Tank Teachworth, former Mr. Atlanta Eagle and American Leatherboy titleholder, readily acknowledges he likes to have fun sexually. As an HIV-negative man, he believes all opportunities to stay safe should be on the table—and for him that means pre-exposure prophylaxis, or PrEP as it’s commonly abbreviated.
“Sometimes in leather things can get intense and sometimes condoms can break. Nothing is foolproof. I wouldn’t call myself an exceptionally promiscuous person, but I like to have fun,” Teachworth says.
“If there’s another opportunity to stop one more case of HIV transmission then I feel PrEP is worth it. If I make a connection with somebody I’d like to do so responsibly,” he adds.
Randy Prophater, chair of Team Friendly Atlanta and organizer of the town hall, wants to cut through the noise and misinformation regarding PrEP by sharing accurate information directly with Atlanta’s LGBT community.
PrEP is a once-daily dose of Truvada, the antiretroviral medication approved by the FDA in 2004 as treatment for people living with HIV. The drug is now heavily marketed to gay men and is the latest method of protection in the effort to decrease the number of new HIV infections.
But it’s likely the groups most at risk for contracting HIV are either unaware that PrEP exists, lack access to the preventative drug or find themselves confused regarding the facts about PrEP amidst a vibrant public debate on its effectiveness and whether or not it will fuel an increase in promiscuity.
“There’s a lot of information out there and it seems a lot of individuals and organizations are cherry picking—they’re not giving the whole picture,” Prophater tells GA Voice. “It’s through education in a town hall forum that we provide people an access point.”
One of the advantages of using PrEP in addition to consistently using condoms is the extra barrier of protection against HIV infection. It’s important to acknowledge how PrEP can be empowering to individuals who lack autonomy when negotiating safer sex with their partner or partners, Prophater says.
Prophater believes we’re “selling ourselves short” if we don’t use all of the tools available to curb new HIV infections, and this includes PrEP. According to the results of a 2010 clinical trial by the National Institutes of Health, “among men who have sex with men with detectable levels of the medication (Truvada) in their blood, the risk of HIV acquisition was reduced by more than 90 percent.”
One might expect that with such a high success rate of PrEP as an anti-HIV blocking agent, more sexually active teens and adults would opt in and the hard data would cause PrEP detractors to retreat—but not so.
A LICENSE FOR RECKLESS BEHAVIOR? Michael Weinstein, CEO of California-based AIDS Healthcare Foundation, one of the largest AIDS service organizations in North America, caused an uproar in the gay community and online when he spoke to the Associated Press this month about the illegitimacy of PrEP as a prevention tool and the gay men who use it.
“Let’s be clear: It’s a party drug,” Weinstein said in the April 7 interview. “If something comes along that’s better than condoms, I’m all for it, but Truvada is not that.”
Weinstein and other critics have expressed doubt in the ability of gay men to adhere to the prescribed drug regimen. Their failure to do so would decrease the effectiveness of PrEP and increase the possibility exposure to HIV through a false sense of protection they believe PrEP provides. Weinstein believes true protection can only be attained through condom use.
But it’s the moral policing and accusations of sexual promiscuity by Weinstein that have angered many in the gay community. “There’s an element in the gay community that espouses ‘anything goes,’ that is for sexual freedom and not giving an inch,” Weinstein said. “But demonizing me or AHF isn’t going to shut us up.”
Teachworth, who is on PrEP, disagrees with Weinstein.
“So people who do heroin don’t deserve to be protected? Is one life more valuable than the other? People are going to make poor decisions. Every human life deserves protection whether they’re partying or not,” Teachworth says.
Dr. Colleen Kelley, Assistant Professor of Medicine in the Division of Infectious Diseases at Emory University and a town hall panelist, believes PrEP should be widely available to people who feel they’re at risk for contracting HIV.
“There’s lots of different ways people can protect themselves from HIV and PrEP is one of them,” says Kelley. “It’s been shown to be effective in clinical trials and if effective intervention is available people should be able to use them.”
PREP AND BLACK GAY MEN One group that is disproportionately affected by HIV/AIDS and could benefit from PrEP is black gay men. But according to the Centers for Disease Control and Prevention, “more PrEP prescriptions are written in the Southeast than anywhere else, of that more than half are actually for the female population.”
So the question remains: what steps need to be taken on behalf of black gay men to ensure PrEP is a viable option in the arsenal of tools to protect them against HIV infection? Dr. Kelley believes this question is best addressed by four measures:
1. A person has to recognize that they are at risk for HIV infection.
2. A person has to be aware of the prevention tool (e.g. PrEP).
3. A person has to have access to the tool (for PrEP this means having access to a doctor and the prescription medication—in short, health insurance).
4. Finally, a person has to actually use the tool as directed (for PrEP this means taking it every day regardless of sexual activity).
But with a price tag of around $13,000 a year, Truvada can seem out of reach for those individuals who are at high risk for contracting HIV, such as black gay men.
“Gilead, the manufacturer of Truvada, has a patient assistance program. This is probably the best way for a person to gain access to the drug who may not be able to afford to pay the exorbitant price out of pocket,” Kelley says of the cost. Teachworth is fortunate to be covered under his employer’s health insurance plan and pays only $25 a month for PrEP.
The town hall meeting will specifically address the alarming rates of HIV infection among black gay men. Prophater and Team Friendly Atlanta believe it’s necessary to direct their focus and efforts more on this demographic. But Prophater is also concerned that a discussion of sexuality along with a sexually transmitted disease will prove to be an intense potion.
“We live in the Bible Belt and there’s already a stigma associated to anything related to sex,” says Prophater. “We then amplify that by encouraging people to have better sex practices and we’re fighting an uphill battle.”
Atlanta resident Charles Stephens, a black gay man and director of Counter Narrative, a media advocacy and public policy group focusing on the lives of black gay men, believes the discussion around PrEP and black gay men needs to be reframed completely.
“I think it (PrEP) is also a part of our sexual rights. As black gay men we absolutely have a right to pleasure, we have a right to health; we have a right to every tool that’s available to protect ourselves. There are arguments that suggest by having access to PrEP it will increase condomless sex and it will make people less afraid of HIV. I believe those arguments are rooted in a very moralistic and judgmental lens around sexuality,” Stephens says.