“In terms of the people who have been yelling the loudest about this, they’ve all been associated with bareback porn,” Weinstein told BuzzFeed.
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Michael Weinstein in his Los Angeles office in November 2013. Mark Boster/Los Angeles Times / MCT
The leader of the nation’s largest community
HIV/AIDS health care organization stands by sharp words he had for a
drug that has been approved for its potential to prevent the
transmission of HIV — comments that some doctors and activists say are
“irresponsible” and even led to a petition demanding his resignation.
“I’ve had debates on this subject, but these people are jumping to
character assassination and I’m not going to respond to it,” said
Michael Weinstein, president of the Los Angeles-based AIDS Healthcare
Foundation, the largest HIV/AIDS medical care provider in the U.S.
“My
record and the record of AHF speaks for itself.”
Outrage erupted among activists and health care advocates after
Weinstein referred to Truvada, a pill that has been proven to be
effective in reducing the transmission of HIV when taken daily, as “a
party drug” in an April 7 article
by the Associated Press detailing some of the differing views on the
HIV prevention method.
“If something comes along that’s better than
condoms, I’m all for it, but Truvada is not that,” he said.
Weinstein, who has long been a critic of the blue pill, has no
intentions of stepping aside or quieting down and blames much of the
backlash he’s received on what he said is the “bareback porn industry.”
Michael Lucas, creator of one of the largest gay porn companies, Lucas
Entertainment, also called for Weinstein to leave his job in an op-ed published by Out magazine.
“In the last few days in terms of the people who have been yelling
the loudest about this, they’ve all been associated with bareback porn,”
he said.
“They’re all associated with bareback porn, which kind of
makes my point that it’s a party drug.”
According to Lucas, Weinstein should be removed from his post
immediately, saying,
“Mr. Weinstein knows how to portray PrEP, along
with gay men, in the most unattractive light,” Lucas wrote.
“… In Mr.
Weinsteing’s eyes, PrEP isn’t about public health. It’s just a highly
expensive way for those horny, irresponsible gays to go back to their
barebacking-gone-wild.”
HIV/AIDS health care providers and activists say Weinstein’s
assessment flies in the face of evidence that Truvada is effective, and
some took offense to his comparing it to a party drug.
“Comments like that of Michael Weinstein really devalue and diminish
decades of research and the opinions of experts the world over that
would very much disagree with his characterization,” said Jim Pickett,
director of Prevention Advocacy and Gay Men’s Health at the AIDS
Foundation of Chicago.
“The idea that [Truvada] is simply some party
drug on par with crystal meth or ecstasy is really ridiculous and
insulting.”
The Food and Drug Administration approved the use of Truvada for
pre-exposure prophylaxis, or PrEP, in 2012 — meaning doctors can
prescribe the pill to people who are at high risk of HIV, such as gay
men and people who are HIV-negative who have sex with HIV-positive
partners, to prevent the transmission of the virus.
Truvada has long
been part of a combination of drugs used in treating people with HIV.
Proponents of the drug point to studies showing massive reductions in
HIV transmissions in cases where the drug was taken daily.
But
Weinstein, and other Truvada critics, question the drug’s ability to be
effective because patients are unlikely to adhere to the daily regimen.
A
factor in this could be the drug’s high cost — about $13,000 per year —
although many insurance plans and Medicaid cover prescriptions.
Additionally, Truvada, unlike condoms, will also do nothing to
protect people from other sexually transmitted diseases such as
syphilis, herpes, and gonorrhea, Weinstein said.
“The primary issue with Truvada is that in the perfect world if
people took it every day they would be protected, but that is not the
case,” he said.
“I read over and over again articles talking about how
it’s more than 90% effective and they don’t even mention the adherence
issue. PrEP is just not 90%-plus effective in the real world. It’s just
not ready for prime time as a public health strategy.”
Dr. Demetre Daskalakis, medical director of the ambulatory HIV
program at Mount Sinai Hospital in New York, said he is a prescriber of
Truvada, telling BuzzFeed,
“I don’t see it as a party drug at all.”
Daskalakis also sits on the board of Gay Mens Health Crisis, one of the
nation’s top HIV/AIDS prevention, care, and advocacy organizations.
He
was also part of the FDA panel that approved Truvada for PrEP.
“The guys I’m giving Truvada to and some women, have a lot of good
reasons to take it,” Daskalakis told BuzzFeed.
“If being in a sexual
relationship with someone who is HIV-positive is a party, then Truvada
is a party drug.”
Daskalakis and Pickett are among critics of Weinstein’s comments who
think likening Truvada to a “party drug” is judgmental of behavior and
detracts from what HIV/AIDS advocates aim to do: Prevent HIV, Daskalakis
said.
Pickett said it equates to “shaming” and “the paternalism and the
infantilization of gay men.”
Weinstein also said numbers from Gilead Sciences (the maker of
Truvada) show fewer than 1,800 people have been prescribed Truvada for
prevention, saying,
“More importantly, the physicians who treat gay men
aren’t recommending it, otherwise more and more people would be on it.
It’s been on the market for two years and it really hasn’t caught on.”
With that said, Weinstein concedes “there’s no problem” if someone’s
doctor thinks Truvada is appropriate for them, but said,
“I still think
that it’s Russian Roulette because of the adherence problem.”
Weinstein’s comments
— from the top of such a large HIV/AIDS health
care group — demonstrate the challenging road advocates face in reducing
new HIV infections, which are currently at about 50,000 per year in the
U.S., Pickett said.
“We need to have thoughtful and critical discussions with people who
want to take Truvada and who need it,” he said,
and Daskalakis said
Weinstein’s comments are
“a conversation stopper.”
“This conversation is great,” he said.
“I think you have to exorcise
this demon, and it has to be processed culturally.
There will be time
when this intervention will be kind of routine.”
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