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Opinion April 18, 2014

Opinion: Why PrEP is a failure

By Robert Brandon Sandor

Since the mid-1990s and to this day, the HIV-negative community has stopped the spread of HIV simply by physically breaking the cycle of new HIV transmissions. During all that time, no HIV agency, organization, expert, professional or researcher has given the HIV-negative community credit for this monumental social and sexual behavioral change.

There has not been any attempt to reach out to our HIV-negative gay youth and create a message of congratulations for a job well done. In fact, the only message coming from the HIV “experts” targeting our HIV-negative gay youth is: Get medicated on PrEP and be happy.

(Editor’s Note: PrEP stands for Pre-Exposure Prophylaxis and is a new HIV prevention method that encourages high-risk, HIV-negative people to take a daily pill to reduce their risk.)

PrEP is a total failure and a worthless effort to cash in on an untapped cash cow — our HIV-negative gay youth. I will not tolerate this.

• PrEP failed because it is not practical.

Years of published articles and scientific reports stating that PrEP failed to gain national support are based on factual evidence; PrEP is simply not practical. One such article published in “The New Yorker” (See “Truvada and PrEP: Why is no one on the first treatment to prevent HIV?” by Christopher Glazek, Oct. 2013) stated: “The medical community’s reluctance to prescribe Truvada — and patients’ reluctance to request it — also stems from a bitter fight over the treatment. Critics have questioned PrEP’s safety, efficacy, and cost, and have accused the government of colluding with the drug manufacturer at the expense of public health.” (Editor’s Note: For a link to the NY article see gay-sd.com).

Also, the supporters of PrEP state that the HIV-negative community is required to take PrEP daily for life, and wear condoms 100 percent of the time. Which begs one to ask the question: Is it the condom keeping you HIV-negative or PrEP?

• PrEP failed because it is harmful.

PrEP is Truvada and according to its own website, Truvada.com, there are serious side effects: “Too much lactic acid in your blood (lactic acidosis), which is a serious medical emergency. Serious liver problems. Your liver may become large and tender, and you may develop fat in your liver. You may be more likely to get lactic acidosis or serious liver problems if you are female, very overweight (obese), or have been taking Truvada for a long time. Worsening of hepatitis B (HBV) infection. If you also have HBV and take Truvada, your hepatitis may become worse if you stop taking Truvada.”

• PrEP failed because there is no need to take expensive medications with harmful side effects for something HIV-negative gay youth are doing now for free.

One example is the national popularity of the disease and drug free revolution. This unique, community-driven, harm-reduction, HIV prevention strategy has been accepted since it was first introduced to the public back in the mid-1990s, with the formation of the nation’s first HIV-negative safe-sex environment, called “Boy Toys – NY”; a private sex party exclusively for HIV-negative gay young men, popularly known as “HIV-UB2 / Safe Sex Serosorting.”

Choosing to remain HIV-negative and drug free (D&D Free) is a freedom of choice issue and a legal right supported by the U.S. government. If this is not true, then why are HIV-negative gay youth required to become HIV+ and hooked on “meth”?

•PrEP failed because it does not address the root element to achieve successful HIV prevention.

Successful HIV prevention will be achieved when the HIV agencies, organizations, “experts” and “professionals” understand the core issue of HIV prevention and create a message focused for the target audience. PrEP failed because it does not focus on your desire and motivation to remain HIV-negative.

In my booklet, “The Essential Sex Venue Etiquette And Resource Guide,” published in April of last year, I explain this phenomenon further.

We consciously work to achieve consistency between our perceptions of self, our own behavior and feedback from the world around us. There is a way to change our perception of ourselves and our behavior if we choose to be consciously involved in learning, and have a desire to improve our actions. We have to be willing to go outside our comfort zone and challenge ourselves to see the situation differently.

The time has come to keep the promise and take HIV prevention seriously. HIV prevention messages in the U.S. must change and adapt to the needs of today’s gay and bisexual youth, otherwise the messages will become obsolete and worthless.

• PrEP failed because it ignored almost 20 years of progress achieved by the HIV-negative community, and their desire to remain D&D Free by having safe sex with their own HIV status.

Robert Brandon Sandor is a New York City-based Air Force veteran, HIV activist, and author. He is founder of POZ4POZ.com and HIV-UB2.net, and author of “The Essential Sex Venue Etiquette And Resource Guide,” Café Press, April 2013. He has been HIV+ since 1983. You can follow Sandor on Twitter at @SayNO2HIV or YouTube “Serious HIV Prevention.”

— For more information on PrEP, visit cdc.gov/hiv/prevention/research/prep.

LETTERS

SDSU President Elliot Hirshman is to be commended for making the Center a major priority [See “A Solid Foundation,” Vol. 5 Issue 7]. He’s only been president for less than two years and already he’s opened a Center and announced the first LGBT Studies major.

Congratulations to Doug Case for making this one of his life’s missions. Please, everyone consider supporting the Center and SDSU’s LGBT students.

—Robert DeKoven via gay-sd.com

CORRECTION

The last issue of Gay San Diego dated April 4, 2014 was identified as Volume 5, Issue 6. However, it should have been identified as Volume 5, Issue 7. We regret the error.

27 Comments

  1. Jake says:

    Firstly, this article is really poorly written. Secondly, if the HIV-negative community has been so successful at curbing transmission rates then why are rates of new infections increasing?

    EVERY medicine has side effects. I’ve been on Truvada for 5 years and I haven’t experienced any side effects. It is a decision that is between the patient and their doctor. Also, PrEp is a great tool (in addition to condoms) for serodiscordinent couples. How do you propose we educate youth without stigmatizing those who are positive?

  2. Terri Wilder says:

    This is a horribly inaccurate article. Fact check anyone? Who is this guy? I’m in NYC and I have never heard of him. How has PrEP failed? Truvada was just approved for use in PrEP in the summer of 2012 and the New York State Department of Health just released guidelines for medical provider in January 2014. Can this paper please invite someone to write a response that is more scientifically accurate article about PrEP so people can actually become educated about their options and this prevention tool? Please invite Jim Pickett (Chicago), Damon Jacobs (NYC), Jim Eigo (ACT UP/NY), Peter Staley, Dr. Tony Urbina (Spencer Cox Center for Health/NYC), Dr, Demetre Daskalakis (Mt. Sinai Health System, NYC), etc to write an article. They actually know what they are talking about. Jeez.

  3. Homo u dint says:

    Are you the same person in this previous article? If so you have no business writing on this topic.

    http://www.browardpalmbeach.com/2003-05-22/news/unsafe-sex/2/

    And NO… HIV negative men are not bring forced to do meth and become positive.

    This article is shameful. It could have been written better by an high schooler.

  4. B.Ryan says:

    This piece is such a bit of rubbish, so utterly filled with errors and lapses of logic.

  5. Andy says:

    PrEP is a failure for all those reasons mentioned and then some. It’s the adherence that is so abysmal that concerns me. This can create drug resistant strains of HIV. Then there’s all the new strains of other STIs that keep popping up from bbing. Who got syphilis in the 90s?! But serosorting is also a failure. Unless you work out a strategy with a monogamous partner you trust, just use a condom every single time for anal sex or get off with non-penetrative sex.

  6. Jeton Ademaj says:

    this article is an incoherent attack on the most important new HIV prevention tool in decades. Truvada is a medication with a proven track record of extremely low side-effects and very high potency in attacking the HIV virus…it had been on the market for a decade with remarkably few side effects. when taken *by itself* as pre-exposure prophylaxis (PrEP) by HIV- people, it provides well over 99% effectiveness at preventing HIV transmission if taken as directed, daily. when taken only every other day, it STILL provides over 90% risk reduction of HIV infection. this is far better HIV risk reduction than condoms…however Truvada does not prevent any other std’s.

    choosing to only have sex with people of your own serostatus (HIV+ only with HIV+, HIV- only with HIV-) has only limited success for HIV+ people, and almost no use at all for HIV- people.

    Why? because the most risk of infecting others actually comes from people who THINK they are HIV-, but are actually HIV+. people in this category are not on medication, which would have controlled or eliminated the chance they would infect others. study after study has shown that the vast majority of HIV+ start protecting their partners once they actually know they’re HIV+…meanwhile, if someone is willing to lie about their status, they have already negated the usefulness of Robert Sandor’s strategy.

    adults have the right to have sex with whatever willing adult partner will have them, and serosorting can be one tactic added to others to reduce a persons risk of HIV infection…but spreading lies about medical issues is irresponsible, even if the writing is poor and illogical.

    Robert Sandor has been a well-meaning but highly damaging “activist” on the New York scene for years…his name is radioactive mud in activist and public health circles. he should stick to organizing sex parties for HIV+ people, and leave medicine and Public Health to experts.

  7. Timothy P Holmberg says:

    Why PrEP Should Not Fail
    By: Timothy P. Holmberg

    It is said that the victors get to write history, but in Gay San Diego’s most recent editorial, “Why PrEP is a failure”, Robert Sandor has gone one step beyond revisionist history and is now writing history before it has been made. In Sandor’s alternate universe, Pre Exposure Prophylaxis (PrEP), the new HIV prevention treatment has failed, and we are led to an HIV free utopia by a corps of young gay men who have sero-sorted the virus out of existence (sero-sorting is the practice of choosing sex partners by HIV status).

    As shocking as it is that Gay San Diego would allow such a column to appear under its own editorial heading, it is even more galling to hear Sandor extol the virtual segregation of the gay community by HIV status while all but suggesting that parades be held in honor of the negative in our community. After which, Sandor invites them to join in a celebration at an HIV negatives-only sex party (HIV-UB2)!

    Where to begin?

    While positive reinforcement is important, HIV prevention is far more complex than Sandor’s sero-sorting “atta boy” prescription could accommodate. There have been several attempts aimed at encouraging those who are negative in their prevention efforts. One such effort in San Diego was called Stãy, and presented a very upbeat message to those who are HIV negative. Even at the program’s peak, it had a negligible impact on infections in San Diego.

    Sero-sorting itself is a poor prevention strategy. According to the CDC website:

    The CDC does not recommend serosorting as a safer sex practice. Serosorting is not recommended because: (1) too many MSM who have HIV do not know they are infected because they have not been tested for HIV recently, (2) men’s assumptions about the HIV status of their partners may be wrong, and (3) some HIV-positive men may not tell or may misrepresent their HIV status. All of these factors increase the risk that serosorting could lead to HIV infection.

    Sadly, I can attest to the failings of this method personally. And I am not alone. As the proliferation of HIV test dates on Adam 4 Adam demonstrates, this method has become quite prevalent.

    Over the last ten years, new infections have hovered at roughly 50,000 a year. Contrary to what Sandor suggests, much of that figure is actually coming from those who think they are negative. The undiagnosed represent just 20% of those who are HIV positive, but are generating well over 50% of new infections.

    Sandor’s assessment of PrEP’s failure is startling to anyone who has followed this story at all, since PreP has only been approved by the FDA since July of 2012. Currently, most of those on PrEP are enrolled in studies that are judging the efficacy of the treatment, and the results so far offer much encouragement, and a few caveats.

    According to the CDC, “Among MSM (men having sex with men) with detectable levels of the medication in their blood, the risk of HIV acquisition was reduced by more than 90 percent.” This is an important statistic that Sandor fails to mention. As a corollary, consider that the most significant drop in unwanted pregnancy came with the advent of the birth control pill, which remains by far the most used method. The potential benefit of PrEP lays in its simplicity – one pill once a day (thus fewer points of failure). Even when patient’s compliance faltered (missing three out of seven doses) protection remained 96% effective.

    There are real concerns with PrEP, including most notably what it’s effect on STD rates will be; the health effects of long term use; and whether improper use could lead to resistance of the drug involved. Current research is showing that these concerns can easily be managed. Much like those who are positive now, there may also be some collateral benefits that come from the regular contact with doctors that is required while on PrEP.

    We, as a community, have much to consider in how to implement PrEP, but at 50,000 infections a year, it is hard to call what we are doing right now a success. While Sandor is right in urging us to embrace harm reduction models of prevention, we should not take up his invitation to become embroiled in the same controversies we faced with clean needle exchange.

    Sandor, and more notably AHF’s Michael Weinstein, who likened the treatment to a party drug, are doing nothing to advance HIV prevention with such rhetoric. Regardless of anyone’s opinion, the use of PrEP should be determined by medical facts and validated research, not negative PR or the use of sex shaming terms like Truvada whore (the nickname given to those on the treatment).

    Sandor’s treatise is a sad concoction of ageism, ignorance and flat out lies. His embracing of a cause does not make him an expert, and his solutions are not only dangerous, but divisive.

    Timothy P. Holmberg is a former staff reporter with both the Gay & Lesbian Times and San Diego LGBT Weekly. His works have also been published in the New York Times and the San Diego Union Tribune. He currently published his works through Lanterns on the Water Publishing at http://www.lotwpublishing.com

  8. Josh Robbins says:

    This is pure ignorance. You don’t congratulate those that don’t get lung cancer, or those that don’t have MS. Point is: you assume all those that are Living with HIV are responsible for their infection. There are many that are positive because they were born with HIV– not their choice. But they do have the option now to be in a mixed status relationship and PrEP is a viable option. Also, those that did contract HIV from an exposure, deserve the chance at love and sex, too. So fundamentally, the failure is actually not of PrEP, but of your ignorance of the indication.

    Finally, PrEP is the only FDA-approved prevention tool for gay men that have anal sex to prevent HIV. Condoms that gay men have been asked to use for 25+ years, aren’t FDA-approved for anal sex. They are for vaginal sex. Sure it’s great HIV-negative guys remain negative. Here’s my grand congratulations to them. But those who choose an FDA-approved method with the indication for HIV prevention, make that educated decision with our support as a community… Not cute op-eds.

    If we are being honest and real about the true HIV Prevention messages that are misguided, let’s start with changing what you are assuming: that those who choose PrEP don’t care on the root level about staying negative. Actually, that’s the entire reason they are on PrEP. Duh! And let’s be honest, many gay men enjoy condomless sex– so the old message of wear a condom hasn’t really worked. And it’s experimental, because that medical device isn’t for anal sex. Just head to the FDA’s website, and they quietly mention this. Finally, condom manufacturers– when have you seen a gay condom ad that they made? Umm. You haven’t. Why? They can’t advertise for an indication that they aren’t approved. PrEP isn’t failing. We don’t know that yet– it’s only been approved a short time. There is a learning curve, tons we want to find out about side effects and efficacy and it deserves the time we’ve given to discovery of that similar to the time we placed on demanding gay men use a tool made for vaginal sex. That’s the failure. What an egghead post.

  9. Trey says:

    I have several issues with this article. It seems the author didn’t do his research and created a click hungry headline. I’ll go point by point.

    1. First sentence of the article states Hiv neg “community” has stopped the spread of HIV.
    False
    First of all HIV negative AND Hiv neg individuals have taken steps to reduce the transmission of HIV but HAS NOT STOPPED THE SPREAD.

    2. Sentence two states no credit has been given to those preventing the transmission of HIV
    False
    The black aids foundation is one of a number of research based orgs that cite or “give credit” to these individuals for slowing the spread of HIV.

    3. Paragraph two states the only message from experts for gay youth is “get medicated.”
    False
    The youth aids project does more than council LGBT youth to get medicated. They also ” YAP’s current HIV prevention program is for 13-24 year old men who have sex with men. It includes individual risk assessment, risk reduction education counseling, peer education, referral to other needed medical, psychosocial services, and longitudinal follow-up.”

    4. The editors note claims prep encourages risky behavior.
    False
    Prep is a medication that builds resistance within the busy to HIV infection. Risky behavior is not caused by prep nor is prep a mood altering drug. Risky behavior is a choice made by individuals.

    5. It’s impractical, years of published articles and scientific reports state…
    Where’s the research? If this is true, list the studies and link to their page, not an article written by the New Yorker.

    6. Prep failed because it is harmful.
    Misleading
    Prep has serious side effects. Liver function is a concern for those taking the drug long term. However, other drugs have equally and greater dude effects but are routinely prescribe under the care and supervision of medical professionals.

    7. Prep has failed because there is no reason to take expensive medications with harmful a side effects…
    The author has difficulty articulating his point in this section. He goes into freedoms and rights and then says, “so why are HIV beg youth required to get hooked on meth and become HIV pos.
    What reputable source suggests this is the case?

    8. Prep failed because it does not focus on your desire and motivation to be HIV negative.
    False
    The only reason individuals take prep is to reduce their risk of HIV infection.

    Prep is a success. I have point by ponint dismantled the reasoning in this article. I am on Prep and am monitored by a general practitioner for liver function, etc.
    I would take this author serious if he was a medical professional and if he cited his work.
    Thx
    Trey

  10. Mark S. King says:

    When our friends are making important decisions about whether or not to use a new tool to prevention HIV infection, they deserve real information from local media, not a barely coherent rant filled with misinformation and strange logic.

    Here is one of many recent articles available online that feature fact-based information on PrEP and the misinformation about it:

    The Sound and Fury of the PrEP Debate (and the Facts to Win it)
    http://marksking.com/my-fabulous-disease/the-sound-and-fury-of-the-prep-debate-and-the-facts-to-win-it/

    Thoughtful debate over the relative merits of PrEP is important, even crucial, to the lives of our gay brothers. It deserves an intelligent airing from our LGBT media and that includes the views of those skeptical of PrEP. But even PrEP critics would find it hard to support the bizarre contentions in this piece.

    Here’s hoping Gay San Diego will return to providing fact-based information in the future. Our community depends on it.

  11. Chris says:

    Please tell me this is an April fools day article a few weeks late. We already know that treatment prevents poz men from passing the disease, so that means it is the untreated (which includes those who think they are negative) who continue the epidemic.

    If a woman could be expected to take a pill daily to prevent pregnancy, and it is considered convenient, a negative person could do the same to prevent HIV.

    I am appalled that the editors would allows his article to even be published as fact when we know he thinks serosorting and discrimination are the answer.

  12. Ian says:

    “Choosing to remain HIV-negative and drug free (D&D Free) is a freedom of choice issue and a legal right supported by the U.S. government. If this is not true, then why are HIV-negative gay youth required to become HIV+ and hooked on “meth”?”

    OK, what?

    This a rather odd rant.

  13. Albert Benson says:

    This is the most irresponsible piece I have seen in this whole discussion. The experience of hundreds of the top doctors working with the gay community, the recommendation of the FDA, the the published PK studies (look it up if you don’t know what PK means) all go to say that PrEP is the best answer we currently have at stopping AIDS dead in it’s track. About the only person of any weight who is opposing PrEP is the notorious manipulator Mike Weinstein who makes $400,000 a year from defending the condom status quo. Condoms of course were never developed for anal sex to begin with and hardly anyone uses anymore. I have to ask, did Weinstein manipulate or pressure you into publishing this tripe? Im guessing he had a hand in this and It will come out eventually which will cost you guys a lot of credibility.

  14. Albert Benson says:

    Here is the PK studies as reported By the BOdy Pro, a publication not given to wild eyed statements where they note that daily truvada gives virtually 100% protection against HIV

    :http://www.thebodypro.com/content/66547/prep-pk-modeling-of-daily-tdfftc-truvada-provides.html

  15. Albert Benson says:

    Let HIV Negative people decide their own protection:

    PrEP (pre-exposure prophylaxis) is a proven concept. Regardless of whether opponents want to admit it or not, “bio-medical prevention” IS the key to reducing new-HIV infections

    http://www.thebody.com/content/74338/let-hiv-negative-people-decide-their-own-preventio.html?ic=wnhp

  16. Jeff Bosco says:

    This OpEd piece is the biggest piece of drivel I have had the displeasure of reading today. You Sir, are an idiot. To call yourself an AID activist is a joke.

  17. Eric says:

    Everything I need to know about this article is summed up in one line of the article: “In my booklet, “The Essential Sex Venue Etiquette And Resource Guide,” published in April of last year, I explain this phenomenon further.” So basically what we have with the anti-PreP crowd is opportunism–”no, no, you’re an idiot if you try that drug; try mine, instead. No really you must try mine. Or else you’re an immoral person. Just take a moment, would you, to shut your mouth and realize what you really are–a snake oil salesman who needs to keep the “D&D free” illusion going in your head to make yourself feel adequate. Go away.

  18. Race Bannon says:

    What an irresponsible article. I’m surprised you published it. The opinions expressed in this article go against all science. To keep people from using something that could prevent HIV infection is reprehensible. The only thing I can imagine is that somehow Michael Weinstein of AIDS Healthcare Foundation coerced you into publishing this. He’s about the only figure in the HIV prevention field that has come out so strongly against PrEP. PrEP works. That’s science. Not opinion.

  19. Morgan says:

    This is not an article, this is an “opinion piece.” – Editor

  20. Morgan says:

    The editors printed an “opinion piece” on the “Opinion” page and these responses are exactly what happens with OpEds that are highly scrutinized by the readership. Thank you for doing so. – Editor

  21. It would seem that I struck a nerve or two, good. Now we can move forward.

    The time has come where we (America) will stop the BSing and wake up to the fact that HIV “Prevention” in America has always been a one sided issue, focusing on HIV+ gay men like myself and ignoring the needs of our HIV- negative gay youth. Until now.

    Our nations HIV-negative gay youth are STILL HIV-negative for a reason, much to the dismay of the HIV Agencies, Organizations, “experts”, “professionals” and researchers. Sadly, NO ONE from these groups is interested in learning WHY our HIV-negative gay youth are still HIV-negative, therefore all this back and forth comments of protest are an opportunity – an opportunity for HIV Researchers nationwide and across the board to start their Grant Funding proposals.

    I am NOT here for anyone’s friendship, funding or political support, I am here to prove that our HIV-negative gay youth ARE the future of successful HIV prevention, and to defend them and their LEGAL RIGHT to remain HIV-negative. Your comments are being read by your local HIV-negative community in SD, and they are getting a clear view of who supports them.

    Visit http://HIV-UB2.ning.com and view the global map to witness the international acceptance my efforts have achieved, otherwise get an HIV Research here in NYC to prove to you that: Having SAFE SEX with your own HIV status is wrong.

    D&D FREE, HIV-UB2 and SAFE SEX SEROSORTING are national, and 100% effective. I am PROUD to publicly say THANK YOU to the HIV-negative gay youth in San Diego, California for remaining HIV-negative. If I don’t who will?

    Thank you for your comments,
    Robert Brandon Sandor
    New York City, NY

    The ONLY sex book written FOR our HIV-negative gay youth: https://www.createspace.com/4232709?ref=1147694&utm_id=6026

  22. All good things must come to and end, and this will be my final reply because no one answered my question or addressed my point:

    My question: Is it the condom keeping you HIV-negative or PrEP?

    My point: PrEP failed because there is no need to take expensive medications with harmful side effects for something HIV-negative gay youth are doing now for free.

    And since no one here offered to THANK the HIV-negative gay youth of SD for a job well done, you all have proven my editorial true and correct: Since the mid-1990s and to this day, the HIV-negative community has stopped the spread of HIV simply by physically breaking the cycle of new HIV transmissions. During all that time, no HIV agency, organization, expert, professional or researcher has given the HIV-negative community credit for this monumental social and sexual behavioral change.

    There has not been any attempt to reach out to our HIV-negative gay youth and create a message of congratulations for a job well done. In fact, the only message coming from the HIV “experts” targeting our HIV-negative gay youth is: Get medicated on PrEP and be happy.

    PrEP is a total failure and a worthless effort to cash in on an untapped cash cow — our HIV-negative gay youth.

    Therefore, I wish to say thank you to all of you who took the time to reply and voice your concerns, and to the editor and staff at Gay SD, and finally I wish to extend a BIG CONGRATULATIONS to the entire HIV-negative gay youth community for a JOB WELL DONE. Regardless of what you are reading here, YOU (our nations HIV-negative gay youth) have really proven the “experts” wrong – YOU ARE HIV-negative WITHOUT PrEP.

    Best Regards;
    Robert Brandon Sandor
    New York City, NY
    https://www.facebook.com/pages/Pledge-to-Remain-HIV-negative/1478464662372135

  23. Benny says:

    Agreed with Robert DeKoven’s letter about SDSU’s new president! Big kudos to president Elliot Hirshman for making the LGBT Center at SDSU a priority. DECADES of work under previous presidents, and then within a 1 1/2 of being at SDSU, Hirshman made this a reality. Excellent!

  24. Mr. Sandor,

    You have indeed struck more than a nerve. You are threatening other’s health during a period of confusion. The people you seek to congratulate for being HIV negative were us once, and moreover, there are many youth who themselves are positive. The message you send them is one of shame and failure. HIV prevention has not, as you state, “been one-sided . . . focusing on HIV + gay men.” In fact, there seem to be several things that you are surprisingly unaware of:
    1. The vast majority of prevention programs have focused on HIV – gay men. But many of those programs have faltered or have shown themselves to be ineffective in the face of improved HIV treatment outcomes.
    2. Prevention involves both those who are HIV positive and those who are negative, not just “young HIV negative gay men”.
    3. The majority of HIV infections are coming from those who think they are negative. At this point, roughly 15% are unaware of their status and account for over 50% of new infections.
    4. The sero-sorting that you suggest ties a significant component of self worth to ones HIV status. This can lead individuals toward denial should they make a “mistake”, and ultimately result in others getting infected.
    5. Segregating the community along HIV lines is not beneficial to anyone. Being around someone who is HIV positive is a reminder to those who are negative that HIV exists in their world no matter how much sero-sorting you do. But you give them a false sense of security.
    While sero-sorting among HIV + individuals can be helpful in prevention, it is an individual choice, and there are many sero-discordant relationships that show HIV positives and negatives need not be afraid of each other or segregate themselves. What you are preaching as a solution to HIV/AIDS stands about as much of a chance as abstinence in achieving significant and lasting changes in infection rates. Of course, in theory, both are 100% affective . . . until the humans using them make a mistake. As humans very often do. And then where are they? Do you take their awards and parades away? Do you disinvite them to your little sex parties?
    6. You discount the “experts” and “professionals” yet, you have no qualifications upon which to be dispensing HIV prevention guides. Certainly not charging $15 a pop for them. And in many respects this shows you to be simply pimping HIV prevention for your own gain. Are you registered as a 501C3? I doubt it.

  25. Matt says:

    I have an opinion piece to share. It’s actually quite short.

    Title: “Why Robert Brandon Sandor is a failure”

    The fact that Mr. Sandor opens this piece of fiction with this line – “Since the mid-1990s and to this day, the HIV-negative community has stopped the spread of HIV simply by physically breaking the cycle of new HIV transmissions.” – is enough to conclude he’s woefully misinformed and the entirety of his knowledge on this subject is nil. Stopped the spread of HIV? Are you kidding? Or just seriously deluded or misinformed? There has been no stop to the spread of HIV. In particular, HIV infection rates among young gay men and MSM have been going up (and continue to going up), not down. Please, for the love of sanity, research some basic CDC stats before you write an op-ed?

    From the CDC:
    “After new HIV infections among men who have sex with men (MSM) peaked in the mid-1980s at more than 75,000 new infections a year, the number of new infections plummeted to less than 18,000 per year by the early 1990s. Unfortunately, after years of steady progress, new infections again began to rise among MSM throughout the 1990s. While in recent years, prevention efforts may have helped stabilize infections, they are occurring at far too high a level (29,800 per year.) Additionally, young MSM are the only risk group in which new infections are increasing.”
    http://www.cdc.gov/nchhstp/newsroom/HIVFactSheets/Progress/Trends.htm

  26. Eric Paul Leue says:

    everyone may want to read this. And all I have to say to Mr Sandor – “you are welcome to your own opinions, but not your own facts.”

    http://www.hivplusmag.com/opinion/2014/04/29/did-lgbt-newspaper-bypass-its-ethical-obligation-publish-facts

  27. Dear Mr. Sandor,

    The fight against HIV is replete with well intentioned individuals who spread misinformation. As a reporter, I covered many of them. I will assume for the sake of argument that you are in fact well intentioned and not just trying to shill sex instruction pamphlets that you lack the credentials to be publishing.

    Which really is my point here, I guess. You have not a single credential upon which to establish any form of expertise. No PHD, no MD, really no healthcare background at all other that being a patient. And a patient does not an epidemiologist make. You cavalierly jaunt around the internet suggesting that others with such credentials are on the take, while you organize sex parties where HIV-UB2′s can screw in ignorant bliss thinking themselves barricaded safely away from the virus. You claim 100% efficacy for something that is dependent on not just one set of human factors, but two or three or more people (as in your sex parties). Not even condoms claim that kind of real world efficacy.

    So one must ask – where are your peer reviewed studies that bear out your claims? Did you publish them in JAMA and I just missed it?

    While we may agree that many of the organizations that work with HIV/AIDS have lost their way, it is not because they are rejecting your sero-sorting elixir. If you truly believe in prevention, you should be encouraging every tool to be brought to the table, and PrEP is one such tool. Though I have vast disagreements with the approach you are advocating, I do think that components of it are useful. Informing others of your HIV status if you are positive is one of them. But for that to happen, we cannot stigmatize the positive through segregative approaches that divide our community along HIV lines.

    Holding HIV- status up as a badge of honor by extension brands those who are positive with the gay scarlet letter. Are they damaged goods? What will you say to those young HIV-’s when they become infected in a moment of humanity? When you disinvite them from your sex parties? When they can no longer march in your parades? You offer them nothing but shame and self loathing.

    The world is not free of HIV, and no matter how well you screen at the door, you can never offer anyone an HIV free alternate reality.

    I was someone who sero-sorted. A young and, frankly, lucky HIV-UB2. The HIV positive community did not fail me, the person who passed it to me did not know their status. And therein lies the problem. You cannot know your status from day to day. Even month by month would be difficult. Most people test once or twice a year. Twenty percent of those who are HIV positive do not know their HIV status and are responsible for over 50% of new infections. The human tendency towards denial makes it difficult to find this elusive group. Your program does nothing to counteract those motivations, rather it incentivizes denial.

    PrEP has not failed, we don’t have the information to make that judgement, and you certainly lack credentials to make such a claim.

    Beyond that, I suggest that you change your wording a bit regarding your HIV status. No one was diagnosed HIV positive in 1983 – because there was no HIV antibody test. That did not happen until 1985. If you were diagnosed in 1983, it was with GRID or AIDS, meaning that you had opportunistic infections. If you were symptomatic in 1983, you are rare indeed to have survived, and the CDC must know you on a first name basis. In other words, though you may be positive, i doubt you were “diagnosed” in 1983.

    It is a nice year to chose in that no one then knew what was happening. They were innocent victims. The rest of us have to own our failings and admit that we made mistakes and became infected even though we knew how to avoid it. That is the story of the nearly 50,000 people a year who are infected. Aggressive testing, encouraging those who are positive into treatment and employing harm reduction techniques is the best and most valid approach for prevention. And PrEP clearly has a role in that. Sero-sorting among the HIV- crowd is a dubious approach at best.

    I will submit this to Gay San Diego to publish under comments, and if you have any response, you may deliver it there. I will not respond to you directly.

    Sincerely,

    Timothy P Holmberg

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