The leader of the nation's largest community HIV/AIDS health care organization stands by sharp words he had for a drug that has been approved for its potential to prevent the transmission of HIV — comments that some doctors and activists say are "irresponsible" and even led to a petition demanding his resignation.
"I've had debates on this subject, but these people are jumping to character assassination and I'm not going to respond to it," said Michael Weinstein, president of the Los Angeles-based AIDS Healthcare Foundation, the largest HIV/AIDS medical care provider in the U.S. "My record and the record of AHF speaks for itself."
Outrage erupted among activists and health care advocates after Weinstein referred to Truvada, a pill that has been proven to be effective in reducing the transmission of HIV when taken daily, as "a party drug" in an April 7 article by the Associated Press detailing some of the differing views on the HIV prevention method. "If something comes along that's better than condoms, I'm all for it, but Truvada is not that," he said.
Weinstein, who has long been a critic of the blue pill, has no intentions of stepping aside or quieting down and blames much of the backlash he's received on what he said is the "bareback porn industry." Michael Lucas, creator of one of the largest gay porn companies, Lucas Entertainment, also called for Weinstein to leave his job in an op-ed published by Out magazine.
"In the last few days in terms of the people who have been yelling the loudest about this, they've all been associated with bareback porn," he said. "They're all associated with bareback porn, which kind of makes my point that it's a party drug."
According to Lucas, Weinstein should be removed from his post immediately, saying, "Mr. Weinstein knows how to portray PrEP, along with gay men, in the most unattractive light," Lucas wrote. "… In Mr. Weinsteing's eyes, PrEP isn't about public health. It's just a highly expensive way for those horny, irresponsible gays to go back to their barebacking-gone-wild."
HIV/AIDS health care providers and activists say Weinstein's assessment flies in the face of evidence that Truvada is effective, and some took offense to his comparing it to a party drug.
"Comments like that of Michael Weinstein really devalue and diminish decades of research and the opinions of experts the world over that would very much disagree with his characterization," said Jim Pickett, director of Prevention Advocacy and Gay Men's Health at the AIDS Foundation of Chicago. "The idea that [Truvada] is simply some party drug on par with crystal meth or ecstasy is really ridiculous and insulting."
The Food and Drug Administration approved the use of Truvada for pre-exposure prophylaxis, or PrEP, in 2012 — meaning doctors can prescribe the pill to people who are at high risk of HIV, such as gay men and people who are HIV-negative who have sex with HIV-positive partners, to prevent the transmission of the virus. Truvada has long been part of a combination of drugs used in treating people with HIV.
Proponents of the drug point to studies showing massive reductions in HIV transmissions in cases where the drug was taken daily. But Weinstein, and other Truvada critics, question the drug's ability to be effective because patients are unlikely to adhere to the daily regimen. A factor in this could be the drug's high cost — about $13,000 per year — although many insurance plans and Medicaid cover prescriptions.
Additionally, Truvada, unlike condoms, will also do nothing to protect people from other sexually transmitted diseases such as syphilis, herpes, and gonorrhea, Weinstein said.
"The primary issue with Truvada is that in the perfect world if people took it every day they would be protected, but that is not the case," he said. "I read over and over again articles talking about how it's more than 90% effective and they don't even mention the adherence issue. PrEP is just not 90%-plus effective in the real world. It's just not ready for prime time as a public health strategy."
Dr. Demetre Daskalakis, medical director of the ambulatory HIV program at Mount Sinai Hospital in New York, said he is a prescriber of Truvada, telling BuzzFeed, "I don't see it as a party drug at all." Daskalakis also sits on the board of Gay Mens Health Crisis, one of the nation's top HIV/AIDS prevention, care, and advocacy organizations. He was also part of the FDA panel that approved Truvada for PrEP.
"The guys I'm giving Truvada to and some women, have a lot of good reasons to take it," Daskalakis told BuzzFeed. "If being in a sexual relationship with someone who is HIV-positive is a party, then Truvada is a party drug."
Daskalakis and Pickett are among critics of Weinstein's comments who think likening Truvada to a "party drug" is judgmental of behavior and detracts from what HIV/AIDS advocates aim to do: Prevent HIV, Daskalakis said. Pickett said it equates to "shaming" and "the paternalism and the infantilization of gay men."
Weinstein also said numbers from Gilead Sciences (the maker of Truvada) show fewer than 1,800 people have been prescribed Truvada for prevention, saying, "More importantly, the physicians who treat gay men aren't recommending it, otherwise more and more people would be on it. It's been on the market for two years and it really hasn't caught on." With that said, Weinstein concedes "there's no problem" if someone's doctor thinks Truvada is appropriate for them, but said, "I still think that it's Russian Roulette because of the adherence problem."
Weinstein's comments — from the top of such a large HIV/AIDS health care group — demonstrate the challenging road advocates face in reducing new HIV infections, which are currently at about 50,000 per year in the U.S., Pickett said.
"We need to have thoughtful and critical discussions with people who want to take Truvada and who need it," he said, and Daskalakis said Weinstein's comments are "a conversation stopper."
"This conversation is great," he said. "I think you have to exorcise this demon, and it has to be processed culturally. There will be time when this intervention will be kind of routine."