Recently, a Chicago-based AIDS historian, Patrick William Kelly, published an op-ed in The New York Times expressing grave concerns about PrEP, a once-daily pill that prevents HIV infection, and the decrease in condom use among gay men. Howard Brown Health, the Midwest’s largest LGBTQ healthcare organization, is committed to using the most up-to-date tools available in the fight against HIV, including PrEP and all safer sex practices, like condoms. We are also committed to public health and the varied, intersectional techniques that are required to reach at-risk communities. This commitment means minimizing stigma and increasing engagement through affirming medical care, not to mention evidence-based practices that incorporate modern and accredited research.
Howard Brown is working to increase access to any HIV prevention tool that is available. Although PrEP has been FDA approved since 2012, uptake has been slow, especially among populations that need it most. A number of factors reduce access to PrEP. Disparities in insurance coverage, lack of awareness, provider bias, and stigma are some.
Tragically, Kelly’s words only contribute to the stigma that surrounds sexual health. While the intention may have been to kick start a movement back to “safe sex,” Howard Brown Health does not believe fear-based tactics are effective, and more likely, could prevent at-risk populations from getting into care. To claim that sex with a condom is the only option for safer sex disregards all that we know about HIV, how it is transmitted, and realistic methods of intervention. It also has dangerous implications — stoking fear around PrEP jeopardizes efforts to increase awareness, access, and adherence to this powerful HIV prevention tool. This is particularly true for communities who are disproportionately impacted by the epidemic — black men who have sex with men (and often don’t self-identify as “gay”) and transgender women. Kelly’s op-ed cites research showing increased rates of STI infection among PrEP users that has since been deemed as statistically unsound.
After someone is aware of PrEP and willing to consider taking it, the next steps are access and adherence. Stigma, in particular, plays a major role in influencing a person’s decision to choose PrEP. “Truvada whore” became a term coined in 2012 describing PrEP users as practicing “unsafe sex” and spreading other sexually-transmitted infections. Studies show that the idea that PrEP is for people who are promiscuous is strongly associated with lack of interest in using PrEP. Providers may also be less likely to prescribe PrEP and insurance companies may be less likely to cover PrEP based on the assumption that PrEP users are more likely to engage in riskier behaviors. It’s important to observe that these assumptions are not grounded in strong evidence. To date, studies have not shown a widespread pattern of increased risk behaviors among most PrEP users.
Howard Brown Health takes a strong stand against Kelly’s views. We believe that HIV prevention cannot utilize a one-size-fits-all approach. There are many ways to prevent HIV, and PrEP is among them. Acknowledging that racial and gender minorities have disproportionate access to PrEP, we must actively work to reach at-risk communities. In the fight against HIV, we must recognize that sexual fulfillment is an important part of a person’s well-being, and thanks to modern medicine, people have more options for safer sex practices.
Efforts to fight HIV should reduce barriers to care, not create more.
LIZ THOMPSON is associate director of sexual and reproductive health at Howard Brown Health, the Midwest’s largest LGBTQ Nonprofit Healthcare Organization. Founded in 1974, Howard Brown Health serves more than 27,000 adults and youth each year in its diverse health and social service delivery system focused on clinical care, research, education and advocacy. For more information about Howard Brown Health, visit howardbrown.org.