Monday, December 14, 2015

PrEParing For The Future

"The argument is over for PrEP. If you use the drug, it works."   - Dr. Anthony S. Fauci, director of National Institute of Allergy and Infectious Disease, at The 2015 National HIV Prevention Conference



Illustration by: Clarione Gutierrez



Pre-exposure Prophylaxis is the controversial practice of using antiretrovirals to prevent HIV infection. When taken properly (one pill, every day) the prophylaxis can build up to a 99% immunity against HIV. Extensive studies prove that *even when taken just four times a week, the pill reduces the risk of contracting HIV by 84%. PrEP is re-inventing the way this generation approaches HIV prevention (whether you know about it or not). 

For those who approach the topic of medical prevention from a personal stance, don't worry; everyone from the Food and Drug Administration right down to the queers in Hell's Kitchen agree that PrEP is not for everyone. However, for **serodiscordant couples, as well as those who engage in risky behavior (i.e. sex without condoms, binge drinking, drug use, SEX WITHOUT CONDOMS), PrEP is a newfound solution to help end the epidemic.

Even though Truvada, the only drug on the market used for PrEP, has only been publicly available since 2012, antiretrovirals have been administered to healthcare professionals as forms of post-exposure prophylaxis (PEP) as far back as the 90's.

Let's just take a pause and celebrate how far we've actually come. Thirty years ago, if a medical professional was treating an AIDS patient and exposed themselves to the then-deadly virus, there would be no hope for either the doctor or the patient. Today, not only can we extend the lifespan and quality-of-life of those being treated for HIV by decades, we can also interrupt ***seroconversion and haphazard infection from those who have been exposed.

Ineffective. Unnecessary. Radical. Apparently, the thought of taking an 'elective' medication to prevent an acquired disease seems drastic to many people. Here's the thing: HIV may not be a big deal in your world, but the plague has been alive and well since the day it came along in the world. AIDS never stopped being a big deal. No matter how hard we try to fool ourselves into thinking that HIV isn't a big deal either, it is. And, all the medical advancements in the world mean nothing if you can't afford them. Or your body has an adverse reaction to them. Or, you're too afraid to even acknowledge you have the virus. HIV AND AIDS IS STILL A BIG FUCKING DEAL.


 

In 2014, an estimated 2 million people were newly infected with HIV. Every day about 5,600 people contract HIV—more than 230 every hour. In 2014, 1.2 million people died from AIDS. Since the beginning of the pandemic, nearly 78 million people have contracted HIV and close to 39 million have died of AIDS-related causes.

*Statistic retrieved from amfAR
 
Clearly, it's high-time for drastic and radical action.


*A 2014 article in aidsmap.com based on results from the iprEx Study found that while adherence was the key to maximizing efficacy, taking Truvada at least 2-3 times a week resulted in an 84% reduced risk of contracting HIV.

**serodiscordant [seer-oh-dis-kawr-dnt]: also known as mixed status couple, pertaining to a relationship that includes an HIV positive person and HIV negative person. When both partners share the same status, that couple is referred to as seroconcordant.

***seroconversion:  the period of time during which HIV antibodies develop and become detectable. Seroconversion generally takes place within a few weeks of initial infection. It is often, but not always, accompanied by flu-like symptoms including fever, rash, muscle aches and swollen lymph nodes.



PrEP and the Nay Sayers

People are so busy talking about how "the gays are going to (continue) to fuck condomless like rabbits", they blatantly ignore the benefits and possibilities that come with this game-changing source of prevention. Such misguided rhetoric would be deemed irrelevant if not for those who promote it. Michael Weinstein is hell-bent on convincing the masses that other STI's will rise because all the bottoms are going to throw their Trojan's to the fire. When the president of the AIDS Healthcare Foundation refers to Truvada as a 'party drug', suddenly, people want to get off the prevention train we waited decades to hop on.

Who would want to sleep with that idiot?

Actor, Zachary Quinto (Star Trek, American Horror Story, Buzzfeed) has his own irrational views on the effects of PrEP. In a self-affirming article he wrote for Huffington Post, Quinto wrote of the second-hand tales he heard about PrEP usage in the young, gay community. "I have heard too many stories of young people taking PrEP as an insurance policy against their tendency toward unprotected non-monogamous sex." So many stories? Really? Did he hear the story about the couple who looks into each others eyes when they make love, comforted with an extra cloth of assurance that their love can expand beyond the fucking virus? That's the story that gets clouded because the uninformed few are pumping the hype.

"What if PrEP had come around in 1985? We would have been burning down the Food and Drug Administration to get that pill."
                                                                                             - Peter Staley



PrEP and People of Color

Don't be fooled by the latest statistic floating around. It's going to tell you that HIV infections have gone down over the years. These stats are going to scroll across the bottom of your TV screen while you're catching up on the latest mass shooting. It will probably provide a subtle level of relief. Maybe a little hope that it isn't all bad. But, there's an ugly truth behind that statistic that tucks you in at night; new infections among people of color has risen by 87%. That is an astronomical amount of human beings. Considering the fact that a mere 39% of people living with HIV are receiving  proper medical care, it's pretty safe to assume that there's a severe portion of black Americans infected with HIV who are not getting proper treatment.

Project Q Atlanta campaigning for PrEP

Getting a black American to talk about HIV without using a slur like, "the monster" or, "sick" is one of the biggest challenges in my community. 44% of newly diagnosed HIV patients were black Americans. There are a variety of factors fueling that percentage.  Socioeconomic circumstances, lack of awareness, stigma, and the fact that *black Americans tend to have sex with partners of the same race/ethnicity means that we face greater risk of HIV infection with each new sexual encounter.

What's clear is that HIV isn't getting better in the black community, it's getting worse. Did I mention that NEW INFECTIONS AMONG PEOPLE OF COLOR HAS RISEN BY 87%?

*statistic retrieved by the Center of Disease Control and Prevention


PrEP and the Stigma

As is always the case with HIV/AIDS talk in the United States, the weight of an international epidemic falls on the back of the American gay man. Just as you can't talk about water on Mars without mentioning aliens, one rarely speaks of PrEP without dropping the phrase 'Truvada whore'. Considering the fact that HIV infections continues to bulldoze through the black community, as well as the dangerous outbreak of new infections in middle-America, the epidemic is knocking on every subculture's door. The longer we continue to point fingers and blame at the gay community, HIV/AIDS is going to continue to ravage every subculture we've created.

Besides the stigma (and, Baby, there's always a stigma whenever you talk about HIV/AIDS) people are apposed the drug because you have to take it everyday. If you don't, the drug won't work properly, which heightens your risk of contracting it. People talk about taking a pill everyday like it's the first time in the world that people have elected to take  a pill to prevent catching something (I used to take a pill everyday so I didn't catch something. Babies!).

Another argument against PrEP is that the pill could give a faux sense of invincibility towards contracting HIV, and lack of condom use will spike outbreaks of other STI's. This notion bears striking resemblance to the argument that women who take birth control pills feel encouraged to be promiscuous. The actions of a few should not or never be the consequence of all. It would be naïve to assume that everyone who uses PrEP will continue to behave responsibly, but really, there's no way to know. What we do know is that PrEP works at both blocking transmission and lowering the rate of new infections.

No, the magical blue pill will not protect you from other serious STI's. It's not meant to act as a slut-shield that wards off every sexually-related disease and virus. PrEP is identical to birth control pills in the sense that the objective is singular. Truvada only offers reduced risk from contracting HIV.




 
*MYTH BUSTERS*
 
Once you start taking it, you can't stop.
 
False. There are no known adverse reactions that stem from discontinued use. Doctors actually advise patients to reconsider using Truvada for PrEP when the patient is no longer in the 'season of risk' they were when the drug was first prescribed.
 
 
That stuff can mess up your body.
 
Barely! Every drug has a fucked-up list of could-be side-effects, from Tylenol to tenofovir. Studies have proven that the vast majority of  Truvada users were unscathed of medical consequence.
 
 
It doesn't work.
 
If there's one thing that's proven certain of Truvada for PrEP, it's that it works. Every scientist, medical professional, clinic rep, and advocate will tell you that it works. And, we have the data, science, and facts to prove it.

It's way too expensive

Maybe for some, but not many. Despite the whopping $8,000-$14,000 a year fee floating about, that's for those who don't have health insurance and are paying out-of-pocket. However, for those with health insurance (especially good health insurance), many users of Truvada for PrEP pay much smaller amounts, and some health insurance and cities offer the drug at incredibly low costs.
 
PrEP and the Future

The reality is that everyone from activists and physicians, to politicians and preachers are in support of PrEP. Whether you're negative and your partner is diagnosed with HIV, or, you're at-risk and willing to take heightened measures to stay off the statistic spreads, PrEP is becoming readily available to more and more Americans every day.

This past spring, Governor Cuomo announced that the Ending the Epidemic Task Force had devised a five-year plan to reduce the rate of newly diagnosed HIV patients to 750 by the year 2020. PrEP takes up a four-part plank on their 30-steps  plan to reduce HIV infections and eradicate AIDS. According to Gay Men's Health Crisis CEO Kelsey Louie, "We have the tools, we have the data and we have the unprecedented political will and partnership with Governor Andrew Cuomo. We now have a Blueprint to help make the plan to End AIDS as an epidemic by 2020 a reality.”

Georgia, Florida, and a slew of other states have incorporated PrEP into their prevention strategies. But, of course, there is no spot on earth that's doing a better job of fighting the virus than San Francisco, USA. With an unbelievably low 350 HIV diagnoses in 2014, the former epicenter of the virus has become the model for treating and preventing HIV. It should come as no surprise that PrEP is one of their biggest weapons.

In the end, prophylaxis won't eliminate HIV/AIDS entirely. But, neither will condoms. The hope is that by encouraging the use of PrEP among those who are in high risk, in conjunction with maintaining undetectable levels in those who are already HIV positive, we can contain the disease (which would be awesome, because I really don't know how many more 'announcements' I can take from a dear friend before I start pulling my fucking hair out).
 
 
"PrEP, along with condoms, TasP (Treatment as Prevention), and better access to healthcare, are now essential public health tools in lowering HIV infections among gay men and trans women. We must use every tool necessary to help them – and to help all those at risk – stop this virus, once and for all."
ACT UP, Fight Back, Fight AIDS."
 
Larry Kramer
Jim Eigo
Matt Ebert
James Krellenstein
Peter Staley




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