Written by Chadwick Campbell for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.
A great deal of attention has been paid in past years and, indeed in 2012, to Pre-Exposure Prophylaxis (PrEP). It has been studied, found to be highly effective (when taken on time and (almost) all the time). The Food and Drug Administration has given its stamp of approval and last week’s International AIDS Conference was a “PrEP Rally” of sorts (a term shared with me at the conference by a colleague in Boston). And off we go, doling it out to “at risk” gay men. But with all the hoopla, I can’t help but take a step back and highlight the ways in which this new and, unarguably, promising new strategy scares the hell out of me.
An important preface is warranted here: I truly believe that all options should be on the table when it comes to the fight against HIV/AIDS. We are 30 years into the epidemic and it is still of the utmost importance that all possible ways to curb the spread of this virus be developed and made available. For me, the very development of biomedical prevention methods is not at all the problem. I am in no way advocating against PrEP, generally.
Now that I got that out of the way…
As a Black gay man, I have MAJOR concerns about PrEP. It should be noted that none of these concerns are related to its effectiveness (if used properly). My concerns are largely social, structural, and behavioral, and are rooted in the fact that the communities I care most about could be left out or, even worse, harmed in this new endeavor.
First, in places like the US, where there is rampant inequality and not all gay men have equal access to information, let alone medication, I fear that this will be one more intervention that will favor middle- to upper-class, mostly White gay men, and leave out the poor, folks of color, and those living in communities where even being tested for HIV is highly stigmatized.
Data suggest that HIV positive Black men who have sex with men (MSM) are 60 percent less likely to begin anti-retroviral treatment, and less likely to adhere to their medications (Millett, et.al. 2012, The Lancet). Why then should we believe that Black MSM who are HIV negative will somehow overcome all the same barriers to take a pill EVERYDAY while, for them, non-adherence has far fewer immediate consequences?
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