by Seran Gee
In early January, Slate ran an article by Mark Joseph Stern called There Is a Daily Pill That Prevents HIV. Gay Men Should Take It. In this article, Stern discusses Truvada, a pre-exposure prophylactic (PrEP) that prevents the transmission of HIV. Essentially, you take this pill every day to prevent contracting the virus and developing the highly-manageable chronic illness. I believe this article is flawed and problematic in a number of ways, especially because Stern seems to have gotten a few of the facts wrong. The article does not provide evidence as to why Truvada is more effective than other, less costly and less extreme alternatives. Furthermore, the article makes the assumption that HIV/AIDS is somehow a gay issue, and it is not. Stern also fails to discuss the systemic complications of treating gay identities as “high-risk” chronic conditions that require being indentured to the medical industrial complex. When Stern writes, “Truvada has virtually no side effects,” he is wrong.
The Truvada website’s Patient Assistance Page identifies lactic acidosis as a potential side effect of taking the drug; this side effect is potentially life-threatening and serious even when it doesn’t result in death. Lactic acidosis is when your body tissue and blood becomes too acidic and has a lactate build up. In the past the FDA has withdrawn drugs (such as phenformin) for the potential development of this condition. I think this is not only misleading, but unethical to suggest that a drug that is potentially life-threatening has “virtually no side effects.” Especially when other drugs have been taken off shelves for the same side effect.
Stern counters the popular argument that Truvada lowers condom use and asserts that Truvada is an effective prevention tool. While I am willing to accept Stern’s claim that Truvada is more than 99 percent effective, I wonder if he knows the same is true for condom use (a much less expensive form of prevention). What is especially interesting to me is this focus on sex in the context of HIV. In particular, the focus on the sex being had by gay, cisgender men. The fact that Stern seems to think this pill is accessible enough to suggest all gay men take it only leads me to question how much Stern understands poverty, race, and structural barriers.
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Stern is shocked that only 1,774 people have filled Truvada prescriptions over the last two-years. He is especially surprised that half of the prescriptions are for women, seemingly unaware that women are the fastest-growing group for HIV infections in North America. Over and over he frames HIV as a gay, cisgender male issue, which ignores the reality of the chronic condition. While I argue against the idea that all gay men should take PrEP, I understand how important it is for doctors and people who work with blood or primates. For instance, 48.3% of med school graduates are women – so it makes sense that half of the prescriptions are for women.
Ironically, Stern suggests gay men take a daily pill to prevent HIV (a chronic illness that is often treated with a daily pill). This is not to say that Truvada is the same as HIV treatments. I think it’s important to note the mental contortions Stern undergoes to support Truvada. Moreover, why should we suggest that people who are HIV negative take this potentially life-threatening pill when there are people who need, but don’t have access to, life-saving antiretroviral medication (especially considering that these necessary medications lower infection rates substantially)? This emphasis on supporting an expensive drug that is potentially lethal (by taking a pill every day, much like how one would if they actually became HIV positive) is suspicious. I wonder who is profiting from this. I do not claim to have all the answers, but I do have a number of questions.
If condoms are over 99 percent effective, why suggest an expensive chronic administration of a drug that is potentially lethal? How does PrEP deal with the systemic causes of HIV/AIDS, such as poverty and stigma, especially when we consider that people living in poverty will likely not have access to PrEP and that chronic management of risk is being portrayed as infinitely more important than chronic management of viral load? To me, this reeks of naturalized stigmatization of HIV.
If only 1 in 6 gay men use condoms unfailingly, as Stern states, how can we expect perfect compliance with a daily drug? Compliance is hard to attain among patients for even life-threatening conditions. If used improperly, PrEp could potentially create antiretroviral resistant strains of HIV, adding further risk to its use. Can we expect perfect compliance for treating the risk of a chronic and manageable condition?
The more I talk to gay men who are HIV positive, the more I realize that articles like Stern’s are more harmful than anything else. I believe that awareness is important, and I’m sure Stern believes his article promotes awareness. However, I think being aware of the truth is important. His article reminds me of my childhood fear of monsters who would hide in dark places. We cannot make HIV/AIDS the boogieman. We do not need to arm ourselves with shotguns, when all it takes is a night-light to keep away the darkness.
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Seran Gee is a queer of colour activist and an MA Candidate in Anthropology at the University of Toronto. They specialize in the AIDS epidemic and queer discourse. Seran is an alumnus of AIDS Committee of Toronto’s outRIGHT sexual health leadership program.
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