Folmsbee: Don’t let stigma block HIV prevention


Sai Folmsbee, Columnist

HIV and AIDS represent a challenge for the medical community, not just one of a rising and potentially deadly disease, but one that has forced doctors to confront their own shortcomings in working with LGBT patients. And as a new treatment for HIV prevention is now available, we now have a chance to take medical action to prevent the spread of HIV. But in doing so, we must not overlook the potential reverberations of our actions in the ever-present scourge of HIV stigma.

Last week, the Centers for Disease Control announced its support for Truvada, the brand name for the combination treatment of tenofovir/emtricitabine, the first-ever preventative medication for HIV. The drug combination itself is far from remarkable, as it is simply two drugs already used for the standard treatment of those already with HIV. But its efficacy has far surpassed that of the many failed HIV vaccine trials, so the CDC has recommended it to individuals who are at a high risk for contracting HIV.

But this announcement needs to be evaluated in the proper medical and societal context. Over the past few decades, we have made important strides transforming what used to be a death sentence into a difficult, but manageable, chronic disease. Although over 1 million Americans are HIV-positive, only about 15,000 die from AIDS each year due to significant medical advances in combinatorial drug therapy. But there are still about 50,000 new cases of HIV each year, so clearly better preventive medicine is needed. Although we expect new and better treatments from the scientific community, it’s increasingly clear that a safe and effective vaccine against HIV is unlikely. There honestly may never be a cure for HIV; the virus itself has a remarkable ability to evolve resistance to drugs, and its infectious process is so complex and evasive that the promise of its eradication may only serve to breed disappointment.

However, there is a big difference between treating HIV and preventing HIV, especially when it comes to promoting public awareness. Just getting proper, effective medical care to those who already have HIV is an enormous struggle around the world. The social pressure and the stigma of having HIV have forced much of the real discussion of preventing HIV underground. Victim-blaming, shaming and ostracizing need to end if we are ever going to honestly prevent the spread of HIV. And this new treatment adds a new twist to an already volatile situation: Who wants to be labeled as high-risk for HIV?

So far, the groups the CDC recommends to take this drug are limited. They include anyone whose partner is HIV-positive and any illicit drug users, but they also include gay or bisexual men in non-monogamous relationships who have unprotected sex. This apparently singles out men who have sex with men, since similar heterosexual, non-monogamous individuals are not included in the recommendation.

HIV infection does not discriminate based on sex or orientation, but the truth is that gay men are typically at higher risk. This is not due to sexual orientation, but rather because any person who has anal intercourse has a much greater risk of transmitting HIV. This can be attributed to the intrinsic properties of the virus and the infected tissues, with rectal transmission about 18 times more successful than vaginal. With this in mind, the clinical trials of tenofovir/emtricitabine focused on studying gay and bisexual men, and information on the drug’s efficacy for other groups is limited for now. For men who have unprotected sex with men, it may be hard to accept a higher risk for contracting HIV. Even more troubling, it may be difficult to discuss personal sexual practices in the cold examination room of a physician. Unfortunately, taking a pill specifically for HIV can be a daunting and morbid reminder of how gay men are often regarded as outsiders.

To correct this stigma and help decrease the spread of HIV, the medical establishment needs to reach out to the LGBT community, but that community also needs to reach back. Clear communication must be maintained about why the new drug is effective, and why gay men may have the most to gain from its use. Although it remains rather expensive for now at over $1,000 per month, if you fall into any of these high-risk categories, it is important to open this dialogue with your doctors. We cannot let inadequacies in physician-LGBT relations prevent anyone from acquiring the best medical treatment available.

Sai Folmsbee is a Feinberg graduate student. He can be reached at [email protected]u. If you would like to respond publicly to this column, send a Letter to the Editor to [email protected].