Viewpoint: No PrEP For Me!



By Al Cunningham
Originally printed 8/7/2014 (Issue 2232 - Between The Lines News)

For some time now, I've been doing a not-so-slow burn as the last phase of a remarkable revolution takes place. With the recent release of the CDC's (U.S. Centers for Disease Control and Prevention) new guidelines for the prescription of antiretroviral drugs as HIV prevention, called PrEP (Pre-Exposure Prophylaxis), the pharmaceutical industry has completed its takeover of "public health" as far as HIV is concerned. Primary HIV prevention (keeping people HIV negative), abandoned long ago in favor of "prevention for (HIV) positives," has come full circle, with the same toxic drugs being prescribed for those with HIV now becoming available to those without it. As a longtime HIV prevention activist, sexual health educator and openly HIV-negative non-hetero Black man, I'm compelled to dissent from the hype surrounding this "breakthrough":

1. Primary HIV prevention was widely discredited in the early 1990s as "unverifiable" and "a waste of money," largely by Congressional wingnutz, their media and "special interest" counterparts, and even some public health leaders. In the wake of its scrapping, HIV infection rates rose astronomically, surprise! Awareness of the value of remaining HIV-negative and how to do so needs to be fully reconsidered as an economically feasible and socially desirable alternative to the cost of supplying expensive, toxic antiretroviral drugs to those most at-risk.

2. The manufacturers of these drugs are among the most profitable companies in the world, and no wonder, at $30+ per pill in the US (drug makers have been shamed into allowing generic versions and reduced prices elsewhere). Thousands of people living with HIV in the UNITED STATES are unable to gain access to these drugs for political and economic reasons. The notion is both ironic and surreal that those in no need would gain access before those literally dying of AIDS.

3. What does it say about our culture, much less the integrity of its public health "civil servants" (already under scrutiny elsewhere), that we would routinely promote the use of drugs intended to treat a disease for its prevention, rather than invest in proven health-related social marketing? As the healthcare industry adds HIV to the list of "chronic, manageable illnesses," why shouldn't HIV prevention be "marketed" along with cancer, cardio-vascular, and diabetes prevention, as a facet of social marketing promoting healthy choices of all kinds?

4. Assuming funding "miraculously" appeared to make PrEP accessible to those most at-risk, men of color who have sex with other men, who will determine how it will be distributed, where, and to whom? The greatest advantage of mass health communication is its availability to everyone, without regard for individual literacy or conventional political ideology. Public health has chosen to virtually ignore the time-tested, outcome-based commercial marketing model from which true social marketing is derived, funding unresearched pop-up "campaigns" and research by academic theorists, rather than formative market research on topics directly related to the practical prevention of sexually transmitted illness.

5. How accessible and/or available will PrEP be in prisons and other detention facilities, or in the military, settings in which the considerable risks for HIV and other sexually-transmitted illnesses are rarely addressed even by condoms, available for a small fraction of the cost of PrEP?

6. In the context of an evolving non-hetero paradigm for those who don't identify as heterosexual, how productive is it to focus attention on penetrative sexual acts, without harm reductive alternatives, when providing sexual health education? How useful is PrEP to males who have sex with males as well as females and need both contraceptive and other sexually transmitted illness protection, prevention, and education? How long will public health continue to reinforce a heterosexist paradigm on non-heterosexuals?

Perhaps the greatest irony in this "perfect storm" of continuing infection is that with the CDC's backing of PrEP, public health is finally catching up to commercial marketing, if bending over backward in order to do so. Over the past few decades, the commercial marketplace has been deluged with sexually-based messages in advertising and entertainment media, including advertising for prescription drugs. Public health, "informed" by political reactionaries whose motives are often linked with those of corporate America, chose to take a "head-in-the-sand" attitude. Instead of acknowledging and addressing these trends and their outcomes, the public health "establishment" has brought us "abstinence only," "no condoms allowed," "prevention for positives," "post-exposure prophylaxis" (immediate treatment for those potentially infected), and now, "pre-exposure prophylaxis" (PrEP).

I came out in the midst of the "gay/sexual revolution," survived the First Wave of AIDS/HIV, agitated and advocated for more HIV-related funding for people of color, made sexual health education my life's work, and have buried far more of my lovers, friends and colleagues from AIDS-related causes than I can ever account for. In almost 30 years of HIV prevention activism and professional work, much of it media and public information-related, I have NEVER received a request for someone HIV-negative to address a group or audience of any kind. Invited or not, my Mission henceforth includes continuing to LIVE OUT LOUD as an HIV-NEGATIVE, NON-HETERO (BLACK) MAN - by CHOICE, not CHANCE - and WITHOUT the assistance of an expensive, toxic daily pill.

Al Cunningham's career as a professional writer began in his hometown, Chicago, five decades ago at his neighborhood weekly newspaper, while he was still in elementary school. In addition to print journalism, he has written and produced nationally syndicated radio, theatre, video, and multimedia. Since 1987, Al has been an HIV prevention activist, sexual health educator, and media/communication specialist for local, regional, national, and international HIV-related projects and organizations. He recently semi-retired to Detroit, in part to work on his multimedia project, YOURS in THE STRUGGLE: Early Responders to AIDS/HIV in Black America and Beyond, and its companion website, BRISTERS.
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