What’s Reckless About a Campaign to Prevent HIV?

As a physician who has been treating people with HIV since the beginning of the epidemic and as a witness to more than a few AIDS-related controversies, I’m profoundly puzzled by how some are overreacting to a new HIV prevention campaign.

F*ck w/out Fear is the admittedly audacious tagline of the Los Angeles LGBT Center’s new campaign to raise awareness about pre-exposure prophylaxis, which consists of taking a pill (Truvada) each day to prevent infection with HIV. PrEP has been in wide use since 2015, is remarkably effective, and is recommended by the Centers for Disease Control and Prevention for people at high risk of HIV infection. 

Critics of the campaign, including people responding through social media and a panel of physicians on the TV show The Doctors, have taken the tagline out of context, claiming it promotes “reckless sex.” The owner of a West Hollywood yogurt store, sandwiched between bars that feature go-go dancers visible from the street, complained that the campaign’s sidewalk art was bad for business and that customers are “ashamed and embarrassed” at the message.

Let’s get real. Sometimes the language to begin a conversation needs to be authentic, even vulgar and shocking to some. There’s now a pill that will prevent people from becoming statistics. There’s nothing reckless about that knowledge, nor is there anything reckless about alleviating the fear of HIV transmission during sex. In fact, the criticism of recklessness reminds me of how some women in the 1960s were branded as promiscuous because they dared to take a new pill to prevent pregnancy. 

Once someone consults with the center about PrEP, counselors engage that person on how to have a healthy sex life with strong advice to use condoms to prevent other sexually transmitted infections. In fact, it goes without saying that prescribers of PrEP emphasize condom use to avoid other sexually transmitted infections. Some people heed the advice and others don’t, but to think that condom promotion alone is enough to stop the spread of HIV ignores 36 years of history with this deadly virus.

The campaign targets HIV-negative black and Latino gay/bisexual youth, and transgender women, who are at an astronomically high risk of becoming infected with HIV in their lifetimes. The CDC projects that half of African-American gay and bisexual men and a quarter of Latino gay and bisexual men will become HIV positive in their lifetimes. Data regarding transgender women is more difficult to come by, but some estimate that as many as 40 percent are already HIV-positive.

What’s most important is that the campaign’s working. Since it launched, the center has doubled the number of people it has helped to get on PrEP each week, and a majority of the clients are those at greatest risk of infection.

Taken correctly, PrEP is a remarkable prevention tool — close to 99 percent effective. Unfortunately, efforts to drive awareness about it have fallen short in reaching the communities most at risk. That’s why I think we should be lauding a campaign that’s helping to boost awareness and the use of PrEP rather than taking its tagline out of context and complaining about language some find vulgar.

Those of us in the trenches of this epidemic have learned that open and honest discussions about HIV/AIDS sometimes make people uncomfortable. Why? Because they inherently involve issues of sex, race, sexual orientation, transmission of diseases, and the nitty-gritty of sex acts. But this is not the time to start censoring messages that are working to promote prevention — not when the HIV infection rate among gay/bi youth and transgender women is on the rise and when we’ve got the ability to change that with a pill. To do that would be reckless.

DR. MICHAEL GOTTLIEB identified AIDS as a new disease in 1981 and is medical adviser to the Elizabeth Taylor AIDS Foundation.