by groundless assertions that gay/bi men and other men who have sex with men (MSM) will misuse PrEP, spread drug resistance and act without regard to their health or the health of others if PrEP is made available. A paid ad campaign by the AIDS Healthcare Foundation running in gay papers across the country has contributed to spreading false ideas both about PrEP and about the commitment of gay/bi men to care for themselves and others. We reject those false assertions and want a full and factual discussion of the pros and cons of PrEP in our community.
 
Recently, two additional studies, Partners PrEP and the CDC’s TDF2 study have confirmed the safety and efficacy of PrEP, this time in heterosexual women and men.
 
A small group of HIV positive gay/bi men who are committed to promoting safer sex and the open exchange of accurate information are circulating the following letter to help clarify the facts about PrEP, open up community discussion and make clear our belief that we are entitled to respect, accurate information and new HIV prevention tools.
 
This sign on letter is part of a broad array of advocacy activities being undertaken by the national PrEP Committee. Members of the PrEP Committee include individuals from a host of organizations working on PrEP and other new prevention technologies who meet regularly by phone and email to share information and strategize. For allies who are not HIV+ gay/bi men, you can learn more about this work and how to participateby sending an email to Jim Pickett at jpickett@aidschicago.org.
 
We encourage HIV+ gay/bimen who are allied in the fight against AIDSto help us clear the record about PrEP by signing on to this letter.
 
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An open letter from HIV+ prevention advocates on pre-exposure prophylaxis (PrEP) and gay and bisexual men
 
We are openly HIV+ gay and bisexual men dedicated to protecting our partners and working to help reduce the impact of the AIDS epidemic for all people at risk.We agree with the National HIV/AIDS Strategy that HIV+ individuals have a unique and vital role to play in helping to stop the spread of this epidemic. Gay and bi men, as well as other men who have sex with men (MSM), account for more than half of new HIV infections in the United States and are in particular need of new HIV prevention approaches.
 
Pre-exposure prophylaxis, or PrEP, is a new HIV prevention method in which an uninfected person takes a daily HIV medication to reduce HIV infection risk. Recently, a new study called iPrEx found that gay/bi men, MSM and transgender women who received a daily HIV medication called Truvada, along with condoms and safe sex counseling, had an average of 44% fewer HIV infections than those whoreceived condoms and counseling alone. Rates of protection against HIV infection were much higher (up to 90%) among study participants who took PrEP consistently.
 
PrEP raises many important questions that should be discussed and debated. We are disappointed, however, that an organization that runs HIV clinics, the AIDS Healthcare Foundation (AHF), has chosen to spend tens of thousands of dollars on ads that use simplistic and often misleading arguments to condemn PrEP before the FDA and the HIV community have had a chance to fully review and debate the study data.The AHF campaign misrepresents key facts about PrEP’s effectiveness and side effects, and about drug resistance. We believe the PrEP discussion should be based on facts. Here are the some of the key facts about the iPrEx study:
 
– A diverse group of 2,499 HIV-negative gay/bi, MSM and transgender women on four continents with a range of sexual practices participated in iPrEx. Participants that received daily PrEP with the drug Truvada in addition to condoms and counseling had an average of 44% fewer HIV infections than the group that received condoms and counseling alone.
 
– No HIV infections occurred in men whose blood test showed high drug levels, indicating that they took Truvada regularly. But, while participants in iPrEx study in the U.S. achieved very high rates of PrEP use, taking the medication regularly was a challenge for many people.
 
– Participants in the iPrEx study reduced their risk behaviors and increased their condom use demonstrating that gay/bimen can use PrEP and condoms together.
 
– Truvada is widely used for HIV treatment because it is generally well tolerated. While research to understand the safety of using PrEP over longer periods of time continues, rates of side effects were very low in the iPrEx study.
 
– Studies to date show no evidence of HIV drug resistance when HIV infection occurs in spite of PrEP use. Resistance can occur, however, when PrEP is taken by someone who has HIV but does not know it.
 
– The iPrEx study was paid for by the U.S. National Institutes of Health and by the Bill & Melinda Gates Foundation, and was not organized or run by any drug company.
 

PrEP is a major breakthrough in HIV prevention for gay/bi men that also raises important questions. These include how to best support regular PrEP use; how to ensure the continued use of condoms and other precautions for those who decide to take PrEP; how to target PrEP to those who will benefit most from it; and how to pay for this new HIV prevention tool. Additional research is also needed to determine whether, and how well, PrEP works in transgender women. A continuation of the iPrEx study is now underway and will provide additional information to help answer many of these questions.
 
The AHF ad campaign claims to have the best interests of gay menat heart. Yet AHF’s anti-PrEP campaign claims with no basis that men who have access to PrEP will throw away condoms and other HIV prevention methods, and urges that gay/bi men be denied access to this new prevention method.
 
Gay and bisexual men have led HIV prevention movements even before HIV was identified as the cause of AIDS. Gay and bisexual men invented safer sex, promoted condoms in the face of opposition from government, church and society, and have worked tirelessly to prevent new HIV infections. The iPrEx study promoted safer sex behavior and the continued use of condoms that HIV+ gay/bi men and transgender women have always advocated.
 
We also reject the argument that providing access to PrEP will result in fewer resources for HIV treatment and care, or for other methods of HIV prevention. We will not put people and interventions in competition with each other in the fight against AIDS.  Resources for HIV prevention and treatment must both be increased, and should not be cast as competing priorities. As outlined in the National HIV/AIDS Strategy, HIV prevention reduces healthcare costs and helps preserve resources for treatment.
 
PrEP is no magic solution to the HIV crisis, no HIV prevention method is. Ensuring combination approaches (e.g., condoms, safer sex and PrEP) and providing multiple prevention options are key to reducing HIV risk and slowing the epidemic. PrEP is a significant advance in HIV prevention, however, and it deserves careful review and debate. One of the best ways to do so is through a prompt and thorough assessment by the Food & Drug Administration (FDA), to determine whether PrEP should be made available as a new tool that can increase options for HIV prevention.
 
Ad campaigns that misinform communities at risk for HIV will not help end this epidemic.  We call on everyone to get the facts about PrEP, seek information, and express opinions, but to do so based on real information, not fear of the scientific process or prejudice against gay/bi men. To that end, we call on AHF to end their expensive and misleading ad campaign, and to work together with us to promote an informed public discussion of HIV prevention that can help reduce HIV risk and save lives.
 
Signed (list in formation)
 
Jeff Berry, Chicago, IL
 
Arick Buckles, Chicago, IL
 
Tom Donohue, Charlottesville, VA
 
Keith Green, Chicago, IL
 
Mark Hubbard, Nashville, TN
 
Tom Hughes, Chicago, IL
 
Ronald Johnson, Washington, DC
 
Mark S. King, Ft. Lauderdale, FL
 
David Munar, Chicago, IL
 
Jim Pickett, Chicago, IL
 
Robert Reinhard, San Francisco, CA
 
Michael Scarce, San Francisco, CA
 
Jeff Sheehy, San Francisco, CA
 
Dana Van Gorder, San Francisco, CA
 
Craig Washington, Atlanta, GA
 
Robin Webb, Jackson, MS
 
Phill Wilson, Los Angeles, CA
 
Full access to sign on letter available at link below –

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