PrEP Debate Continues As Advocates Hold Conversations In State

Jesse Anguiano only wanted an extra layer of protection during sex. The 31-year-old gay man had been hearing about pre-exposure prophylaxis (PrEP) for some time from HIV test counselors at the Lansing Area AIDS Network, but when he sought out the pill he ran into barriers.
"It was actually very difficult to access," Anguiano said during a phone interview. "A lot of doctors were ignorant in Lansing and unwilling to help."
PrEP is an HIV prevention intervention that's been out for more than two years using the anti-HIV drug Truvada. When an HIV-negative person takes the pill daily, it has been shown to be at least 92 percent effective in preventing HIV infection, and in a study from the National Institutes of Health, the efficacy of daily use of the drug was pegged at 99 percent. In May, the CDC released new clinical guidance on who should take the little blue pill – clearing the way for as many as 500,000 Americans to meet the clinical guidance.
However, Anquiano's experience is not unique for men who have sex with men seeking out what is considered a new prevention technology by many physicians unfamiliar with the drug – or the unique cultural needs of sexual minorities. He said he rejected three doctors over his pursuit of the drug because they were not culturally sensitive to the gay community.
Anguiano will join Dr. Peter Gulick, an infectious disease doctor in Ingham county; Dwayne Riley, the HIV prevention manager at the Lansing Area AIDS Network; Joel Murr, assistant deputy health officer for Ingham County; and Eric Paul Leue, Mr. LA Leather 2014 for a discussion about PrEP on Sunday, Dec. 7 at Lansing's Esquire Club, 1250 Turner St. The panel discussion is part of Leue's national tour to promote conversations about general sexual health for men who have sex with men in addition to specific PrEP talk.
"PrEP made itself my mission," Leue said. The debate, which has taken on a "moralism" and "judgement" tone, needs to change he said. "The science is utterly clear, right? It's black and white. Take a pill once a day and you're protected from HIV."
However, there is a divide among public health officials, leaders in the gay community and people in the HIV prevention community. Some are concerned that widespread adoption of the drug will result in a spike in other sexually transmitted infections in men who have sex with men – they believe it will empower those men to engage in riskier sexual activity, called risk compensation in science. Some say the drug has too many potential negative side effects.
Studies show that those on PrEP are not falling into riskier sexual activity than before they were on the drug. In fact, the initial study (iPrEx, which determined Truvada worked as PrEP) found that study participants reported more condom use and less unplanned sexual activity.
As for the concerns about STIs, Leue points out that condoms don't necessarily prevent those, either. Syphilis, a growing concern among men who has sex with men, can be spread by skin to skin contact. Gonorrhea and Chlamydia can be transmitted via oral sex.
"People who are on PrEP are being screened for STIs regularly – they are more likely to be diagnosed early," Leue says. "That means they are less likely to transmit the infection to someone else."
Viral infections are trickier, but Leue points out that Truvada has been shown to have some impact on the acquisition of herpes. Meanwhile, he says, Hep. B and HPV can both be prevented with vaccines.
Both Anguiano and Leue note that PrEP is another layer of protection from HIV. Both men have been on the drug for about four months.
Most importantly for Leue, however, has been witnessing the shifting conversation that PrEP is bringing to the gay community.
"The positive person was always the one charged with prevention," he says. "That divide is being challenged by PrEP. Now it's about shared responsibility."
"I would like to inspire people to rethink what prevention means," Leue says.
Anguiano shares that mission. Before PrEP, he says he was nervous during and after sex. Now, he suffers no such concerns. And he is frustrated by the "moral" arguments he hears from some in the gay community.
"You don't have to be a 'Truvada whore' or promiscuous to use PrEP," Anguiano says. "It's about taking care of your health and taking responsibility for it."
Leue will appear at PrEP panels at 8:30 p.m. on Dec. 6 in Grand Rapids at Diversions Nightclub, at 7 p.m. on Dec. 7 in Lansing's Esquire Club and at 7 p.m. on Dec. 8 at the Affirmations Community Center in Ferndale.