Officials from local HIV/AIDS organizations and other advocates spoke out against an anti-PrEP ( Pre-Exposure Prophylaxis ) advertisement, paid for by Los Angeles-based AIDS Healthcare Foundation ( AHF ), that ran in gay media outlets, including Windy City Times, the week of June 15.
The ad, headlined The War Against Prevention, is an "advertorial" penned by AHF head Michael Weinstein that suggests that the PrEP intervention, largely available as the pill Truvada, is a failure: "[Truvada] was first recommended by an FDA committee three years ago this month. Three years of promotion later, Truvada has not caught on with medical providers or patients."
AHF opened a Chicago facility in January 2015.
Implementation of Truvada has indeed been slow-going; advocates admit that myriad stumbling blocks have impeded its use, among them high drug costs, insurance complications and low awareness amongst both the public and medical professionals. But they nevertheless characterized Weinstein's remarks as unfair.
David Munar, president and CEO of Howard Brown Health Center said the ads "delegitimized choices of responsible adults. [HBHC] has patients who made that choice and decided what's right for them. We need to take these ads with a grain of salt—they are just adding confusion to what is really an artificial argument—PrEP works for some people, and other people have decided it doesn't work for them. At the heart of our work is matching up people with an intervention that [works]."
AIDS Foundation of Chicago ( AFC ) largely concurred in a statement it released June 16: "AIDS Healthcare Foundation has released a highly inaccurate advertorial about PrEP once again. They continue to use faulty science and fear mongering to oppose PrEP, refusing to accept extensive research and CDC recommendations that indicate PrEP works, and works quite well, to prevent HIV. The AIDS Foundation of Chicago fully endorses PrEP and calls on AIDS Healthcare Foundation to halt their dangerous and disingenuous PrEP denialism and to stop spreading misinformation in Chicago and beyond."
In the ad, Weinstein specifically mentions a speech by Damon L. Jacobs, a New York City-based therapist in private practice who has been a visible advocate for increased access to Truvada. Weinstein writes, "No matter how irrational it seems, when Gilead Sciences first sought approval for PrEP, the company contended that Truvada would be exclusively used with condoms. That message has been thrown out the window with PrEP advocates such as Damon L. Jacobs, the creator of the PrEP Facts website, who brazenly asserts [that], 'people want to experience the maximal pleasure with minimal consequences. They want to have more connections, with fewer barriers. They want to feel heightened physical sensations, with lowered medical risks.' Public health be damned."
Jacobs said that the quote quite accurately summed up his own perspective. "I stand by that. I'm very proud of that. I'm pretty pleased that got highlighted. In my 20-plus years of working in this field as an educator, an activist and a therapist, this is pretty much the synopsis of what it comes down to for many people in terms of how they choose to practice any kind of prevention-strategy for HIV—this is not just gay men and people with HIV. This is pretty much 'human beings,' [all of whom] want to experience maximal pleasure with minimal consequences."
Jacobs said that the ad was nevertheless filled with "distortions and lies, consistent with his history of going against PrEP, and with his history of going against HIV vaccine trials—anything to do with prevention, other than the condoms-only approach."
Windy City Times reached out to AHF for comment and Weinstein responded in an email message. He said that he cited Jacobs because "his quote epitomizes the counter-position between sexual freedom and public health that PrEP activists have been espousing."
Weinstein also noted that the advertorial framed PrEP implementation efforts as a "war on prevention" since "the rhetoric of those promoting PrEP is saying that gay men are not [using], and will not use, condoms, and the frenzy about PrEP has squeezed out discussion about reducing the 60 percent of HIV-positive people in this country who are not being treated at all."
Despite Weinstein's rhetoric, AHF facilities do prescribe the PrEP intervention and the ad indeed states that it is right for some patients. AHF's Chicago clinic is listed as a PrEP provider in listings maintained by AFC. Windy City Times asked why the organization would then place such an oppositional ad. Weinstein responded: "As we have said consistently, and repeat in the article, the data from the studies does not support PrEP as a mass public health intervention."
Munar said, however, that health providers and advocates need to keep focused on what works best for the patient. "The real question is, do individuals know about tools at their disposal? Can they make informed choices? That's the 'debate' here—how best to educate people and allow them to make their own decisions for prevention."
[Note: After this article's initial publication online, AHF spokesman Christopher Johnson contacted Windy City Times to say that the organization, after reports of researchers creating subdermal implants to treat or prevent HIV infection, had voiced support for an HIV vaccine or potential implant technology. According to a May 1 AHF statement Johnson forwarded, "While patient studies, federal approval, and information on pricing and availability is still needed at this early stage, the news that scientists have created the first implant to deliver HIV medications for prevention or treatment is a potential medical breakthrough that AHF wholeheartedly welcomes."]
