![]() ![]() In their opening paragraph, Weinstein and his coauthors recognize the recent decrease in HIV infection rates in the United States and then rightly stress how various populations remain at disproportionately high risk for the virus, mentioning racial minorities, adolescents and young adults, and Southerners-but not a word about MSM. This admission notwithstanding, the editorial makes no explicit reference to men who have sex with men (MSM), who are both the chief candidates for PrEP and apparently make up the vast majority of its users. “Eradicating HIV transmission is a goal shared by us all,” the AHF essayists state, allowing that “PrEP clearly has a role in selected populations.” ![]() More on PrEP’s psychosocial benefits from Mitzy Gafos Courtesy of Benjamin Ryan Additionally, the routine STI testing that accompanies a PrEP prescription provides an excellent opportunity to rapidly diagnose and treat STIs. These benefits extend beyond the medical realm and include the reduction of stigma toward people living with the virus as HIV-negative individuals reevaluate their attitudes toward partnerships across the HIV-status divide, as well as mitigated anxieties about and increased enjoyment of sex among those taking Truvada for prevention. Keen to highlight a lack of data proving definitively that PrEP has succeeded in preventing HIV on a grand scale in the United States (very challenging to prove in real-world settings), the essay all but ignores the numerous benefits of PrEP that have nevertheless become increasingly apparent in recent years. Complex circumstances have restricted the powder-blue tablet’s awesome power to prevent HIV-they do acknowledge PrEP’s high, adherence-based efficacy-from key demographics at greatest risk of the virus.īut by and large, the editorial is compromised by unsound logic, the cherry picking of evidence and the tendency to ignore important granular details about HIV infection and PrEP-use trends. They commendably sound the alarm about racial, regional and age-group disparities. The authors’ position that PrEP has had limited reach in certain high-risk subgroups does indeed have considerable merit, as does their conclusion that Truvada’s use among HIV-negative individuals likely contributes to an increase in sexual risk taking. PrEP, these three argue, “has not had the positive impact anticipated by the CDC.” ![]() Weinstein, who leads the largest HIV nonprofit in the world, published the “viewpoint” journal article, titled “Were We Prepared for PrEP? Five Years of Implementation,” in the journal AIDS along with Otto Yang, MD, ScD, scientific director at AHF, and Adam Carl Cohen, PhD, MPH, the nonprofit’s director of advocacy and policy research. AHF has long slammed the federal agency for its failure to contain a fast-rising sexually transmitted infection (STI) epidemic and, on the HIV prevention front, for shifting its focus away from condom promotion and toward the use of PrEP and antiretroviral (ARV) treatment to prevent HIV (known as biomedical prevention). The principle target of the AHF coauthors is the Centers for Disease Control and Prevention (CDC). Now, five years since PrEP’s approval in the United States, Weinstein has returned to the fore, with an editorial in the prestigious journal AIDS in which he and a pair of AHF scientists dismiss Truvada as a mere “boutique intervention” against HIV, one that wreaks collateral damage on society and offers limited benefit in exchange. While he denies being simply “anti-PrEP,” Weinstein has played the largely isolated role of the media’s go-to guy for negative sound bites about Truvada’s use as HIV prevention. Over the years, AHF has run misleading and on certain points flat-out incorrect full-page advertisements about PrEP in gay newspapers as part of Weinstein’s years-long effort to chip away at Truvada’s image as a promising, or successful, means of combating HIV. After something of a lull, AIDS Healthcare Foundation (AHF) president Michael Weinstein has revived his ever-the-skeptic public campaign regarding Truvada (tenofovir disoproxil fumarate/emtricitabine) as pre-exposure prophylaxis (PrEP), publishing a critical editorial on the HIV prevention method in a major medical journal.
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