We really needed a memorial, and we really needed it to help us that are still
alive keep
fighting.
What's the effect of this march today on you?
I think it gives me a greater sense of community,
just to see the other people from the other states.
It's just pretty moving.
It is, it's a beautiful thing, It is a beautiful thing.
This is the first time
that we have an approved
drug by the FDA for
the prevention of
HIV infection.
Truvada, it's been on the market for some time.
But now for the first time,
it's been approved as what's being called a prevention drug.
What does this mean in the overall fight against HIV and AIDS?
PrEP has been a godsend.
It's been the ingredient we have needed for so long and haven't had.
Everyone should have a right to sex without fear.
Across the world, this is not a trivial matter.
Just today, 137 people in this country will get HIV, and
my question is what are we really doing today to stop this?
People have had an opportunity to hear about it, and
they're not voting to swallow those pills.
If this generation puts its body on the line by taking a pill,
the virus is gonna be gone.
If there's nobody to infect you, then the epidemic will be over.
We thought this
was gonna be over
in the 90s.
At least I did.
I thought this can't keep going like this.
And when 2000 came and went, and we were no closer to a cure and
we were no closer to a vaccine.
That's when this hopelessness started coming in,
that I don't think I'm ever gonna live without this being a presence in my life.
And I don't think I'm ever going to be able to have sexual freedom without
the fear of HIV.
That came to be something I accepted.
So 30 of these come in a bottle.
This is one single dose that I take every single day,
just one of these, to remain HIV negative by taking this.
So Truvada was originally developed and indicated for
people that are HIV positive for treatment.
Mm!
Good to the last drop.
So when people talk about this new medication,
they're not really talking about a new medication.
We're talking about medicines that have been around now for about 20 years.
But their indication is new.
So when I refer to PrEP, that is what is called pre-exposure prophylaxis.
When the FDA approved use of Truvada as PrEP, I naively thought that that meant
everyone was gonna learn about it and was sadly disappointed when that wasn't true.
And then I decided that if no one else was gonna do this kinda work, I'm gonna do it.
I started a group on Facebook.
We now have 5,032 members as of today, 147 of which just joined in the past week.
So we're on the way to the lab here.
These are the people who work at the Gladstone Institute of Virology and
Immunology, and including my laboratory and other laboratories.
We study how HIV causes disease here and drug resistance.
We also study HIV transmission.
In the United States, we have 50,000 new HIV infections every single year, and
that has not changed in the last 20 years.
Men who have sex with men are disproportionately
impacted by HIV around the world,
having a 19-fold higher prevalence of infection than the general population.
This is an epidemic that's out of control, and so
finding new ways to prevent HIV is critically important.
We have been interested in using anti-viral
drugs to prevent the acquisition of HIV for some time.
And so, once Truvada became approved for HIV treatment,
we immediately proposed to evaluate whether it could work for PrEP as well.
Truvada is a single tablet that contains two medications.
One is called Tenofovir and the other is called Emtricitabine.
Both of those medications block the HIV life cycle.
So, people could still be exposed to HIV infected fluids but
the virus cannot spread inside the body because the medications prevent
viral spread from cell to cell.
Clinical trials are essential for knowing whether a medicine actually works or not.
I had an opportunity to lead the iPrEx trial.
The goal of the iPrEx trial was to show whether Truvada was effective for
HIV prevention, and whether it was was safe.
When we first started presenting our data, we always emphasized how well it works.
And finally, we started asking people, why are you choosing to use PrEP or not?
And the people who chose not to use PrEP always said, I'm afraid of the safety.
You told me all these things about how well it works.
But my concern is, is it safe?
And people should feel assured that they can use it safely, and
it'll work if they take it.
So, I'm about to see my doctor, Howard Grossman, for my quarterly PrEP screening.
Have a seat.
So, how's it going?
Pretty well.
Well, I've been involved with HIV since the beginning of the epidemic.
So when I was in training, I'll usually say,
when I hit the wards the first cases of HIV were hitting the wards as well.
First I'm gonna swab your throat and we'll end up swabbing your anus.
Relax, okay, you can do better than that.
So my protocol for the PrEP process is I have him come in every three months, and
every three months I see them.
We talk about their sexual activity, whether they're taking the drug,
how often they're taking it.
And we test for HIV, we test their kidney function, and we test for
sexually transmitted infections to make sure they're not having some idiosyncratic
reaction to Truvada.
Oh, you get Big Bird.
All right!
This is one of the biggest selling and biggest used HIV drugs in the world.
It wouldn't be if a significant numbers of people had real problems.
The two main side effects are first, a decrease in bone mineral density.
Bone mineral density, we know of people who get checked for osteoporosis.
It's not progressive.
It doesn't lead to increased fractures.
So we say that it is statistically significant,
cuz you can see it on a graph, but it's not clinically significant.
The more important side effect is a drop off in kidney function and
that's something that's been relatively common, but
generally in most people that drop off still stays within the normal range.
The only other side effect is some incidences of abdominal upset.
It's not very common but it has been reported, and it goes away.
The secondary benefit here is that we're doing a lot more STD testing,
that people are coming in more regularly.
They're getting HIV tested four times a year.
They're getting STD testing four times a year.
And we're talking about sex a lot more, which is really good.
Once I had been using it for a year, and the FDA approved it and
more of the science came out,
I felt much more assured that Truvada would protect me if I was exposed to HIV.
And for the most part, I gave up using condoms.
And now I don't use condoms in my sexual encounters.
Okay.
Not with people that are positive, not with people who are negative identified.
Do you worry about STDs at all?
I'm concerned about STDs.
I'm not gonna worry about STDs.
I feel like I've spent enough of my life losing sleep
over consequences of sexual behavior.
My name is Michael Weinstein.
I am president of the AIDS Healthcare Foundation and also a co-founder.
And we provide medical services to 36 countries and
381,000 patients across the world.
Being in the hospice business, so
to speak, I saw hundreds and hundreds of people perish.
As a member of an older generation that lived through the worst of it I feel like
I have a moral responsibility to tell young people where things are at,
whether they want to hear it or not.
So the question about PrEP is,
does the scientific data support it as a public health intervention?
And that answer is conclusively no.
Adherence is a huge obstacle.
Getting people to take their medication everyday is very difficult, so
when you're looking to control the spread of HIV
across a whole population group it has not been effective.
I mean, I see really there being a war on prevention.
We need to revive the prevention movement that existed in the 80s and 90s.
We're gonna do that by distributing condoms in bars,
by putting out billboards.
This is an ad called, what if you're wrong about PrEP?
And this is an open letter to the Center for Disease Control.
Unfortunately, there's been so much controversy and
debate about PrEP, that it's left many people confused.
One person, who claims to be an expert, says that PrEP doesn't work.
Other people say it does work.
One person says nobody can take a pill a day.
Other people say, well, of course, you can take a pill a day.
It's a personal choice.
I see more and more people saying that gay men have a right to have unprotected sex.
The majority of gay and bisexual men
gave up consistent condom use a decade before PrEP ever became available.
So for people to think that a message that didn't even work in 1992 is going to work
effectively in 2015, when the consequences of being HIV positive are no longer death,
it's irrational!
You need to understand that people are coming in begging for this drug.
And they know they have to take it every day and so they do.
I think we could be sitting on something that could change the course of
this epidemic.
I think it remains to be seen how well we can make PrEP available.