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Still no generic HIV meds. If this stuff ain't uranium, it certainly don't come grow on trees.
Mitch, your convolutions multiply. what you call a "recreational drug" is in fact a medically valid and appropriate option for some. smokers are not denied pulmonary treatment based on the theory that it enables their unhealthy choice to smoke. smoking is unnatural, conversely so is sex with condoms...whereas bareback sex is an intrinsically valid and natural choice, albeit it one with serious risks in the present medical era...tho that risk is already evolving downward. it SHOULD be the mission of the medical community to facilitate human functioning at the most natural and unimpeded level...humans have a tendency to constantly want that. as for funding, you make several leaps. despite the suggestions of Dr. Sonnabend and others on POZ, i have yet to see anyone offer a shred of evidence to show that PrEP has siphoned off funding for any other form of HIV-prevention *anywhere*. conversely, approving PrEP would mean that less adventurous doctors with less financially-capable patients would have a needed option that is already in use by the more affluent. as for ADAP, your confusion of terms is telling. if you mean that some Floridian on an ADAP waiting list should get to decide how their Federal tax payments are spent, that's actually why we have a Congress...once Uncle Sam takes your money, it's not yours anymore unless/until he says so. however i'll assume you meant to say that there should be no Government or private insurance coverage of PrEP until all HIV+ people that need meds can get them. if you limit this to the USA, i would actually agree with you in principle...but that's not how it works. FDA-approval of PrEP does not redirect ADAP funds to PrEP coverage, and the lack of sufficient ADAP coverage in some states is something to take up with individual State legislatures...perhaps ObamaCare will genuinely fix that 2014, barring any legal or political shifts. At that point, approving PrEP simply means that people who would otherwise become HIV-positive would have a far better chance at staying HIV-negative. the idea that funding coverage of PrEP somehow competes with funding for HIV+ people seems based on internalized stigma. medically speaking, it is already well-established that prioritizing ARV-availability and adherence for HIV+ people is *the most* cost-effective means of stopping the spread of HIV. It's also the most humane and correct thing to do...plainly so. if some of you feel that HIV+ people will be written off in favor of giving ARV's to HIV- people, i wish you would explicate that fear rationally and in public. furthermore, Bill Clinton's recent suggestion of allowing generic availability of ARV drugs in the USA points us all in the proper direction: Truvada and ARV's are not finite resources, they are simply patented ideas for manufacture. patents are like any other property: Government can seize it for the public good. face facts: barebacking/raw/condomless/all-natural sex is never going away. serosorting will always be less than reliable. condoms were never the only, final answer to HIV-prevention...they are simply a cost-effective stopgap for many or most. they require yet more selling as prevention tools...but as moral totems, they have been long oversold. how many "safe only" guys do you think are honestly telling researchers about how often they "slip up"? the sis-boom-bah over condoms often obscures the limitations of relying solely upon them as an infection-prevention strategy. more solutions are needed, and PrEP is very clearly one of them. people with HIV and people who remain at risk for it are not crabs in a big bucket...but it sure can seem otherwise around here.
Insurance companies don't pay for recreational drugs, how exactly is this a fight for "the poor and disadvantaged"? I hope to god you're not suggesting that some floridian on an ADAP waitlist should have their federal tax money redirected towards other peoples "good sex".
Mitch, the limb you have gone out on cant hold the weight of your sanctimony...let alone the sanctimony of your allies on this issue. what you call "condomless sex" is actually just normal, plain-old sex for most of humanity. i thank you for underlining my point about the sputtering sexual fundamentalism of much of the AIDS-service establishment...though you boldly ignored the reality that the subset of people who can afford PrEP right now, desire to use it and have the knowledge to use it consistently CAN ALREADY DO SO. i have met and had sex with quite a few of them already. the campaign to get FDA approval for PrEP has always been a campaign to help save the lives and health of those who continue to fall through the widening cracks of condom-boosterism and activist-NewSpeak...especially the poor and disadvantaged. THEY are the ones who would benefit from widely available and targeted PrEP access. the utterly benighted self-righteousness of the AHF and its allies on this issue is no less murderous than that of the Republican legislators who gut AIDS funding...but hey, Mitch, once those poor and disadvantaged people who "failed" to follow your wagging finger actually get infected, you'll have a chance to convert them to your point of view more easily! of course, by then they will need considerably more medicine and medical attention than PrEP...and they can serve as cautionary tales for your self-congratulating narrative! i suppose this fault-line has lied underneath the POZ-community all along, and it took medical advancements to reveal it. i expect this gap to widen, unfortunately. somewhere in the depths of Hell, Jesse Helms and Strom Thurmond must be chuckling...
If you really love your boyfriend, why don't you just take the meds yourself? His relative risk would be much lower than if he was on prep. Are you not on meds because you don't have access to the drugs? Why not? Maybe because they cost several thousand dollars a month, AIDS drug assistance programs have collapsed and we're directing our resources to the development of the bareback party pill? As for phrasing, the term "bareback party pill" is perfectly apt. I don't know what types of "high risk" gay men it was tested on, but I'm going to go out on a limb and assume that there aren't a lot of negative partners of stable, disclosing, undetectable guys who are actually seroconverting from unprotected oral sex. In fact, I've yet to hear any examples of people who NEED to use the pill that will benefit from it. What I've heard are claims from supposed serodiscordant couples who for one reason or other want to have unprotected sex. Notions that these people are in any danger of seroconverting are dubious, and serve to reinforce the notion that effectively diagnosed, treated, honest pozzies are the ones driving infections. This is not only scientifically inaccurate, but highly stigmatizing. I'm going to go out on a limb and assume that the study probably didn't involve a lot of undetectable serodiscordant gay couples having unprotected oral sex. There just aren't enough infections in this cohort to yield any usable data. There probably aren't any. Instead, when they went looking for "high risk" gay men, they looked for people in immediate danger of seroconverting in large numbers-prostitutes and people who prefer the thrill of condomless sex. Prostitutes aren't going to have access to this pill though. They tend to lack access to health insurance, and no one is in any rush to formulate a plan that would make this stuff cheap or accessible enough for them. So we're left with barebackers. Precisely, the types of people who realize they're going to engage in risky behavior, can go to a doctor weeks prior to an exposure, take the drug consistently AND afford it. In other words, we're talking about sex tourists. "Bareback party pill" is a perfect description for what this drug is.
I find it odd to believe you can class this as a "bareback party pill".... But obviously you are all so safe when you perform sexual acts be it in a gay or straight relationship and this also include oral sex. I made the mistake of having unprotected sex with someone out of a relationship (the first person i had unprotected sex with who wasnt a boyfriend) and through this i contracted HIV. I am now with my partner who is HIV negative and care for him alot.Tthe pleasure of being able to have unprotected sex is obviously missed as i am concerned for his health and would not like him to get what i have. But, with a preventative measure like this out there, it would help people like me and my partner have a loving relationship where i dont have to constantly consider the danger of me infecting him. I feel that people who are at high risk should be able to take the PrEP like my boyfriend as in this situation it is not used as a "bareback Party Pill" its protecting someone who is at high risk of catching the virus.
Has the entire HIV service industry gone insane? How can someone invoke the growing HIV epidemic in disadvantaged men of color to justify the legalization of a recreational party drug that costs more than a thousand dollars a month? How exactly will a pill that requires weeks of pre-planning and high adherence decrease the incidence of a disease that spreads mostly amongst people who don't realize they are at risk? Since when is 42% more effective than 98%? We are truly at a low point in HIV politics when our "activists" and "leaders" prioritize the expedition of a recreational sex pill to benefit the social lives of those who don't even have HIV. I'd urge Mr. Munoz and other "leaders" to focus on caring about people who actually have the disease, but I'm not certain I even want their kind of "help". The reality of prep is plainly obvious: it will not decrease anyone's likelihood of infection. Arguments that it won't increase the rate of infection are ridiculous. Tell me, if gay men won't be using the drug for unprotected sex, why exactly will they be taking it? Gilead and other drug companies realize the drug won't slow the spread of HIV, as does virtually anyone with a passing familiarity with what sort if situations have resulted in infections since the mid eighties. The real question WHY Gilead is interested in finding a new use for this old drug? I suspect that Gilead wants to renew it's patent on the medication. Magically discovering new uses for old drugs is one if the oldest tricks in the book for desperate pharmaceutical firms. It would allow Gilead to continue outlandish rate hikes and prevent the distribution of safe, legal generic versions. It would also keep the drug out of the hands of millions worldwide who desperately need it, and eliminate the possibility of a tolerable modern cocktail-atripla-from going entirely generic. The subsequent costs to taxpayers in the US and throughout the world would be billions of dollars and inconceivable human suffering. To me, that is too great a price to pay for a bareback party pill.
Tom
We are seven months past the promise of generic HIV meds. There are still more than 2,000 people on waiting lists. Truvada was approved as prep today, and will cerainly allow Gilead to renew its patent, at enormous expense to us with no corresponding reduction in infections. Funding for HIV services has collapsed in Mr. Munar's home state, a prospect that would be greatly alleviated by a generic drug we will not see. How many people are going to die for the bareback party pill?
July 16, 2012