Scott Wiener: ‘After 30 years of prevention efforts, we clearly need to do more’

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Last month, San Francisco politician Scott Wiener became one of the first US politicians to confirm his use of Truvada as PrEP to reduce his risk of HIV infection.

Mr Wiener, a member of the San Francisco Board of Supervisors, went public in an op-ed published by the Huffington Post.

PinkNews spoke to Wiener about the shifting attitudes towards this little blue pill and why he felt it was time to disclose his use.

PN: What made you decide to come out as a user of PrEP and why now?

SW: “I thought long and hard about whether to disclose my use of PrEP and ultimately decided I had a responsibility to be public in order to move the conversation forward. My hope is that by disclosing my own personal health decision, we can make PrEP a better-known and better-understood prevention measure, one that will help move us toward ending the epidemic. HIV isn’t over, and we continue to see way too many new infections. After 30 years of prevention efforts, we clearly need to do more.”

As an elected official, are you concerned about being stigmatised for your use of PrEP?

“I think that any time, as a public figure, when you disclose something personal, there’s always risk involved, and people may judge you or be critical, but we also have a responsibility as elected officials to lead and lead by example. If you go through your time as a public official being scared of your own shadow and worrying about what people think about you all the time, you’re not going to get very much done, and you’re not going to be effective.

“When I saw that there was an opportunity for me to move the conversation forward in a way that it had not been moved forward before, it became an easy decision in the end, even though I understood that there could be ramifications.”

Do you think other high-profile people need to come out as PrEP users?

“I think a lot of different people, whether they’re elected officials or actors or performers, or simply people who are respected in their communities — once they’re open about PrEP we can start changing attitudes about using PrEP as a very effective prevention method. I can’t tell you the number of people that have come up to me already and said: ‘I’ve never heard about this before,’ or ‘I’ve heard about it, but I’ve never really thought about it for me, and now I’m going to talk to my doctor,’ or ‘I’m on PrEP, but I never told anyone because I was scared people would judge me, and now I feel more comfortable telling people.’ Those are the conversations that move the dial.

“When I first started hearing about PrEP, what got me seriously thinking about going on it, was hearing about my friends who were on it. Friends are the greatest influencers, so the more people who are open about being on it — from well-known people to people who are simply respected in the community — that will allows us to make progress.”

What do you see as obstacles for the widespread usage of PrEP?

“There are several roadblocks, including stigma and public awareness, but one of the biggest roadblocks is access. For people who have really good insurance or who are on Medicaid, they can access Truvada. But for people who don’t have insurance or they do but they have high co-pays and high deductibles, it becomes very expensive. If we really want to move the needle on prevention and take full advantage of reducing infection by up to 99 percent, people need to know about all of the sources available for them to access the drug. It also means public investment.”

What about the adherence issue?

“Adherence is definitely a challenge, as it is with other drugs. That is an education issue. We have to make sure that we aren’t just giving people these drugs, but that they understand that you have to take the pill everyday, and that if you don’t take the pill every day, then you won’t be protected at the same level.

“It also shows why it’s important for people to be ‘out of the closet’ in terms of using PrEP. For every population that is impacted by HIV, it’s important for them and for the people who are admired within the community to be open about their usage.

“The good thing is that this is one pill a day, so while there is an adherence issue, at least it isn’t a situation where they have to take many pills a day. Before some of the advances in retrovirals, people used to have to take a ton of pills everyday, especially if they were HIV positive. Now, this is one pill — that’s a heck of a lot easier in terms of getting used to a regime.”

Why do you think there is this shift in attitudes surrounding PrEP? We went from wanting innovation, to shaming people for taking PrEP. In your opinion, do people think we are in a post-AIDS crisis America?

“Media coverage does have an impact. And there’s a lot of lingering frustration for people who don’t use condoms. For those of us who have had a lot of years being preached to about using condoms — I mean, they are very, very important for prevention. But the reality is that five out of six gay men are not using condoms all the time — and that’s not unique to gay men. There are straight men who don’t want to use condoms all the time, and straight couples who aren’t using them consistently. No one is judging them. So whether someone likes it or doesn’t like it, this is the reality after three decades of condom prevention education. Good health care is about meeting people in the middle, where they are, and not demanding for people to do what you want them to do. WHO recommends it for all gay men who are sexually active because condoms have a failure rate. So PrEP is a great in addition to condoms.”

Why are people so hesitant about going on PrEP?

“One aspect is awareness, people may not realise that it makes sense for them, or they have certain notions about side effects, or they think it’s an older retroviral that had a lot of side effects. But a huge part of it is stigma. There is a lot of shaming. It is perplexing to me, because if PrEP had come out 20 to 30 years ago, there would have been lines around the corner and we would be shaming the people who weren’t on it.

“Now fast forward several decades and we see the opposite. People are afraid that they’ll be judged for acting in a certain way or being reckless, but people need to understand that this is just a smart prevention measure, just like birth control was for women and the HPV vaccine is for women. It will allow people to take ownership and personal responsibility over their own bodies.”

Anything else to add?

“I came to terms with being a gay man when I was 17 years old, since 1987, and I’m just sick of meeting 19 year olds that are positive. I just want people to have every single tool at their disposal and for us to stop shaming people for taking care of their own sexual health.”