HIV prevention pill stirs debate in Atlanta’s gay community

Since Fulton County public health officials quietly began giving Truvada to uninsured patients at a new public clinic last winter, it’s triggered a debate within the very population it’s intended to protect.
Truvada controversy

Illustration by Justin Renteria

While a cure for AIDS still eludes scientists, a drug called Truvada has been heralded as the next best thing: a way to prevent HIV infection in the first place. Taken daily, Truvada works by blocking the enzyme in the body that allows HIV to replicate itself.

If the statistics are any indication, there are few places in greater need of a drug like Truvada than Fulton County, which accounts for almost half of all new HIV infections in the 20-county metro Atlanta area. Infection rates are now so high that AIDS has become the leading cause of death for African Americans in Georgia between 35 and 44. In February the Atlanta based Centers for Disease Control and Prevention predicted that half of all gay black men in the U.S. will contract HIV. Atlanta now ranks fifth among major American cities in infection rates, and studies suggest nearly a quarter of those don’t yet realize they have the virus.

Truvada received approval in 2012 as a pre-exposure prophylaxis medication, or PrEP. Since Fulton County public health officials quietly began giving away the drug to uninsured patients at a new public clinic last winter, it’s triggered a debate within the very population it’s intended to protect.

When AIDS activist Michael Baker, who’d taken part in an early clinical trial of a similar drug, posted on Facebook last year about the benefits of a PrEP regimen, he wasn’t prepared for the negative responses. “It’s not the gay community’s decision to tell me how to manage my healthcare,” posted one commenter.

“A lot of gay men were uncomfortable with the growing availability of PrEP because they felt it would increase promiscuity,” Baker says. In fact, almost as soon as Truvada was endorsed by the CDC for HIV prevention two years ago, stories appeared in national media about a “slut-shaming” backlash within the gay community against the drug’s users.

“Life in 2016 is a lot different than it was in the early years of the AIDS epidemic,” Baker says. “Back then, we had to make sex scary so we could stabilize HIV infections. Now we have another tool in addition to condoms. Why not use it?”

Atlanta sex columnist Michael Alvear is among those unwilling to climb on the PrEP bandwagon. “There was this lock-step mentality,” Alvear says. “It was, ‘Take this pill or you’re ignorant, evil, and working against the safety of our community.’” Last August, after Baker compared Alvear to parents who refuse to vaccinate their children, Alvear fired back publicly with a Huffington Post column. “I’m not against PrEP,” says Alvear. “I’m against it being pushed as the only solution.”

Mark S. King, an HIV-positive blogger, notes that the arguments against PrEP—unknown long-term side effects, the potential to promote promiscuity—are similar to those directed more than 50 years ago at the then-new birth control pill. “I always thought that getting back to a place where we could have sex without fear was kind of the point,” he says.

Truvada can cost up to $1,500 a month, but its manufacturer, Gilead Sciences, is providing the drug free to the uninsured and at reduced cost to those who can demonstrate financial need. To qualify for the Fulton County program, patients must be HIV-negative and submit to blood work and a medical assessment that includes a frank discussion with a doctor about their sexual habits. Participants are given a PrEP prescription and a schedule of follow-up visits.

Thanks to free supplies of Truvada and operating funds from the Georgia Department of Public Health, Fulton County’s overhead costs for the new PrEP clinic have been relatively minimal. And the initiative could help repair the county’s image after it was discovered to have forfeited nearly $9 million in CDC grants that it failed to spend on HIV prevention efforts. Following a series of news reports about its poor management of funds, county health director Patrice Harris stepped down in December.

Emory Medical School professor David Holland, who serves as Fulton’s chief clinical officer, says the new PrEP clinic—located in an existing county health center across the street from Grady Memorial Hospital—enrolled 116 patients in its first six weeks and placed another 32 in the pipeline to receive a prescription. While those numbers may sound small for a city Atlanta’s size, Holland says he’s pleased considering that the clinic has been largely reliant on word of mouth and media coverage to promote the program.

“In order for this work to succeed, people have to be very honest with their doctor,” says Holland. “We’re tried to control HIV by telling people [to use condoms]. That didn’t work. Now we have an option to protect people regardless of what kind of sex they’re having. This is a very good thing.”

This article originally appeared in our June 2016 issue.