"Coming out in that environment was challenging and stressful," he said. "Immediately associating sex with illness and death was very stressful and many, many people, I think, had that same experience." He spoke of friends who have started using PrEP recently who "have told me that their general anxiety level around intimacy has gone down significantly."
Wiener said that only a few people knew that he was taking PrEP. James Loduca, vice president of philanthropy for the San Francisco AIDS Foundation, called Wiener's disclosure "incredibly courageous."
"We need more people like Supervisor Wiener," Loduca said. "In my own personal network, many of my HIV-negative gay male friends are on PrEP. None of them talk about it publicly, and that is a reflection of the enormous stigma and shame that we still have around sex, around a desire to have intimacy. … It's an important watershed moment for our community that someone so visible steps forward and says 'PrEP is helping me.'"
Wiener spoke openly of people availing themselves of all options to prevent acquiring the virus, including the use of condoms and being tested regularly. If someone becomes infected with HIV, identifying the infection sooner yields more immediate treatment, which can lead to improved long-term health outcomes.
When taken to prevent HIV infection, Truvada carries a risk of side effects that include headache, abdominal pain and weight loss. Potentially serious side effects include kidney problems, liver damage and a buildup of lactic acid in the blood. Not everyone is affected. Wiener says he is not suffering from any side effects of the treatment.
Move to Subsidize PrEP Treatment
Wiener's announcement comes on the eve of a rally to be held Thursday, coordinated by San Francisco Supervisor David Campos. Campos is calling for San Francisco to make PrEP available to San Franciscans regardless of income. New York Gov. Andrew Cuomo has made a similar proposal for his state.
Despite a massive public health campaign to fight the spread of HIV, nationally there have been 50,000 new HIV infections every year for the last 20 years. "PrEP is the first new tool in our fight to protect ourselves from HIV since the epidemic began," Campos said in a release.
Wiener backs the effort. "In order for PrEP to be successful, we have to do three things," he said. "We need to raise awareness about it, make sure people know about it. … We need to secondly remove the stigma around it, so people are able to talk about it, are able to consider it, and finally, we need to expand access."
But that kind of community-wide campaign is exactly the wrong idea, some advocates say.
"To deploy (PrEP) as a community-wide preventive is a public health disaster in the making," said Ged Kenslea, spokesman for AIDS Healthcare Foundation, a global advocacy group. He stressed the organization is not opposed to the use of PrEP on a case-by-case basis.
"The crucial problem is adherence to the medication," he said. He also pointed out that condoms are not only effective against protecting against HIV infection, but also against other sexually transmitted diseases "for which PrEP does nothing." Kenslea said that he's worried that people "seem to be throwing condoms out the window."
Dr. Robert Grant with the UCSF Gladstone Institute led the research that ultimately showed Truvada's effectiveness as a preventive agent against HIV and has followed it since.
He said that there's no link between PrEP and increasing high-risk sexual behavior. He also supports efforts to make PrEP available more widely and compared having a variety of tools to fight HIV with having a variety of methods of birth control available.
"Just like contraception," he said. "We're happy to have people using different methods. Same way with HIV. We have to have lots of different methods for people to use, so people can find one that's attractive to them."
Grant said that in his research "we have not seen anyone become infected who has taken PrEP daily or nearly daily."
Wiener published an essay in the Huffington Post Wednesday about his decision to use Truvada.