Brave new world: Test, treat, and PrEP

via Bay Area Reporter, by Luke Adams and Race Bannon

We are both community organizers and spend a lot of time talking with the target populations of the long-awaited New Directions in HIV Prevention in San Francisco. As those changes take shape and the rest of the country looks on to see how we will make them work, we felt that it was time to address some misunderstandings. We also wish to address some reckless and deceptive misinformation in the AIDS Healthcare Foundation's ad campaign against Truvada and in the recent Guest Opinion ["DPH's risk behaviors: A case study," July 28] by Billay Tania and some members of Off the Grid.

Tania argues that the outgoing San Francisco HIV prevention model has proven successful – that HIV has decreased over the last decade, and so he questions the move to a new test-and-treat model. Tania's statistics fail to account for the following discrepancy. In the 1980s and early 1990s, when the "use a condom every time" message was being widely heeded amid the carnage of a barely treatable disease [Catania, 1991], San Francisco went from averaging over 600 to about 300 seroconversions per month [Coates & Collins, 1998]. But as of 2010, evidence tells us (depending on the study [Catania 1991, CDC 2002, Foster et al. 2011, Rosenberg et al. 2011]) that only one-third to one-half of sexually active gay and bi men are using condoms even "frequently." That's in the age of undetectable viral load thanks to effective medications. Yet last year, depending on which set of numbers you use, San Francisco had between 300 and 700 seroconversions all year [SFHIV/HPPC 2011; CDC 2011]. The outgoing model of risk/harm reduction hasn't been an ongoing success; it has been an increasing failure – biomedical science has succeeded far better.

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