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Op-Ed: PrEP Works, So Drop the Backlash

Michael Lucas

A recent study shows 100% resistance to HIV for participants on PrEP. Michael Lucas responds to the most frequently-repeated misinformation, and asks why there is resistance to this game-changing prevention technique.

It's never polite to say,"I told you so." But I think I'm justified in using the somewhat less offensive, "Now do you believe me?" in this case.

I'm referring to the game-changing results of a new study on the antiviral drug treatment "pre-exposure prophylaxis," known as PrEP, or by its brand name, Truvada. Researchers at Kaiser Permanente San Francisco tracked 647 men, 99% of whom have sex with men, over the course of 32 months. Not a single participant taking PrEP contracted HIV.

I have been speaking out in support of PrEP for several years, so let me repeat the stunning conclusion of this study: Taking PrEP in the real world had an HIV prevention rate of 100%. Previous smaller clinical trials had indicated about 90% protection from the virus. Nothing is perfect, but this is clear: PrEP works.

One would think that all who deal with HIV and AIDS would embrace a nearly miraculous medication like this with open arms. Not the case, despite the fact that approximately 50,000 Americans are newly infected with HIV every year.

So allow me to respond to some of the misconceptions about and objections to PrEP that have been heard for years, and are still being pushed by opponents of the treatment:

1. "It's too expensive." Not true. PrEP is FDA-approved, and may be largely covered by health insurance (depending on your policy and provider). It's available free from the maker, Gilead, for those without health insurance and on low or moderate incomes, or who don't qualify for Medicaid. And that includes every immigrant living in the U.S., regardless of his or her legal status.

2. "It doesn't protect from STDs." True. But this is irrelevant. Those supporting PrEP have never claimed it would prevent STDs. PrEP also doesn't prevent diabetes, but why should that diminish its value in protecting people from HIV?

3. "It encourages men to have more sex without condoms." PrEP is the most highly-effective tool we now have to help sexually active people avoid contracting HIV. The corollary of the bareback argument is "Only gay men with high risk behavior need to take PrEP." That is a shameful contention that creates an unnecessary stigma. All you need is to have had one instance in your entire life of not using a condom, with a partner you don't know and trust 100%, to find value in taking PrEP. Each individual now can decide if PrEP fits his or her life, and if their risk for HIV is high enough to merit taking a pill every day.

4. "It doesn't guarantee 100% protection, and hasn't been studied enough." These arguments hold no weight after the publication of the Kaiser Permanente results in Clinical Infectious Diseases, a top publication in the field. Condoms should theoretically work 100%, but sometimes they break. The chance of condoms not working doesn't mean you shouldn't use them. PrEP will work 100% of the time, even in the real world outside of a clinical study, if taken as prescribed.

5. "Taking PrEP has side effects." Actually, so many people have no side effects that they reportedly question whether the drug is actually working. About one in ten people studied do report short-term effects such as headaches, weight loss, and stomach problems; most of those problems lessened after the first few weeks. But what drug doesn't have side effects? Where would we be if people never took antibiotics, due to the drastic side effects often associated with those powerful drugs?

I interview models for Lucas Entertainment in person or by Skype, and if they live in New York I will recommend that they visit the Mount Sinai Comprehensive Health Care Clinic in Manhattan. Since it's just a couple of blocks from my office, I often take them myself. I've brought at least 60 young men there in the last year.

If their blood test shows they are negative, they start taking PrEP; if it's positive for HIV, they begin medication. The medication has serious side effects, and there's no choice other than to take it daily until a cure is found. I begged a close friend to go on PrEP for the last two years. He hesitated for all the reasons cited above. When he finally decided to discuss it with a doctor, he was found to be HIV positive. He's now on HIV medication, which he takes along with a daily dose of regret. And there's no option to stop.

I should also point out that those who take PrEP automatically will be seeing their doctors on a regular basis, with the increased health awareness that brings. Often, taking PrEP means these people are getting appropriate sexual and other healthcare for the first time. This in itself may prevent HIV and STDs.

I often wonder why there has been such a backlash against PrEP. I have come to the conclusion that many of the opponents lived through the horrific time when sex equaled death, and they cannot imagine people having sex without fear. They cannot conceive of gay men enjoying sex without being paranoid about contracting HIV.

Then there is the most strident voice against the use of PrEP: the AIDS Healthcare Foundation. That's the Los-Angeles organization accused in April of bilking Medicare and Medicaid in a $20 million scam spanning twelve states. Three former managers of AHF, the country's largest supplier of HIV and AIDS medical care, alleged a system of kickbacks for referrals that would increase funding from federal health programs. Let me be very blunt here: PrEP prevents HIV. Without HIV and AIDS, this foundation would be out of business.

Despite all the attempted distractions, the focus must remain on the simple message in the new study: If you take PrEP, you will not get HIV. Period. It is time to wake up, stop the endless debating, and take action.

The war against HIV rages on, and when scientists actually win a battle, we must avail ourselves of the powerful weapon they have developed.

MICHAEL LUCAS is the creator of Lucas Entertainment, one of the largest studios producing all-male erotica, and the producer of two independent documentaries: Undressing Israel and Campaign of Hate. His essays and documentaries are available at This essay is the opinion of the writer, and does not reflect the views or opinions of Out.

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