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Viral Panic: Fear Has Been Useful in the Fight Against AIDS, Until It Wasn't 

Tuesday, Dec 16 2014
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But Grant also blames the George W. Bush administration for de-emphasizing condoms on a national level and claiming that abstinence and monogamy were better choices. Condoms are still touted in high school sex education programs, but not with the same fervor of the early '90s. "[They] went from being a mainstay of prevention to being a backup of a backup plan," Grant notes.

Because AIDS is a sexually transmitted disease specifically associated with gay men, it's always had a moral aspect. Advances in medical technology haven't destroyed notions that the virus is some kind of punishment; meanwhile, abstinence movements have turned back the clock on years of safe-sex messaging.

That could also be what's raising infection rates, Grant says. Denying the existence of the lion doesn't keep it at bay.

Had PrEP emerged in the 1980s or '90s, it would have gotten a different reception, says Neil Giuliano, CEO of the San Francisco AIDS Foundation. "If someone would have told us 25 or 50 years ago that you could take one pill a day, and it would protect you from HIV, there would have been lines around the block," he adds.

Yet now that the pill exists, it's not getting the notice it perhaps deserves. People have to be reminded that AIDS is a disease they don't want to get, Giuliano says. Some have even expressed reservations about the drug, or condemned it with moral platitudes. Doctors who might have once thought of PrEP as a necessary tool now view it as a luxury item — or worse, a means for permitting wayward lifestyles.

But Americans have a long history of conflating prevention with promiscuity. When birth control pills were first approved for in 1960, they were only prescribed to married women, on the assumption that their unmarried counterparts might seize the opportunity to have sex out of wedlock. Similar notions have stymied the vaccine for human papillomavirus (HPV), which is failing to reach its intended demographic. Recent national CDC data shows that only 37.6 percent of girls ages 13-17 received the recommended three doses of the HPV vaccine, despite legislative efforts to endorse it.

Detractors of PrEP are trotting out the same arguments, contending that people will have more sex, and use fewer condoms, if they're given a pill that inoculates them from the HIV virus. AIDS Healthcare Foundation leader Michael Weinstein said as much in an April interview with the Associated Press, in which he dubbed PrEP a "party drug."

Many health care providers harbor those stereotypes too, Grant says. He remembers one patient complaining about a doctor who wouldn't prescribe PrEP because it was too expensive; other doctors simply insist that condoms are better. In another case, a patient who asked for PrEP was advised to lose weight instead, so that he could wind up "in a loving relationship." Grant's colleague, Bay Area Perinatal AIDS Center director Shannon Weber, knew a woman who requested PrEP in order to have a baby with her HIV-positive partner and was offered Xanax instead — because having an HIV-positive partner must be "soooo stressful."

Grant is the protocol chair for the Pre-Exposure Prophylaxis Initiative (iPrEx) clinical trial, a study to prove the efficacy of PrEP, in 11 countries. He's also working to develop a form of PrEP that can be taken every three months, instead of every day. He's bullish about making the drug available to everyone, and adamant that it won't cause users to become more cavalier about their sex lives.

"People want to think of human behavior as being very rational," Grant says. "But economic behavior is irrational, so why are we assuming that sexual behavior is going to be rational?"

He believes a drug that emphasizes planning, and forces people to consider their future behavior, will in fact promote safe sex rather than discourage it.

But Grant and other PrEP advocates have trouble conveying that message, even to the people who need it most. Zeboski, who is outspoken about using the drug himself (he's taken it for two years) says that many LGBT people believe it's a product for "older, privileged, white gay men." Zeboski has made a valiant effort to fight this misconception, but he can already see its effects: The privileged-white-man stereotype, coupled with the high cost of PrEP, might be what's concentrating new HIV infections among lower-income black and Latino men in San Francisco, he surmises.

San Francisco defies national trends in that infection rates here are decreasing overall, including in populations of men who have sex with men. Testing and treatment rates are increasing, as is the distribution of antiretroviral drugs, says Susan Buchbinder, director of the Bridge HIV program at San Francisco Department of Public Health.

Yet, even in a city with a much sunnier outlook, HIV rates still manifest unevenly.

Of the 359 new HIV diagnoses reported in San Francisco in 2013, 44 (12 percent) came from African-American patients and 88 (24 percent) came from Latinos. That means both groups comprise a much larger portion of the infected population than of the city's general population; according to census data, the city is 6 percent African-American and 15.3 percent Latino.

That pattern preoccupies health workers like Eva Kersey, the assistant manager of HIV testing services at Larkin Street Youth Services. "There's a lot of talk about this increase [in infections] being mostly in communities of color," she says, attributing the disparity to lack of health care access and educational resources, but also to cultural perceptions. Many men who sleep with other men don't identify themselves as gay or bisexual, and don't want to be associated with the AIDS virus; to Murray, that's particularly true in black and Latino communities, where the stakes of coming out are much higher. (Health-care providers have tried to help with nomenclature, lumping all "men who have sex with men" into an all-encompassing "MSM" category.)


About The Author

Rachel Swan

Rachel Swan

Rachel Swan was a staff writer at SF Weekly from 2013 to 2015. In previous lives she was a music editor, IP hack, and tutor of Cal athletes.

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