First Politician Comes Out of the PrEP Closet

San Francisco city councilman Scott Wiener announced in a statement last week that he takes the pre-exposure prophylactic drug Truvada.

“After consulting with my physician, I went on PrEP to further protect and take personal responsibility for my health. I'm HIV-negative, and I want to remain that way,” Wiener said in a post on The Huffington Post.

“I recently decided to be public about my use of PrEP in order to raise awareness about this relatively new tool for preventing HIV,” he said. 

The antiviral drug was approved for use by the FDA in 2012 and was touted as a miracle drug in the fight against the spread of HIV. According to one research study, Truvada, when taken correctly, has an efficacy rate of 99 percent at preventing HIV infection (though this figure is somewhat disputed).

However, Truvada hasn’t been embraced as enthusiastically as expected.

Part of this is the cost. Truvada must be taken daily and can cost between $8,000 and $14,000 a year, though, according to Wiener, most insurance companies cover the pill and payment plans are available for those struggling with the price tag.

But greater criticism comes at the thought of using the drug at all or in place of condom use. In a May interview with The New York Times, AIDS activist Larry Kramer blasted the drug. “Anybody who voluntarily takes an antiviral every day has got to have rocks in their heads,” Kramer told reporters, describing the side effects of drugs he has taken. “There’s something to me cowardly about taking Truvada instead of using a condom. You’re taking a drug that is poison to you, and it has lessened your energy to fight, to get involved, to do anything.”

Critics of PrEP have argued that it will encourage men who have sex with men to stop using condoms altogether, but proponents argue that men are already abandoning safer sex practices established during the AIDS epidemic. According to AIDS Map, only one in six men use condoms 100 percent of the time.  

They have also claimed that using methods like Truvada leads people to engage in riskier behavior, though no study supports this claim and there is some evidence that using PrEP does not make one more or less likely to use condoms.

Truvada as PrEP has wide support among public health organizations like the World Health Organization and the Center for Disease Control and Prevention, and is being encouraged for use with condoms, not as a standalone preventative measure.

In his statement Wiener pointed out that despite increased education and condom usage, new HIV infections had not disappeared. He also said that people should choose what method is best for them in preventing infection.

“None of this is preordained,” he said. “People don't need to continue to get infected, and we know that PrEP has the potential to help stop the epidemic in its tracks by ending new HIV infections.”

The benefits of PrEP extend beyond the gay community as well, said Wiener. It is possible, he claimed, that an HIV positive woman could use PrEP in order to conceive an HIV negative child.

“We know how to end HIV infection. We simply need the political will to ensure that the community has accurate information about and access to all prevention methods, including PrEP,” he said. “I hope my disclosure can play a role in moving us toward these goals.”