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LETTERS PrEP rally
2014-05-07

This article shared 3453 times since Wed May 7, 2014
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An open letter to the AIDS Healthcare Foundation ( AHF ) President Michael Weinstein

Dear Mr. Weinstein:

We, the research team at The Hunter College Center for HIV Educational Studies and Training ( CHEST ), are deeply concerned about your recent inflammatory remarks about HIV Pre-Exposure Prophylaxis ( PrEP ), calling Truvada a "party drug" and "ineffective" in preventing HIV transmission. We know that the AIDS Healthcare Foundation ( AHF ), as the largest HIV/AIDS services organization in the United States with a $300-million budget, provides services to a diverse range of patients and clients. People who are at risk for HIV and who are HIV-positive often experience barriers due to intersecting factors in accessing HIV services.

The AHF staff and board are also quite diverse in their experiences and approaches to HIV work and in all likelihood, there are staff and volunteers at AHF that do not agree with your position on PrEP. Your position on PrEP ignores the data on its effectiveness and further fuels stigma around sexual behavior and HIV, especially amongst communities that are most at risk for HIV infection—young men of color who have sex with men and serodiscordant couples. The AHF should represent the needs of all people at risk for or living with HIV/AIDS rather than catering only to those who engage in particular behaviors deemed "appropriate" ( especially considering they are likely at less risk for HIV in the first place and thus in less need of the AHF's services ).

Mr. Weinstein, your position on PrEP is out of touch with the realities of HIV prevention. PrEP is the most promising biomedical intervention to date for preventing new HIV infections in high-risk populations and is designed to provide protection against existing levels of HIV risk. In fact, there is no evidence that the use of PrEP will increase risk behaviors. Research suggests that a majority of people struggle to use condoms 100 percent of the time, and PrEP would provide an added layer of protection in the face of their existing risk. Men already engaged in bareback sex deserve and need an effective HIV prevention method—condoms should not be the only tool that people have to protect themselves from HIV infection. There are also contributing factors that impact decisions around condom use, such as using substances and engaging in high risk sexual behavior. Shaming non-mainstream sexual practices along with fueling stigma can potentially increase their risk and the difficulty of providing prevention for people engaged in such practices.

Over the past couple of weeks, leading experts and activists working in the field of HIV prevention have spoken out against your position on PrEP, yet you continue to stand by your statements. There is a significant amount of misinformation and confusion about PrEP—misleading information about its effectiveness, side effects and health-insurance coverage, to name a few, that can contribute to the relatively small numbers of people who are currently on PrEP. As professionals working in HIV prevention and care, we need to focus on the realities of the HIV epidemic and work to make PrEP more widely available to those individuals who are at most risk for HIV infection.

Further, we must focus on understanding and addressing barriers to PrEP uptake, factors that contribute to difficulties with PrEP adherence ( e.g., drug use ), issues with dissemination of accurate information regarding PrEP to community members and service providers, and the continued stigma that is associated with the sexual practices that put individuals at risk for HIV.

The continuation of the HIV epidemic both nationally and globally requires a shift in the HIV prevention paradigm, and it is clear that the position you have taken on behalf of AHF is dangerous, stigmatizing and out of touch with such paradigm-shifting approaches to prevention.

Signed,

The CHEST Research Team

Center for HIV Educational

Studies and Training ( CHEST )

Hunter College of the City

University of New York ( CUNY )


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