A friend recently called me an "anti-vaxxer" because I refuse to take Truvada, the PrEP drug that's proven to stop the spread of HIV.
"You're just like those parents who refuse to vaccinate their children," he said. "No matter how solid the science they stick with their misinformed opinions and endanger the rest of the children in their schools."
Are guys like me the new anti-vaxxers? Are we endangering other gay men by refusing to take the drug? Are we stubborn anti-science rubes who distrust the medical establishment to the point that we're harmful to those around us?
Sure sounds like we are. We see the studies on Truvada and they are remarkable. The results are so close to 100 percent prevention that some have taken to calling Truvada the closest thing to an AIDS vaccine that we've ever had. Yet we refuse to take it.
But the anti-vaxxer epithet, which my friend and a growing number of AIDS service workers are using to pressure the "hold-outs," doesn't hold up. First, Truvada is not a vaccine; it's a medication. You have to take it every day for the rest of your life (or for as long as you stay sexually active). Stop the medication, and you stop its effectiveness.
Second, I (and many of my ilk) have no quarrel with the science behind Truvada's effectiveness. I absolutely believe in its ability to substantially decrease the rate of HIV infection. I think taking Truvada is a rational choice for many people and I'm grateful that we have the option to take it and have insurance pay for most of the cost.
But me? No thanks.
My decision has nothing to do with the skepticism that "Truvada Skeptics" like AIDS Healthcare Foundation President Michael Weinstein have about the effectiveness of the drug. My objection has nothing to do with the science; it has to do with the unintended consequences of taking such a powerful drug.
Am I willing to go through some of Truvada's nastier side-effects like nausea and diarrhea for days, weeks and sometimes months before it goes away? No.
Am I willing to risk kidney or liver failure for protection against a disease that I've managed to avoid for the last 20 years? No.
Am I willing to curtail the quality of my life to pay for the substantial after-insurance deductible costs that Truvada would burden me with? No.
Context Is Everything.
No one should answer the questions I've just posed without looking at the context of their lives. For example, I would answer differently if I were in a high-risk sexual category (sex addict, intravenous drug taker, consistently having unsafe sex, consistently bottoming without condoms, in an open relationship or dating someone I suspected of being unfaithful). But none of those things are true for me. And because of that, I don't see the value of taking Truvada. Not for others. For me.
Truvada Is a Trade-Off.
In the hoopla surrounding Truvada's effectiveness a lot of its fans seem to forget that it poses some significant trade-offs to people who aren't in high-risk sexual categories. It's going to make a fair number of people sick with nausea, diarrhea and other complications for a little while (I understand that most people will not suffer these spells but hell, I can't even take aspirin without suffering side effects. I can't imagine what Truvada would do to me). And it's going to pose a significant risk to your organs. If it didn't, why are doctors obligated to test your kidney and liver functions every three months?
All medications have a trade-off, and they require you to weigh the pros and cons before taking it. Want Viagra? You better weigh the consequences of taking it if you have low blood pressure. Want Celebrex? You'll have to weigh its awesome pain-killing benefits with its not-so-awesome effects on your heart.
Personally, I hate taking medicine. They all give me unwanted side effects. And then I have to take medicine for the side effects. Soon, I start taking medicine to counteract the effects of the medicine. And then I take medicine for the medicine for the medicine.
Do You Eat Organic?
A lot of us do. Why? Because we care what we put in our bodies. We know that many of the chemicals they use on foods are harmful to us. If preservatives and other chemicals are linked to cancer what will powerful medicines like Truvada be possibly linked to in the future? If I were in a high-risk sexual category it wouldn't matter to me -- I'd take Truvada in a second. But I'm not. And the idea that I'm endangering other men's lives because I "ignorantly" refuse to ingest a powerful drug with unknown long-term effects on my organs is a bit much to take.
The friend who called me an "anti-vaxxer"used to work at an AIDS services organization and he, along with others, seems to have taken on the fervor of right wing fundamentalists convinced that anyone who doesn't see things their way is deaf, dumb or worse, a Democrat.
In their understandable zeal to decrease HIV infection rates, some AIDS service folks have adopted the "divide and conquer" tactics of social conservatives: You're either part of the problem or part of the solution. You're either with us or against us. You're either a Truvada believer or an anti-vaxxer.
My grandmother used to tell me about the Curse of The Plotnick Diamond. It was the most dazzling, expensive jewel of all time, available to any woman who wanted it, yet no one came forward to claim it -- because of the curse. What was the curse?
Mr. Plotnick came with it.
And that's why I don't take Truvada. I don't like the looks of that Plotnick guy.