BROOKE GLADSTONE: Late last week, the World Health Organization announced that HIV infections are rising among gay men in many parts of the world. While the annual number of new infections in the US has dropped roughly two-thirds from its peak in the 80s, it now holds steady at 50,000 a year. We’re still living in an epidemic. Now the focus in the fight is toward PrEP or Pre-Exposure Prophylaxis, to prevent infections rather than treat them after the fact. In May, a powerful endorsement for one specific PrEP was announced.
MALE CORRESPONDENT: The CDC said hundreds of thousands of Americans at risk of AIDS should take a daily pill called Truvada. It has been shown to prevent HIV infections, and many insurers already cover it.
BROOKE GLADSTONE: Studies have shown that Truvada, if taken daily, can cut the risk of contracting HIV by as much as 99 percent. Endorsed by the WHO this month, this should be huge news. But there's a catch. Many AIDS advocates, such as the AID's Healthcare Foundation, worry that users won't necessarily take it every day and that widespread use of a drug that almost guarantees you won't get infected will lead to condomless sex and the spread of other diseases.
Gawker staff writer, Rich Juzwiak, has been writing about Truvada for the past several months. He says there’s a deeply-rooted fear that holds Truvada back, particularly among groups that could benefit the most. If you’re listening with young kids or are otherwise easily offended, we'd like to let you know that there is some mild language about gay sex in this interview.
RICH JUZWIAK: We’re working off of 30 years of it being drummed into our heads that if you have sex you will die, that you have to protect yourself, you have to use a condom – condom, condom, condom. And then comes along a pill that changes our entire notion about safe sex. And I think a lot of people think that it's an easy way out. I mean, Larry Kramer called it cowardly.
BROOKE GLADSTONE: Larry Kramer, AIDS activist, writer of “The Normal Heart,” opposes strenuously the use of Truvada to prevent infection.
RICH JUZWIAK: Yes. He said that anybody who voluntarily takes an antiviral every day has got to have rocks in their heads. You’re taking the drug that is poison to you, that has lessened your energy to fight, to get involved, to do anything.
Now, Truvada is specifically prescribed because of its lack of side effects. It’s one of the easiest antiretrovirals on your system.
BROOKE GLADSTONE: Right, but that's not saying a lot. I mean, you had, at least initially, side effects when you took Truvada.
RICH JUZWIAK: I did, and there is a kernel of truth in Larry Kramer’s words because fatigue is one of the things that I experienced. Now, it wasn't constant fatigue. It's not clouding people's heads to the extent that if you're politically inclined, you’re gonna just forget everything ‘cause you’re in a Truvada haze.
BROOKE GLADSTONE: Does Truvada, in the research you've done, affect how often you use a condom?
RICH JUZWIAK: The first thing I would say about that is that a lot of gay men don’t use condoms, that, that there is a study in which it was over five years and one out of six gay men reported that he used a condom every time.
BROOKE GLADSTONE: One out of six.
RICH JUZWIAK: One out of six.
BROOKE GLADSTONE: Mm! So it’s not as if a perfect situation is being disrupted by Truvada.
RICH JUZWIAK: Exactly. Truvada is sort of something we need, in addition to condoms.
BROOKE GLADSTONE: As I was reading the argument over Truvada, the kind of coverage and the lack of coverage and the prevailing narratives in the debate, I was thinking of all sorts of other kinds of drugs. For instance, the debate over e-cigarettes and the coverage is that it will once again normalize smoking, and that will be bad for the general population, because they don't want to change people's prevailing attitudes toward cigarettes by introducing the e-cigarette into the world-
RICH JUZWIAK: Right.
BROOKE GLADSTONE: - as an unstigmatized object. I mean, if you think about all the arguments about pot over the years, especially medical marijuana because of the concern of normalizing it, and then you have this, where the stakes are huge, life-and-death.
RICH JUZWIAK: Right. The most convincing concern people have is that if everybody gets on Truvada or everybody's on antiretrovirals because they’re positive or negative and everybody starts having condomless sex, as they did in the 70s, then what we’re doing is we’re creating a pool in which another unknown microbe can rise up and start attacking us. And we also have to worry about antibiotic-resistant gonorrhea, for example. So I do think that that sort of pressure maybe helps keep people in check in a certain way, but absolutely this can be something that's useful. I mean, HIV is the big one, right?
BROOKE GLADSTONE: If it turns out that the side effects are negligible, why wouldn't gay men not in a long-term monogamous relationship just take it the way people take baby aspirins to prevent heart attacks? Why aren’t there headlines that say, hooray, taken every day a cure for AIDS?
RICH JUZWIAK: Because we have this cultural baggage of shame and of the devastation the AIDS caused, because of the way that we regard AIDS and HIV just needs to change. Personally, I'm so glad that I have this thing in my system that makes me worry about my life a little bit less, and I’m trying to do the best I can with that.
BROOKE GLADSTONE: Some of us may remember that when the birth control pill was introduced it seemed like they were headlines everywhere, Life Magazine cover stories, but the fact is when Searle, the drug company, applied for FDA approval in 1957, it was presented as a drug to treat menstrual disorders, in the full knowledge that its major use would be to prevent pregnancy. Searle would not market it as a birth control drug because it didn't believe it could. After that, we saw an epidemic of menstrual disorders.
I mean, when you talk about stigma, it's really a proxy argument, right? Back then, freedom from pregnancy equaled women's liberation. Right now, Truvada suggests liberation from the fear of death.
RICH JUZWIAK: Yes, and it comes at a time where marriage equality is at the forefront of the conversation about gay people, and so much strategy in that is saying, we are just like you, we're not crazy sex fiends. The idea that this drug could come along to facilitate what is seen as risky, if not destructive, behavior, i.e., sex without condoms, confounds that, and then people get worked up. The moral judgment that comes along with sex is just insane, and AIDS just confirmed what a lot of people believed, that gay people had it coming to them, that their sex was deviant and wrong and, hey look, this proves that.
A little-read Huffington Post article by David Duran was called, “Truvada Whores?” – with a question mark - and this was written in 2012 – castigates people for enjoying raw sex.
BROOKE GLADSTONE: Meaning without condoms.
RICH JUZWIAK: Without a condom, which is like, have you had sex, because it’s better without condoms. Unless you’re a latex fetishist, I don’t think you’re gonna disagree with me. But this created such a ripple that “Truvada Whores?” is now on t-shirts, it’s mentioned in basically every New York Times article, but it so perfectly crystallizes the way that gay them talk to each other, but hypocritical judgment that gay men talk to each other, the hypocritical judgment that we cast upon each other. And look, this is a huge unlearning that we all have to do as a culture, you know?
BROOKE GLADSTONE: Unlearning?
RICH JUZWIAK: Unlearning, yes.
BROOKE GLADSTONE: But HIV still exists. It still can kill you.
RICH JUZWIAK: It, it absolutely does but, at least for me, for a child of the 80s, I watched AIDS on PSAs, on TV shows as a death sentence; 1996 comes along, antiretrovirals cocktails, protease inhibitors, the notion of being undetectable comes along.
BROOKE GLADSTONE: And undetectable viral load and, with it, the likelihood that you will live much longer.
RICH JUZWIAK: Live much longer, also are not nearly as contagious, to the point of not being contagious at all, perhaps. So, in effect, the most mind blowing thing to me when I got out of my 10-year relationship in 2012 and had to learn all of this about HIV, is that the most contagious guys are the guys who don't know that they have HIV and aren’t on meds. So a guy who's gonna tell you, I’m positive is, in fact, in theory, safer than a guy who says, I’m negative, because he just doesn’t know. And what I love about Truvada, though, is that for the first time in history sexually active gay men can say with certainty, “I am negative.”
BROOKE GLADSTONE: Can you tell me then how in 2012 the narrative that you grew up with that was presented in, in countless sex education classes and in ads and on posters and throughout the media, how that narrative shifted?
RICH JUZWIAK: Personally for me, it was through Grindr.
BROOKE GLADSTONE: A social app that enables you to hook up with gay men. You know, pretty much, you know how many feet away they are.
RICH JUZWIAK: Yeah, it’s GPS-based, so that’s the, that’s the real technology of it.
BROOKE GLADSTONE: Mm-hmm. [AFFIRMATIVE]
RICH JUZWIAK: Yes, it was through Grindr that positive guys schooled me, causing me to look into this more. So it took a lot of unlearning and research for me to be comfortable enough, after watching AIDS be the murderer for so many years, to understand that it's not necessarily so much like that anymore. It’s no walk in the park. I don’t want HIV. That’s why I’m on Truvada right now.
BROOKE GLADSTONE: Rich, thank you so much.
RICH JUZWIAK: Thank you, Brooke.
BROOKE GLADSTONE: Rich Juzwiak is a staff writer for Gawker. He wrote about Truvada and gay culture in his series on the site called, “Pride and Shame.”