Tuesday, March 11, 2014

MY BODY IS A CONDOM (KINDA)


Smudge sticks and salt lamps aside, I stick by the scientific method.  So far, I haven't been swayed by the alternatives: Magick?  G-d?  Knee-jerk cynicism?  Ultimately, what option do we really have?  Each one of us places a firm foot forward in the march of human history, whether we trust our best collective guess or not.  Logic lead me forward.  

As some of you might know, my brief foray into the world of sex-advice came to a close recently.  Blogs change hands and companies pursue different profit strategies.  My relationship with Manhunt ended happily, much as it proceeded throughout the course of our professional relationship together.  I deeply appreciated the degree of creative freedom Manhunt allowed me to exercise.  They never once interfered with suggestions, proposed I censor answers or asked that I curtail my aesthetic choices, except once. . . for one specific set of videos. . .

Two years ago this July, the FDA approved a pharmaceutical solution to the problem of HIV transmission.  Truvada, a single pill composed of two seperate drugs already used to suppress the virus in HIV positive patients, could now be prescribed as a pre-exposure prophylaxis (PreP) for HIV negative individuals-- for all intents and purposes, a condom in pill form.  

Last January, Manhunt asked if I'd like to interview one of the principle research scientist working with Truvada and create three separate informational videos conveying my understanding to viewers.  Like many who first hear about Truvada (or any new pharmaceutical product for that matter) I turned instinctively to skepticism to guide inquiry further.  A pill for what???  Really!?  That said, I tend to trust peer-reviewed medical research.  I'm plenty paranoid about the government's relationships with big business, but I tend to support the rigorous standards of the United States Food and Drug Administration and its hard working employees.  

Skepticism closely guarding my back pocket, I'd happily trust the first FDA approved HIV vaccine too.  Truvada isn't a vaccine, but so far it's the closest thing we've got.     

Thousands of people already take Truvada and have for years.  The few recorded negative side effects are well documented.  My biggest question quickly turned to matters of access.  Without insurance, a prescription for Truvada costs nearly $1,000 a month.  Would insurance companies cover an expensive prophylactic pill when cheaper alternatives (condoms) are widely available?  I immediately called my insurance company expecting a quick dismissal and instead got a pleasant surprise.  They do cover it.  

After cautious consultation with my physician and a full-panel of blood tests, I popped my first pill more than a year ago, both to protect myself and to relay my experience with future viewers.  Thanks to a drug rebate courtesy of Gilead, Truvada's manufacturer, I don't pay a dime.  

I submitted my videos and waited. . . . waited. . . and waited some more. . . . 

Nothing.  

Manhunt paid me promptly but never posted any of the three well-researched videos I created.  Why?  I can't say for certain, but I came to understand that Manhunt had already encountered a good deal of pushback simply for considering the project.  I, in turn, received the only bit of kindly editorial censorship I would ever encounter while working for Manhunt: never mention Truvada again.  

That said, I defer to someone with less restrictive professional obligations to explain the controversy surrounding Truvada further.  For an incisive, in-depth personal discussion I highly recommend the recent Gawker article "What is Safe Sex: The Raw and Uncomfortable Truth about Truvada" by Rich Juzwiak.  

Otherwise spot-on, one glaring mistake in Juzwiak's essay stands out; I feel obligated to issue a correction:

"He sent the prescription to my pharmacy. The email notifying me that my prescription was ready informed me that this would cost me $1,389.99. "Welp," I thought. "There goes that idea. I don't need it that badly." Not that I could afford it if I did. Gawker hardly pays me a gay porn salary."

I can assure Rich that no gay porn performer earns "salary".  What we do make hardly allows us to splurge on unnecessary pharmaceuticals.  Sadly, no performers receive insurance through porn studios.  I most certainly earn less than your average poorly-paid journalist.  My generous insurance policy comes courtesy of BSD Minister of Propaganda Karl Marxxx.  That said, a group insurance plan for sex workers of all stripes (pie in the sky perhaps, but worth imagining) would go a long way to help protect the health of performers.  

I also can't claim any of the negative side effects Rich mentions in his article.  I continue to take Truvada every day.  I get my kidneys and blood tested every three months and haven't experienced a single complication.    

Some statistics are worth restating if you don't feel compelled to read Rich's article fully:


Taken as prescribed, once a day, nearly all studies suggest a rate of protection against HIV infection somewhere in the range of 90-99%.  Unfortunately, in some studies, nearly 50% of recipients failed to take the drug consistently, leading to a higher likelihood of potential infection and thereby statistically lowering the effective rate of protection cited.  Patients must take Truvada once a day, every day, for the drug to effectively protect against infection.  For comparison, studies show that condoms, especially when used in anal intercourse, only protect users at a rate as high as 76%.  

Studies of HIV negative gay men using Truvada have also failed to reveal any statistical increase in the rate of transmission of other STDs, like syphilis, which can spread easily even with condoms.  Many patients report having less sex because of "slut-shaming" suspicion surrounding use of the drug.    

For additional information, I highly recommend the following:

A study measuring the effective rate of protection for users of Truvada

"Why is No One On the First Treatment for H.I.V.?" by Christopher Glazer for the New Yorker

"There Is a Daily Pill That Prevents HIV.  Gay Men Should Take It."  By Mark Joseph Stern for Slate



10 comments:

  1. I read that article and was excited, frightened and outraged all at once. I'm glad you added you two cents. I think you are doing a smart thing.

    ReplyDelete
  2. Colby: thanks for this. Given that HIV is now often controlled by drugs similar to the ones you are voluntarily taking every day - to the point where those infected with it have undetectable viral load and are as (if not less) likely to infect third parties as those who are infected but don't know it, it would be interesting to know *why* you actually chose to go on Truvada. The main resistance I have seen to the drug among gay friends and peers is precisely this: why take a pill every day to prevent a condition whose main effect (to all intents and purposes) may be to take this same pill every day?

    ReplyDelete
  3. In a civilized society sex workers would be unionized and get automatic group health care simply because of the nature of their jobs, but if you get me started on that rant it'll be hours before I stop. To me, it seems like the resistance to taking Truvada is similar to the mindset behind not getting your daughter vaccinated against HPV. "God forbid -- they might actually *gasp* have unprotected sex, then!" Well, yeah, that's *kind of the point.* Condoms break, or they're forgotten, or you hear, "I just got tested and I'm clean -- please?" It's called CYA -- Cover Your Ass. If you don't experience side effects, wouldn't it just be safer to take a PrEP, especially if your health insurance covers it? As for taking a pill every day, it's really not that difficult -- get up, brush your teeth, take your pill. Simple. I've been doing it since I was 24, and I'll be doing it for the rest of my life.

    ReplyDelete
  4. @HighEstate - HIV infection does not simply mean you take a pill for the rest of your life. That is naive urban legend. For many people, meds like Truvada can keep the virus at bay for very long periods of time, but it does not guarantee permanent suppression. Nor does an "undetectable" virus count guarantee someone as transmission-proof.

    Further, when you cross these best-case scenario with a human problem of missing doses and increasing risk, it creates a false sense of safety and encourages people to have unprotected sex.

    Ask any long-term survivor - you do NOT want to be HIV positive and you do NOT want to take these drugs the rest of your life. (Hell, ask any suffer of chronic disease - they will all tell you that you don't want to take meds of any sort the rest of your life...) There are side effects to all meds, and the list for HIV treatment drugs is long and unpleasant/dangerous.

    Having said that, I agree with your suspicion that there is a built-in profit motive for Gilead and other pharma companies to encourage prophylactic use of PreP drugs. I would just argue it differently, without minimizing the effect and treatment of HIV.

    As Melanie indicates, Truvada is a good second-line of defense for condoms in prevention of HIV. If I was in a place in my life were I was having lots of sexual fun, I would consider it for this reason. However, given that it cannot prevent any other STI's nor is it, by any measure, absolute protection, I cannot advocate for it's use as a singular protection against infection.

    I long for the day that we have an actual CURE and a PREVENTATIVE vaccination. We're still looking, but we don't have it yet.

    ReplyDelete
    Replies
    1. Thanks JP. I guess it comes down to doing the equation in your head: do I want to take a pill every day for the rest of my sexually-active life (and you - and all those long-term survivors - seem to suggest that I do not) thereby materially increasing the chances of side-effects (Colby has had none, but others have), impaired kidney function, etc etc just so that I can prevent (assuming I take the Truvada pills every day - which again, I agree with you, I may have trouble doing) the possibility of infection with a virus that I may never encounter and, if I do, may never be infected by? For me - and many many others, it would seem - the answer is an unequivocal "no": wear a condom, don't be stupid, get tested frequently and take the calculated risk of not getting HIV or, if you get it, taking similar pills to keep it at bay. Of course, that is not to diminish the issues that people have had with HIV/AIDS historically, nor to imply that everyone should pick the same option: many will want to go the Truvada route and good for them.

      I guess my point is just to say that - unlike the many articles recently published that seemingly cannot imagine why everyone isn't on it - there are very good reasons to avoid the possible expense, potential side effects and the "false sense of safety that encourages people to have unprotected sex" that Truvada brings. Not going on it is not irrational.

      Delete
  5. It may not be a cure, but it's a step in the right direction. I can't believe anyone would suggest you NOT mention it, why WOULDN'T you? I think you're doing the smart thing. I enjoyed your interviews on YouTube on the subject. I understand the push back, but you researched the very thing you were paid to research and then told to never mention it again. It's just very weird to me, especially in regards to the demographic watching the videos. Anyway. I'm sorry your time with ManHunt came to an end. I always looked forward to those videos. Maybe you'll just have to get your beautiful soul back on YouTube and read us another book :)

    <3

    ReplyDelete
  6. 1. There are a lot of industries in our economy today which would benefit from unions, including the sex industry, and I think the formation of these would actually give our economy the boost it needs to get going again.
    2. As Melanie and JP said - You get used to taking those daily pills. It's not necessarily a fun thing, but it's just something you have to do.
    3. I would like to see these videos. Where are they? Would you be able to post them so we can see them?

    ReplyDelete
  7. Nao tome o mdeicamento, não deixe que a indústria pornô te empurre para esse tipo de idéia muito controversa. não faça isso.
    continue usando camisinha, quero ver voce saudável ainda por muito tempo
    abracós

    ReplyDelete
  8. In Europe there are studies that refer two particular side effects: people using Truvada are aging in a quicker way and if they get infected, the virus is somehow stronger and already partially resistant to drugs.

    ReplyDelete
  9. When should we expect Colby's first bareback video to be out? After Michael Lucas--who was likewise formerly a vocal advocate of condom-based safer sex--announced in Out Magazine that he had personally started taking Truvada as PrEP, it was only six weeks before his company's first bareback video was released. Is it reasonable to think that Colby might follow suit? Or is this only about him barebacking in his personal life?

    ReplyDelete