Whole Phil
The podcast where I talk about whatever I want with whomever I want.

S1E8 - Free PrEP!!! (for everyone)

PrEP could end new HIV transmissions as we know it. So why isn't it more available?

a year ago

Welcome to The Whole Phil podcast, I am your host, Phil Reese, the DJ, that's my Facebook name, Really Phil Reese, that's my Twitter, Phillip J Reese, that's my Instagram, my dot com and my real life. Tweet me right now, hashtag #getyourwholephil and tell me about yourself. I am a loving, lovable, chubby, queer, sober, spiritual, vegetarian, feminist radical leftist web developer, and deejay in DC. This is the podcast where you get your whole Phil. I talk about whatever I want, with whomever I want, and do whatever I want, because there's no rules, no format, and no fucking censors. Let's start the show.

Today is Saturday, January 18, and we're talking about PrEP. No, not getting ready for a big test, I'm talking about the big blue HIV preventing pill, Truvada.

You probably know the Human Immunodeficiency Virus, or HIV, attacks your immune system turning your immune cells into factories for more virus cells, and leaving you open to suffering from all sorts of diseases your body normally easily fights off. HIV is an insidious virus that even creates reservoirs of dormant virus in your body that reactivate later even if your body has fought off a previous wave of infection.

HIV infection was once very fatal, but over the years, drug treatments have made it possible for most people infected with HIV to live full normal lives, as long as they maintain their daily drug regimens religiously. Early antiretrovirals had wicked side effects. Over time, though, new drugs were developed to try to minimize and even eliminate those side effects.

Though there is no cure for HIV, after the invention of protease inhibitors in 1996, it became possible for drug regimens to destroy the live viral load in a person with HIV, which means their immune systems function normally and over time, in most cases, those sticking to these drug regimens are unable to transmit the virus to others. Undetectable means untransmittable.

PrEP is an acronym for pre-exposure prophylaxis. It is an HIV drug that HIV-negative people take daily to prevent HIV infection. If a person on PrEP is exposed to HIV, the chemicals in their body from PrEP kill the HIV virus and prevent it from replicating and creating reservoirs in the uninfected person. It's like the 80s Star Wars defense system for HIV in your body. If HIV tries to get in, it's obliterated before it can do anything.

This episode is in no way sponsored by the pharmaceutical company, Gilead, who have the patent on the brand Truvada. And while this is a pro-prep episode, Gilead isn't going to love everything I say here.

Truvada is the name brand of em-tri-citi-bine/teno-fo-vir, a groundbreaking HIV and Hepatitis-B medication that came out in 2004, combining two antiretroviral HIV/Hep-B medicines. It was very successful in eliminating HIV viral loads in patients that took it; so successful folks started to wonder if it could even be used to prevent new infections. It also showed, long term, to have very few serious side effects in many of the patients who were on it, though some patients saw kidney and liver issues crop up from long term use.

In 2007, the four year iPrEx study began in Peru and Ecuador, exploring whether or not those uninfected but high risk for HIV infections taking Truvada would remain uninfected long term. Truvada was selected because of it's effectiveness in knocking out viral load, and it's low instance of serious side effects. In 2008, the US, Brazil, South Africa and Thailand jumped in on the study. The results published in 2011 were significant.

Not everyone who stayed in the study had stuck to taking it daily, and among those who stopped taking it altogether or took it very sporadically, there were infections. But among the study participants who maintained the recommended daily dose, there were zero new infections. That was huge.

It was like a big giant triple locked steel door got kicked in for the HIV prevention community. In 2012, the FDA approved Truvada to be taken for prophylactic purposes. In 2013, as soon as my insurance would cover it, I got myself on PrEP.

Despite all the hopeful data about PrEP, however, there was a huge backlash against those taking and promoting PrEP, and it sadly came from a very unexpected source: inside the LGBTQ community itself.

We'll be right back.

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Now on with the show.

Despite the fact that since the creation of protease inhibitor drugs, we've seen people living with HIV taking these drugs consistently maintain a viral load of zero, stigma of those living with and treating their HIV remained very high in the queer community. Despite all our best efforts at education, ignorance prevailed. Illogical fear and discrimination reigned. People did the wrong things to try to protect themselves based on this bad information, and HIV transmission remained high in our community. One in four HIV infected people did not know their status.

That ignorance and stigma was extended to any discussion of PrEP. In the early days, like most people promoting PrEP, I was attacked online constantly and vociferously by people who I had previously respected. I was told I was encouraging bad behavior and irresponsibility, and that people on PrEP were going to create a supervirus that no HIV medicines would be able to treat. I was told by several people that their friends that had died from HIV related illness would be disappointed in me, and one said his friends were rolling over in their graves because of me.

But even more shocking, Michael Weinstein, the founder and leader of the AIDS Healthcare Foundation, started a massive and well funded disinformation campaign to sew fear in anyone considering getting on PrEP and shaming those promoting it. One of the biggest and most well funded HIV healthcare advocacy groups went to war with people trying to prevent new infections. It was gross and sad.

But it looked like PrEP wouldn't be stopped. Aside from Weinstein and the uneducated people loudly protesting online, most voices in the HIV healthcare community began loudly banging the PrEP drum. Even the Human Rights Campaign started to promote PrEP, and I was featured as part of a social media campaign they did, proudly holding my big blue pill up in a picture, despite the public shaming I was still receiving.

PrEP use grew, and despite detractors sensationalizing doomsday predictions, the numbers didn't lie. Since PrEP has become a cornerstone of HIV prevention strategies, new HIV transmissions have gone down 68% in New York City, 50% in San Francisco, 50% in DC, 44% in Australia, 32% in New Orleans, 19% in Chicago, 18% nationwide in the US and most starkly, more than 70% down in the UK.

PrEP prevalence also reduces the stigmatization of HIV infected individuals, helping them be treated like everyone else in the community.

Truvada is expensive, through, at nearly $12,000 a year. Gilead holds the patent on the drug in nearly every country it's approved for PrEP use. There is no hope for a generic anytime soon. The FDA recently approved another drug, Descovy, for PrEP. Guess who owns that one too.

If you are insured, your insurance may cover large portions of the cost for PrEP. And Gilead has a copay assistance program that covers the copay up to $200 a month. If you're not insured, and you meet other eligibility requirements, Gilead may pay for a big portion of your annual bill for the drug. Still, people with shitty or no insurance can't afford to keep up with the daily efficacy that's required for PrEP to actually be effective.

When HIV is properly treated, an infected person can live a long, healthy life. But you have to catch the infection before it ravages your immune system, and you have to have the money to afford that treatment. And again, HIV is incurable. If you can't continue to treat it or don't catch it, it can still be fatal.

PrEP, is therefore for many at risk people, a LIFE SAVING NECESSITY. Drug patents can be diabolical. Look no further than Valiant Pharmaceuticals or Martin Shkreli to see recent stories of drug companies abusing their patients and using drug patents to fuck people over.

Drugs like HIV drugs should have their patents broken, and generics should be available to all. At risk people should be able to get PrEP free without a hassle. If we're serious about actually ending new HIV infections, PrEP needs to be free.

Until we can break the patents, though, on these life-saving drugs, you should do whatever you can to make daily adherence to PrEP a reality for you. Talk to your doctor and visit the Advocate article I've put at bit.ly/affordprep to start researching how to make it affordable to you. Then sign up at breakthepatent.org to find out how you can help us break the patent and make prep free for everyone.

That's it for today. I hope you're enjoying the show. If you like what you hear, please subscribe wherever you listen to podcasts, just search Whole Phil or go to bit.ly/findwholephil, and please drop me a rating. Tweet me at @reallyphilreese with topic ideas you think I should cover. [DJ GIGS] Learn more about my upcoming DJ gigs at my website phillipjreese.com. And remember, be good to yourself, love yourself, and we're all in this together.

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