Truvada: Chill Pill or Party Drug?

A new method of HIV prevention leads to old-school sex-shaming


Would taking a pill every day make people less responsible?
Credit: Jeffrey Beall

Did you know that there's a pill you can take that greatly reduces your risk of contracting HIV? Chances are, unless you're in a major risk category, you probably don't.

The drug is named Truvada, created by Gilead Sciences. It has been around for years as part of the treatment regimen for those already infected with HIV. But more recently, researchers have discovered its usefulness in preventing the disease's spread as well.

In 2012, the Food and Drug Administration (FDA) approved the use of Truvada as a daily medical regimen for those without HIV looking to avoid infection. The system of using the drug as an HIV version of birth control is known as pre-exposure prophylactic, or PrEP.

The drug is a boon for anybody having unprotected sex (though Gilead encourages users to still engage in safer sex practices, and the drug doesn't protect from other types of diseases) or for anybody who is uninfected who is in a relationship with somebody who has HIV. The drug isn't cheap, costing thousands of dollars per year, but because of the FDA approval it is covered by some health plans.

The drug hasn't really taken off as a form of HIV prevention and has instead become embroiled in controversy that should seem familiar: Detractors argue that, among other things, a pill version of HIV prevention encourages irresponsible sexual behavior. Taking what appears to be a major role in opposition to Truvada is Michael Weinstein, president of the AIDS Healthcare Foundation (AHF). AHF is responsible for pushing the recently passed Los Angeles ballot initiative requiring porn actors to wear condoms.

Weinstein was out of the country and unavailable for comment, but he was quoted by the Associated Press in April criticizing the use of Truvada as a preventative drug. "If something comes along that's better than condoms, I'm all for it, but Truvada is not that," he said. "Let's be honest: It's a party drug."

Those last two words—"party drug"—symbolized and helped fuel the argument by detractors that a daily pill was an irresponsible method of preventing HIV transmission. Weinstein's characterization of the drug and its users prompted a petition to try to have him removed as president of AHF.

But this latest quote isn't anything new for AHF's opposition to Truvada. AHF had been opposing the quick FDA approval of this PReP system back in 2011. They even used to have a site devoted to criticizing the medication, called, but it no longer appears to be working.

Other HIV groups have shown much more support for the PrEP system. The CEO of the San Francisco AIDS Foundation lauded the FDA's approval in 2012, calling it "a new era in HIV prevention." The opposition to the medication has taken on a moral tone, and the Associated Press noted a negative social connotation to the drug, a gay version of "slut-shaming." One HIV counselor in San Francisco responded to the attitude toward those who take the drug by embracing it, offering T-shirts emblazoned with #TruvadaWhore.

Some of the criticisms of Truvada—that success depends on taking the pill daily, that it encourages irresponsible sexual behavior, that it may fail—seem rather strange coming from AIDS activists who want to keep condoms the primary form of infection prevention. After all, the same potential flaws can be ascribed to condoms.

Given Weinstein's campaign to force condoms onto porn actors, it's worth looking to see whether the adult film industry had considered PReP. Diane Duke, president of the Free Speech Coalition, the trade association for the adult film industry, says they were currently in discussions about whether to add Truvada's PReP system to the health protocols for actors.

"PReP has a significant amount of promise," Duke says, "not just for performers, but for everyone." As a former worker at Planned Parenthood, Duke says she sees similar judgments against those who use Truvada that she saw against women who used birth control. She argues that there's no reason to believe users of the drug would be any less responsible than anybody using any other form of prophylactic.

"For those who choose to use Truvada PReP, it will be just as well thought out as women taking birth control," she says. "Any moral judgment on somebody taking care of themselves is absurd."