I’ve never met Michael Weinstein, the president of the AIDS Healthcare Foundation. I don’t know his likes, his dislikes, his virtues, his vices.
But I can say this unequivocally: Michael Weinstein should quit his job immediately–today–and have nothing more to do with HIV/AIDS outreach, education, advocacy, or activism. He is actively doing harm to gay men, regardless of their HIV status.
Weinstein’s problem? PrEP.
Since Truvada was introduced as a once-daily medication for pre-exposure prophylaxis, or PrEP, Weinstein has gone increasingly off-script. Off-message. Off-the-charts crazy. He’s become so concerned about what people–particularly gay men–do in their bedrooms that he’s become blind to the fact that PrEP appears to offer 100% protection against HIV.
In his apoplectic, ill-conceived fight against PrEP, Weinstein has pulled the AHF dramatically off-mission. AHF was founded to reduce HIV infections and treat those who’ve already been infected. But Weinstein is so narrow-minded that he can’t envision any means of HIV prevention other than condoms–which, by the way, have slightly lower rates of effectiveness than PrEP and which gay men really, really don’t like to use anyway.
And so, he’s become a sort of PrEP denialist. He can’t deny the effectiveness of PrEP itself, but he loves to talk about its downsides, like reduced condom usage and the increased prevalence of other sexually transmitted diseases.
Now, are STDs worthy of concern? Of course they are.
Are STDs the focus of AHF? Nope. AHF should be focused primarily on HIV prevention and treatment. And PrEP is the best tool for prevention on the market. AHF should be working to make sure that every sexually active adult has easy access to it and understands how to use it.
Unfortunately, Weinstein treats PrEP like Jenny McCarthy treats vaccines. And like McCarty, he’s endangering millions of lives.
Also, by shaming people who use PrEP, he’s encouraging a cycle of self-loathing, particularly among gay men. He makes them believe that they’re doing something dirty, that any sex acts that don’t follow his prescribed methods are dangerous, worthy of disgust.
If Weinstein’s actions have prevented anyone from using PrEP, if he has driven anyone to depression or suicide because of their sexual acts, he should be held accountable–no less accountable than Ronald Reagan, whose unwillingness to act in the early days of the AIDS crisis cost untold numbers of lives. Weinstein and Reagan: they’re really no different in my book.
Too harsh? If you’re one of those who’s inclined to defend Weinstein, ask yourself this: would he have been so anti-PrEP if it were available in 1981? 1985? 1990?
Also, consider this AHF press release, which landed in my inbox late last week:
AHF: New UCLA Study Shows Gay Men on PrEP Are 45 Times More Likely to Contract Syphilis; 25 Times More Likely To Be Infected With Gonorrhea
LOS ANGELES (September 8, 2016) — Researchers at the University of California Los Angeles (UCLA) issued a damning new report this week showing a dangerous link between the usage of pre-exposure prophylaxis (PrEP) by men who have sex with men (MSMs) and an astronomical increase in sexually transmitted infections (STIs).
In a research letter by Noah Kojima, Dvora Joseph Davey, and Dr. Jeffrey D. Klausner published in the September 10th issue of AIDS, the official journal of the International AIDS Society, the authors report that a meta-analysis of 18 cohort studies of MSMs with incident STIs found that “incidence rate ratios showed that MSM using PrEP were 25.3 times more likely to acquire a Neisseria gonorrhoeae infection, 11.2 times more likely to acquire a Chlamydia trachomatis infection, and 44.6 times more likely to acquire a syphilis infection versus MSM not using PrEP.” The studies included in the meta-analysis, including the PROUD and IPERGAY trial studies that PrEP supporters often reference to promote PrEP usage, covered a time period from 2010 to 2016 for MSM using PrEP and from 1998 to 2016 for MSM not using PrEP.
“These results by the UCLA researchers add timely, statistical evidence to the concerns AHF has long held and expressed regarding PrEP being widely promoted as a public health strategy,” said AHF President Michael Weinstein. “While we’ve often been mischaracterized and criticized for our position on PrEP, AHF’s mission and goal has always been to use scientific evidence to advocate for public policies that will inform and help protect the public from all STDs. This latest analysis should be a wakeup call for MSMs and other sexually active people that PrEP is not the magical panacea it’s often promoted to be.”
Heralded as a breakthrough medical advancement in the fight against HIV/AIDS, Gilead Sciences, Inc.’s antiretroviral HIV drug Truvada was approved for PrEP by the U.S. Food and Drug Administration (FDA) in July 2012. Following its FDA approval, the U.S. Centers for Disease Control and Prevention (CDC) threw its full support behind PrEP, championing PrEP coverage as one of its “key prevention strategies” and encouraging in May 2014 that 500,000 MSMs should go on PrEP. Last November, the CDC upped its support for PrEP by recommending that 1.2 million “high risk” Americans—including 25% of all sexually active gay and bisexual men, 20% of people who inject drugs, and 1 in 200 sexually active heterosexual adults—should be considered good candidates for PrEP.
Yet after four years of Truvada being available for PrEP prescriptions and millions of dollars spent to promote its benefits and usage, the number of PrEP prescriptions remains at a miniscule fraction of the recommended numbers, with Gilead releasing a report in June that declared that only 49,148 total cumulative PrEP prescriptions have been filled based on data reported by 82% of all pharmacies. In response, AHF issued an “Open Letter to the CDC on PrEP” that called on the federal agency to “rebalance your prevention efforts to align with what patients want and need so that we can achieve better success in preventing new infections.”
“Not only have gay and bisexual men largely rejected the relentless drumbeat for PrEP by the CDC and other agencies who have been dubiously shilling for Gilead, the men who are using PrEP are having increased condomless sex—contrary to the PrEP guidelines set by the CDC—and, as a result, are exposing themselves to dangerous sexually transmitted infections,” continued Weinstein.
The UCLA researchers’ report supports a 2014 study from Kaiser Permanente that revealed that the use of PrEP resulted in a 45% increase in condomless sex among certain study participants, leaving them vulnerable to disease.
Their findings come amid growing international concern about the rise of antibiotic resistant strains of gonorrhea and other STIs. In releasing its new guidelines for treating bacterial STIs last week, the World Health Organization (WHO) expressed concerns that “resistance of these STIs to the effect of antibiotics has increased rapidly in recent years and has reduced treatment options. Of the 3 STIs, gonorrhoea has developed the strongest resistance to antibiotics. Strains of multidrug-resistant gonorrhoea that do not respond to any available antibiotics have already been detected. Antibiotic resistance in chlamydia and syphilis, though less common, also exists, making prevention and prompt treatment critical.” Last December, Britain’s top doctor and pharmaceutical officer issued warnings about an antibiotic resistant “super-gonorrhea” that had been identified in the country.
“These global warnings about antibiotic resistant STDs must be taken very seriously, especially considering that using PrEP alone offers zero protection against infections like gonorrhea, syphilis, and chlamydia,” Weinstein added. “Despite some people’s desire to simply wish them away, these common STDs remain health risks that must be taken seriously and are best avoided by using condoms.”
According to the Centers for Disease Control and Prevention (CDC), gonorrhea is the second most commonly reported notifiable disease in the United States, with 350,062 gonorrhea cases being reported in 2014.
AHF’s Wellness Centers provide free testing for sexually transmitted diseases, including chlamydia, gonorrhea, syphilis, and HIV. To find the nearest location for STD screening and treatment, visit www.freestdcheck.org
I admit, it’s a complicated situation. However, Weinstein should focus on the mission of the organization he leads, which is about HIV prevention and treatment. If he’s unwilling to find ways to incorporate PrEP into AHF’s prevention programs, he should resign immediately, before he does any more harm.