Though the list of organizations that are loyal exclusively to condoms as a method of prevention is dwindling, AHF has been one of the most powerful and resolute allies of latex protection since the very beginning. Even before Truvada was approved by the FDA as PrEP in 2012, AHF campaigned to prevent it from happening. Even though AHF may be growing more and more isolated in its anti-PrEP stance, it is anything but ready to give way.
Though the efficacy rate for using PrEP is upwards of 90 percent reduction in risk, AHF and other critics consistently cite a drastically lower 40 percent reduction. The difference between these two figures lies in patient behavior: When Truvada is taken correctly, that is, every day without skipping doses, then it's been shown to reduce new HIV infections by over 90 percent. However, when research studies publish data they must include all participants, regardless of whether they took the dosage as instructed. Average out the effectiveness of the drug between participants who adhered religiously and those who didn't take it at all, and you arrive at about a 40 percent reduction in risk.
But as AHF points out, the outcome for the participants who did not follow instructions is an important reality that should not be overlooked.
"When you read these studies carefully, what they say is that research modeling can be whatever percent effective, but research modeling is not real-world applicable," said Ged Kenslea, AHF director of communications. "In every study participants were given incentives and paid to participate," yet still didn't adhere to instructions consistently.
"We can't even get people who already have HIV to take their pills as prescribed," Kenslea added.
Even amid legitimate concerns about health risks associated with improper use of PrEP or its inability to act as a safeguard against other STDs, much of the debate has become infused with anti-PrEP rhetoric rooted in stereotypical assumptions about the promiscuity of gay men. Patients who use it to protect themselves are reduced to "Truvada whores," men who live capriciously and are always on the lookout for their next fuck.
"The last couple of years that we've been prescribing [Truvada], there have been reports from patients who have received negative reactions from some people," said Nienow. "Some people, particularly online, regard it as a marker for whores and promiscuity, and others as a marker for self-protection. The stigma kind of ranges from, 'Great, you're protecting yourself,' to, 'Horrible, you're a slut.' My patients have seen all of those."
Just last month, AHF President Michael Weinstein referred to Truvada as a "party drug," setting off such a fury that a petition to remove him as head of the organization is now circulating around the Internet. It has amassed nearly 4,000 signatures.
AHF's policy of championing condoms above any other method is strange, considering that it cites poor adherence to Truvada as the drug's primary downfall. While the efficacy of the drug clearly drops when it is not taken correctly, AHF critics point out that condoms are not used consistently either, and having multiple methods of protection is better than one.
After viewing donations by Gilead to HIV/AIDS groups, the Bay Guardian requested a list of donors from the AHF as well, but the organization provided a 2012 tax form that did not include a donor list.
PrEP does have some efficacy, Kenslea said, and AHF clinicians are free to prescribe Truvada as a preventative drug.
"If an AHF physician feels that prescribing PrEP is appropriate, then we do not stop that," Kenslea said.