Opinions
PrEP not ready for prime time
Data supporting drug for HIV prevention weak, inconclusive
By JAMES DRISCOLL, Ph.D.
Government picking favorites among technologies on the basis of politics is always risky.
Political favoritism that clears a regulatory path for marketing a new, incompletely tested, drug can cost lives.
Under pressure from Gilead Sciences and its AIDS advocate allies, the FDA antivirals advisory panel will soon consider accelerated approval for Gilead’s AIDS treatment drug Truvada for prevention of HIV infection. Opposition is widespread in the HIV advocacy and medical communities. AIDS advocates warn that such approval would be, at best, years premature. At worst, it would be an unwarranted, dangerous experiment with public health.
Clinical trial data supporting Truvada as prevention, or PrEP (pre-exposure prophylaxis), is weak and inconclusive. PrEP is a far less effective preventative than are condoms (44% versus 98+% in U.S. conditions). Doctors fear that PrEP will be used instead of condoms or that its use will discourage condom usage. Cynthia Davis, an HIV doctor at Drew University of Medicine in Los Angeles, counsels that the drug must show 90 percent efficacy to be used safely in the U.S.
Davis worries that too many people will think that because they are taking the pill they will be safe. Dr. Kevin Fenton, CDC Chief of HIV-AIDS Prevention, has warned: “Some studies suggest that even a small increase in risk behavior due to a false sense of security about the pills’ effectiveness could actually increase HIV infections.”
Drug adherence among those already infected is difficult; it will be even more so among the uninfected. If the uninfected lack therapeutic levels of Truvada in their bloodstream before sex, they will remain unprotected. Patients will need careful monitoring and counseling to insure adherence; such handholding will be costly, inconvenient and in today’s economy unlikely.
Truvada is the most widely used anti-retroviral (ARV). Poor adherence, by the uninfected, will generate drug resistant viral strains. Curbing Truvada resistant strains is important to the well being of the HIV infected population and critical for those who become infected in the future.
ARVs are toxic, healthy people shouldn’t just pop them like vitamin C. The long-term toxicities of Truvada are unknown. Kidney damage, diabetes and hypertension have all been reported. Why risk these toxicities when safer, more effective prevention methods are readily available?
The NIH 052 study has proven that ARV treatment is 96+ percent effective in preventing infection of HIV-negative partners. Indeed, Science named 052’s results the No. 1 scientific advance of 2011.
Resources for ARV treatment in the U.S. are stretched to the limit. PrEP approval will result in scarce resources being diverted from proven preventatives that are 96+ percent effective into an experimental preventive which, even with ideal adherence, promises only 44 percent efficacy.
At $13,000/patient/ year retail, Truvada is a very expensive drug. In an era of severe fiscal constraints, Truvada used as PrEP would not only risk human lives, it would misallocate public and private resources needed for the healthcare of all Americans.
FDA Commissioner Margaret Hamburg has rebuffed appeals to meet with AIDS doctors and advocates who oppose accelerated approval for PrEP. She is ‘too busy’ to listen to them about either the health risks of PrEP or the political influence on its behalf. During the Clinton administration, Commissioner David Kessler met with AIDS advocates more than 20 times to discuss drug approvals.
Kessler’s door was open, he listened. Dr. Hamburg and her staff could learn from Dr. Kessler. One hopes the Obama White House can accelerate her learning curve — she appears to be stalled at go.
The FDA plays a crucial role in the fight against AIDS. When FDA listens to all AIDS advocates, it advances the solutions. If FDA closes the door to all but its friends, it becomes part of the problem.
President Obama has given America its first National AIDS Strategy, increased resources for HIV testing and ADAP, and sustained funding for international AIDS treatment in a difficult fiscal environment.
President Obama has listened and responded. The FDA needs to follow his example.
James Driscoll, Ph.D. is a longtime AIDS activist and an adviser to AIDS Healthcare Foundation.
Commentary
‘Live Your Pride’ is much more than a slogan
Waves Ahead forced to cancel May 17 event in Puerto Rico
On May 5, I spoke by phone with Wilfred Labiosa, executive director of Waves Ahead, a Puerto Rico-based LGBTQ community organization that for years has provided mental health services, support programs, and safe spaces for vulnerable communities across the island. During our conversation, Labiosa confirmed every concern described in the organization’s public statement announcing the cancellation of “Live Your Pride,” an event scheduled for Sunday in the northwestern municipality of Isabela. But beyond the financial struggles and organizational challenges, what stayed with me most was the emotional weight behind his words. There was pain in his voice while describing what it means to watch spaces like these slowly disappear.
This was not simply the cancellation of a community event.
“Live Your Pride” had been envisioned as a celebration and affirming gathering for LGBTQ older adults and their allies in Puerto Rico. In a society where many LGBTQ elders spent decades hiding parts of themselves in order to survive, spaces like this carry enormous emotional and social significance. They become places where people can finally exist openly, without fear, apology, or shame.
That is why this cancellation matters far beyond Isabela.
What is happening in Puerto Rico cannot be separated from the broader political climate unfolding across the U.S. and its territories, where programs connected to diversity, inclusion, education, mental health, and LGBTQ visibility increasingly find themselves under political attack. These changes do not always arrive through dramatic announcements. More often, they happen quietly. Funding disappears. Community organizations weaken. Safe spaces become harder to sustain. Eventually, the absence itself begins to feel normal.
That normalization is dangerous.
For years, organizations like Waves Ahead have stepped into gaps left behind by institutions and governments, particularly in communities where LGBTQ people continue facing discrimination, social isolation, economic instability, and mental health struggles. Their work has never been limited to organizing events. It has involved accompanying people through loneliness, trauma, rejection, depression, aging, and survival itself.
“Live Your Pride” represented much more than entertainment. It represented visibility for LGBTQ older adults, many of whom survived decades of family rejection, religious exclusion, workplace discrimination, violence, and silence. These are individuals who came of age during years when living openly could cost someone employment, housing, relationships, or personal safety. Many learned to survive by making themselves invisible.
When spaces like this disappear, something deeply human is lost.
A gathering is canceled, yes, but so is an opportunity for healing, connection, recognition, and dignity. For many LGBTQ older adults, especially in smaller municipalities across Puerto Rico, these events are not secondary luxuries. They are reminders that their lives still matter in a society that too often treats aging and queer existence as disposable.
There are still political and religious sectors that portray the rainbow as some kind of ideological threat. But the rainbow does not erase anyone. It illuminates people and stories that society has often tried to ignore. It reflects the lives of young people forced out of their homes, transgender individuals targeted by violence, older adults aging in silence, and families that spent years defending their right to exist openly.
Perhaps that is precisely why the rainbow unsettles some people so deeply.
Its colors expose abandonment, hypocrisy, inequality, and fear. They force societies to confront realities that are easier to ignore than to address honestly. They reveal how fragile human dignity becomes when political agendas decide that certain communities are no longer worthy of protection, funding, or visibility.
The greatest concern here is not solely the cancellation of one event in one Puerto Rican town. The deeper concern is the message quietly taking shape behind decisions like these — the idea that some communities can wait, that some lives deserve fewer resources, and that safe spaces for vulnerable people are expendable during moments of political tension.
History has shown repeatedly how social regression begins. Rarely with one dramatic act. More often through exhaustion, silence, budget cuts, and the slow dismantling of organizations doing essential community work.
Even so, Waves Ahead made one thing clear in its statement. Although “Live Your Pride” has been canceled, the organization will continue providing mental health and community support services through its centers across Puerto Rico. That commitment matters because people do not survive on slogans alone. They survive because somewhere there are still open doors, trained professionals, supportive communities, and people willing to remain present when the world becomes colder and more hostile.
Puerto Rico should pay close attention to what this moment represents. No healthy society is built by weakening the organizations that care for vulnerable people. No government should feel comfortable watching community groups struggle to survive while attempting to provide services and compassion that public institutions themselves often fail to offer.
The rainbow has never been the problem.
The real problem is the discomfort created when its colors force society to confront the wounds, inequalities, and human realities that too many people would rather keep hidden.
Opinions
LGBTQ community must say NO to Janeese Lewis George
Mayoral candidate should disavow Jauhar Abraham
Unless she disavows the support, and words, of those like Jauhar Abraham, which she hasn’t done, the LGBTQ community should say a resounding NO to voting for Janeese Lewis George. I don’t know her personally, but I do know what Abraham said about my community, and I know George not only accepted his endorsement, but went to help celebrate his birthday with him.
Abraham called gay men ‘fags.’ He then ranted, including saying gay men, who he called ‘sissies,’ should not be allowed to teach his children in our public schools. We have spent too many years fighting for our rights and dignity as gay men, and have come too far, to have a mayor who will not call out that kind of language, and the person who uses it.
Another issue on which I criticized George is her asking for, and getting, the endorsement of the Democratic Socialists of America (DSA), a group that is considered antisemitic. The DSA calls for the abolishment of the State of Israel, from ‘The river to the sea’ and tells endorsed candidates they may not meet with any Zionist organization, among other things. Her response to being called out on this by Ron Halber of the Jewish Community Relations Council of Greater Washington, was to have a private meeting with some Jewish leaders, where she blamed the answers to the questionnaire she submitted asking for the DSA endorsement, on a staffer. She neither fired the staffer, nor said which statements the staffer made she disagreed with. She has never disavowed the positions of the DSA. No one at that meeting was satisfied, and the same week she headlined, with others, a DSA rally. She claimed she is only a member of the Metro DSA group, but you cannot be a member of the local group, without being a member of the national organization. She also said she is a member of the Democratic Party, and doesn’t always agree with all they say. Well, it’s simple. In both cases, tell us what you disagree with in both their platforms. She has refused to do this.
I want the next mayor of D.C. to be willing to take responsibility for what they do, and say. I never agree 100% with any politician I have supported, and never expect to. But I want honest politicians. When something gets screwed up in the mayor’s office, will George blame it on a staffer?
It is also clear she doesn’t fully understand the tightrope a D.C. mayor must walk because we are not a state. George is clearly trying to emulate the campaign Mamdani ran for mayor in New York City. It was a great campaign. Mamdani is a great speaker, and charismatic. He also had the benefit, George doesn’t have, to run against a totally flawed candidate. Mamdani deserved to win.
I also want my adopted city of D.C., having moved here in 1978, to succeed. But what we are seeing in New York as Mamdani tries to make good on his promises, is his needing the help of the governor, and the state legislature. What George apparently misses completely, is, we have no governor, or state legislature. In reality, our governor is the felon serving as president, and the state legislature is Congress. We have seen generally how unwilling they are to help, and in most cases would rather try to hinder us from moving forward. It requires the mayor to be a constant advocate, but while doing that, also walking a tightrope. While fighting for statehood, and in the meantime, budget and legislative autonomy, the mayor has to deal with what exists today. Even if Democrats win back Congress in 2026, and I think we will, the felon will be there for the first two years of our next mayor’s term. Because of that, it is even more crucial they understand how to deal with him. Whether it’s housing policy, our court system, the national guard, parks department, or a host of other agencies and issues, we don’t have full control.
So, for all these reasons, I urge the LGBTQ community, and all voters, to say NO to Janeese Lewis George. She is wrong for D.C. at this time. I urge voters to say YES to, and cast their ballot, for Kenyan McDuffie for mayor. All my reasons to vote for him can be found in a column I wrote previously for the Blade. Let’s make sure our city, a city we all love, moves forward for ALL of us.
Commentary
He is 16 and sitting in a Cuban prison
Jonathan David Muir Burgos arrested after participating in anti-government protests
Jonathan David Muir Burgos is 16-years-old, and that fact alone should force the world to stop and pay attention. He is not an armed criminal, nor a violent extremist, nor someone accused of harming others. He is a Cuban teenager who ended up behind bars after joining recent protests in the city of Morón, in the province of Ciego de Ávila, demonstrations born out of exhaustion, desperation, and the growing collapse of daily life across the island.
Those protests did not emerge from privilege or political theater. They erupted after prolonged blackouts, food shortages, lack of drinking water, unbearable heat, and a level of public frustration that continues to deepen inside Cuba. People took to the streets because ordinary life itself has become increasingly unbearable. Families are surviving for hours and sometimes days without electricity. Parents struggle to find food. Entire communities live trapped between scarcity and silence.
Jonathan became part of that reality.
And today, he is sitting inside a Cuban prison.
The World Health Organization defines adolescence as the stage between approximately 10 and 19 years of age, a period marked by emotional, psychological, and physical development. That matters deeply here because Jonathan is not simply a “young protester.” He is a minor. A teenager still navigating the fragile years in which identity, emotional stability, and personal growth are being formed.
Yet the Cuban government chose to place him inside a high-security prison alongside adults.
There is something profoundly disturbing about a political system willing to expose a 16-year-old boy to the psychological brutality of prison life simply because he exercised the right to protest. A prison is never only walls and bars. It is fear, humiliation, emotional pressure, intimidation, and uncertainty. For a teenager surrounded by adult inmates, those dangers become even more alarming.
The situation becomes even more serious because Jonathan reportedly suffers from severe dyshidrosis and has previously experienced dangerous bacterial infections affecting his health. His condition requires proper medical care, hygiene, and adequate treatment, precisely the kind of stability that is difficult to guarantee inside the Cuban prison system.
Behind this story there is also a family living through a kind of pain impossible to fully describe.
Jonathan is the son of a Cuban evangelical pastor. Behind the headlines there is a mother wondering how her child is sleeping at night inside a prison cell. There is a father trying to hold onto faith while imagining the emotional and physical risks his teenage son may be facing behind bars. Faith does not erase fear. Faith does not prevent parents from trembling when their child is imprisoned.
And this is where another painful contradiction emerges.
While a Cuban pastor watches his son remain incarcerated, there are still political and religious voices outside Cuba romanticizing the Cuban regime from a safe distance. There are people who speak passionately about justice while remaining silent about political prisoners, repression, censorship, and now even the imprisonment of adolescents.
That silence matters.
Because silence protects systems that normalize abuse.
For too long, parts of the international community have spoken about Cuba through ideological nostalgia while refusing to confront the human cost paid by ordinary Cubans. The reality is not romantic. The reality is families surviving in darkness, young people fleeing the country in massive numbers, parents struggling to feed their children, and now a 16-year-old boy sitting inside a prison after joining a protest born from desperation.
No government has the moral right to destroy the emotional and psychological well-being of a teenager for exercising freedom of expression. No ideology should stand above human dignity. And no institution that claims to defend justice should remain indifferent while a child becomes a political prisoner.
Jonathan David Muir Burgos should not be in prison.
A 16-year-old boy should not have to pay for protest with his freedom.
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