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November 28, 2014

What if you’re wrong about PrEP?

An open letter from the AIDS Healthcare Foundation to the CDC

The Centers for Disease Control and Prevention recently recommended that half a million gay men in the United States receive Truvada for the prevention of HIV. Further, they changed their wording from “unprotected sex” to “condomless sex” to describe intercourse without a condom, thus saying that sex without a condom could still be safe if accompanied by medication while ignoring the transmission of all other STDs besides HIV. AIDS Healthcare Foundation regards these decisions as dangerous to the public health of the country. Both of these decisions are based on the premise that PrEP (pre-exposure prophylaxis) with Truvada is a sound public health strategy.

AHF believes that while Truvada may work to protect a small segment of the population of HIV-negative individuals, all of the scientific studies have shown that it will not work on a community-wide basis because of consistently bad adherence by study subjects – even under ideal circumstances.

However, if the data that will be reported in the next two years show that we are wrong about PrEP, we will be the first to admit it. We challenge the CDC to make the same pledge.

Currently, the gay male community is facing soaring rates of syphilis and other STDs. The CDC knows that Truvada offers no protection against syphilis. If those numbers continue to go higher, will the CDC go back to calling unsafe behavior “unprotected?” If people on Truvada become infected with HIV, will the CDC reconsider its rash decision on PrEP? If men who become infected develop drug resistance, will the CDC apologize?

Medical ethics are based on the concept of “do no harm.” Beyond the potential damage to the health of the individuals, the CDC’s ill-advised strategy of mass treatment with Truvada poses a significant risk to the condom culture, which while it has eroded, has still prevailed among gay men for three decades.

Studies show that the majority of gay men use condoms always or sometimes. This is borne out by the fact that the current rates of infection would be far higher if they didn’t. Therefore, spreading misinformation that Truvada is an effective community-wide prevention strategy has the potential to do grave harm.

Both the community and the government must be accountable for the guidance they give to vulnerable populations. The debate about safer sex goes back to the beginning of the epidemic. Every time we didn’t heed advice to protect ourselves, we paid a terrible price. AHF will do everything that we can to make sure that doesn’t happen again. However, if we are wrong, we will take responsibility for our decisions. We hope that everyone else will do the same.

The AIDS Healthcare Foundation wants it to be very clear that the open letter and concerns about PrEP are directed at the Centers for Disease Control and Prevention and not towards other AIDS Service Organizations.










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