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.
Opinions
D.C. is the place for the Democratic Socialists of America
Our endorsed candidates hold their affiliation as a badge of honor
D.C. is the place for the Democratic Socialists of America (DSA). We believe in a District where everyone can live a happy and dignified life. That means housing, healthcare, transit, education, and safety are treated as guarantees rather than privileges reserved for the wealthy and well-connected.
Our endorsed candidates do not hide what they believe. They engage in the democratic process openly, explain their politics clearly, and ask their fellow members to spend long nights and weekends doing the hard work of campaigning. And as the last six years of local elections have shown, including three successful D.C. Council campaigns and the overwhelming passage of Initiative 82, D.C. voters are often a great deal more interested in the endorsement of Metro DC DSA than in the handwringing of the Washington Post editorial board.
That is what makes Peter Rosenstein’s April 2 op-ed in the Blade so revealing. His piece was not just wrong. It was smug, unserious, and politically disconnected from the actual lives of queer people in this city. Worse, he used the platform of our local LGBTQ outlet to disregard Palestinian humanity while scolding democratic socialists for refusing to join him in that moral failure. Put plainly, Rosenstein has been publishing crank op-eds for years, and this one was no exception.
My name is Hayden Gise. I am a transgender, lesbian, Jewish, Democratic Socialist, and I am a union organizer. I do not speak on behalf of the national DSA organization, the local chapter, or any campaign. But I will not sit quietly while Rosenstein wraps himself in the mantle of queer Jewishness to sell the lie that anti-Zionism is antisemitism.
He packages that lie in the same kind of pinkwashing rhetoric used by Benjamin Netanyahu, who mocked solidarity with Palestinians by saying, “Some of these protesters hold up signs proclaiming ‘Gays for Gaza.’ They might as well hold up signs saying ‘Chickens for KFC.’” Rosenstein’s liberal Zionism is not thoughtful, brave, or nuanced. It is just a more polished way of telling Palestinians their lives matter less and telling queer people we should be grateful for the empire so long as it flies a rainbow flag. Which, by the way, is showing itself to be a losing strategy.
The ongoing genocide in Gaza is not some tragic deviation from the history of an otherwise peaceful Israel. The Nakba was the mass expulsion and displacement of Palestinians during Israel’s establishment in 1947–49, when hundreds of thousands were driven from their homes. My Jewish values tell me that is wrong. Rosenstein’s politics treat anti-Zionist Jews like me as illegible. No serious person should treat that accusation as an argument.
But the deeper problem with Rosenstein’s piece is that he has no real understanding of why Democratic Socialism resonates here. For queer people in D.C., Democratic Socialism is not an abstract theory. It is rent that does not consume half your paycheck, a union on your job, childcare you can actually afford, public transit that works, and a city where working-class Black and brown queer people are not displaced so developers and donors can cash in. Queer politics is not only about recognition. It is also about whether ordinary people can afford to survive.
That is why D.C. is fertile ground for Democratic Socialism. In the race for mayor, one of the leading candidates is Kenyan McDuffie, whose campaign already looks like a focus-grouped merger of Andrew Cuomo’s slogan and Donald Trump’s graphic design instincts, backed by big business interests and the super PAC money that follows them. The other has the endorsement of the major labor unions in the District. Who has a cohesive vision to make D.C. more affordable and childcare universal. Who puts people over profit and human rights over political expediency. Our next mayor, and our first Democratic Socialist Mayor: Janeese Lewis George.
D.C. is exactly the kind of city where Democratic Socialism should grow: working-class, queer, tenant-heavy, union-minded, and tired of being told that dignity is too expensive. Which side are you on? I know what side the queer people of the District of Columbia will be on.
Hayden Gise is a union organizer in Washington, D.C.
For half a century, the arc of LGBTQ progress in America has bent—slowly, imperfectly—toward justice. We fought for visibility, for legal protections, for the right to marry, serve openly, and live with dignity. Each generation built on the courage of the last.
And yet today, that progress is in peril. Across the country, lawmakers are rolling back protections, demonizing LGBTQ people for political gain, and trying to erase us from public life.
Opponents of our equality are working to erase us from the Constitution, and indeed, public life. In moments like this, based on my personal involvement working with one of the most effective leaders for LGBTQ rights I find myself asking a simple question: What would Jeffrey do?
Jeffrey Montgomery—the focus of a new documentary “America You Kill Me” and a long time Michigan activist and founder of the Triangle Foundation—was never content with quiet advocacy or compromise. He was a rabble-rouser, a strategist, and a relentless thorn in the side of powerful bigots. When politicians tried to marginalize LGBTQ people, Jeffrey didn’t politely ask for scraps. He forced the issue.
Jeffrey Montgomery started with his own determined voice and turned it into a movement. His story is living proof that personal courage can spark national conversations about justice and inclusion.
At a moment when the LGBTQ movement again faces hostility and regression, Jeffrey’s playbook offers lessons we would be wise to remember.
First, Jeffrey understood the importance of punching above our weight. In the early days of LGBTQ organizing, our movement was small, underfunded, and politically marginalized. But Jeffrey refused to let opponents see us that way. Through visibility, media savvy, and relentless organizing, he made LGBTQ advocates appear larger, stronger, and more unified than our numbers alone might suggest.
That perception mattered. Political opponents think twice before attacking a movement that looks organized, energized, and capable of mobilizing public pressure. Jeffrey knew that power is partly about reality—but also about what your opponent believes your power to be.
Second, Jeffrey never compromised on the value of our lives. Movements make compromises all the time. Politics often requires it. But Jeffrey understood that some things are not negotiable. The basic humanity of LGBTQ people is one of them. You can’t put our basic rights on the ballot. You don’t tell people to wait their turn. There are no turns. It’s now. It’s always now.
Too often, our opponents frame equality as something to be bargained over—as if the dignity and safety of queer people were a policy preference rather than a fundamental right. Jeffrey rejected that premise entirely.
You can negotiate strategy. You can negotiate timelines. But you cannot negotiate the worth of human lives.
And finally, Jeffrey understood the power of coalition. Today, one of the most effective tactics used against marginalized communities is division. If LGBTQ people can be fractured—by identity, ideology, generation, or strategy—our collective strength weakens.
Jeffrey instinctively resisted that trap. He worked with civil rights groups, labor leaders, faith communities, civic leaders and allies across movements. He understood that the fight for LGBTQ equality was never isolated from the broader fight for justice.
When opponents try to divide us, the answer is not retreat into smaller camps. The answer is to build broader ones.
If Jeffrey Montgomery were here today, he would not be discouraged by the backlash we are seeing. He would recognize it for what it is: the predictable response of those who feel their power slipping away.
And he would remind us that progress has never been linear. It has always required courage, persistence, and a willingness to challenge power directly.
So, when the moment feels uncertain, when the political winds shift against us, and when our opponents try to make us feel small, the question remains a useful one: What would Jeffrey do?
If history is any guide, the answer would be simple. He would make some noise. And making noise, today, means refusing to let fear, fatigue, or false unity quiet us when our lives are on the line.
Sean Kosofsky was director of policy at the Triangle Foundation.
Opinions
D.C. not the place for antisemitic Democratic Socialists of America
Candidates like Janeese Lewis George should reject its endorsement
D.C. is not the place for the antisemitic Democratic Socialists of America (DSA), who advocate for the end of the State of Israel from the ‘river to the sea.’ The candidates they endorse agree to their platform, which includes not talking to any Zionist organizations. Being a Zionist simply means supporting the existence of the State of Israel. It does not mean supporting the war criminal who heads the government, or what he is doing, including murdering innocent Palestinians, or bombing civilians in Iran and Lebanon. As Ron Halber, CEO of the Jewish Community Relations Council of Greater Washington, wrote in a column in DC Jewish Week, the views of the DSA are totally unacceptable.
The Council is non-political, but I am not. I can say one candidate for mayor, Janeese Lewis George, has asked for, and received, the endorsement of the DSA, and by doing so agrees to its antisemitic platform. After her endorsement became public, George tried to ‘privately apologize’ saying she didn’t see the questionnaire submitted by her campaign, rather it was submitted by a staffer. Now George says she is both not antisemitic, and supports Palestinians. Well, that sounds good. But she, and anyone else who accepts the DSA endorsement, has to answer a series of questions: 1. Are you for a two-state solution and the continued existence of the State of Israel, contrary to the position of the DSA? 2. Do you support BDS? 3. What is your definition of a Zionist? 4. What is your acceptable definition of antisemitism? 5. Will you meet with Zionist groups in DC?
Then, we must recognize if one candidate, like George, can go after and accept an endorsement from an antisemitic organization, it gives tacit permission for others to do the same with organizations that might be Islamophobic, racist, homophobic, sexist, or anti-immigrant. All unacceptable. I urge D.C. voters to reject any candidate, for any office, who has the endorsement of the DSA. That is not what we want the leaders of our government to represent.
Thankfully, there are many choices in this year’s Democratic primary elections for every office. There is a race for mayor, congressional delegate, attorney general, Council chair, two D.C. Council at-large seats, additional Council seats, Democratic State Committee seats and ANCs. D.C. political leadership will look very different after this election.
I urge voters to whittle down their choices by first rejecting anyone endorsed by the DSA. The DSA’s platform, aside from being antisemitic, also includes suggestions to ‘Defund the Police.’ That is a slogan some of the candidates running adopted a few years ago, thinking the people wanted it. They quickly found the people of D.C. didn’t want fewer police, they wanted their police better trained, with better community oversight. They wanted to be sure the police were here to protect them, not to harass them. People should know the DSA at one point even withdrew its endorsement from Rep. Alexandra Ocasio-Cortez (D-N.Y.) as she wasn’t strident enough in her opposition to Israel and actually met with a Zionist organization. There are many Zionists like me — a gay, Jewish man — who support the existence of the State of Israel, yet want to see Netanyahu, a war criminal, a murderer, tried for his crimes and in jail, and his government replaced. Zionists who support Palestinians and want them to have their own free state.
As you decide who gets your vote, one way to find out about a candidate is looking at their website. I would suggest you reject any candidate who doesn’t have a strong issues section. The least you can expect of a candidate is to tell you in detail what they intend to do if you elect them. That includes our delegate to Congress, even if they won’t have a vote. If Democrats take back the House of Representatives, we can expect our delegate to once again get a vote in committee, and that can be very important.
In the next couple of weeks, I will make some endorsements and share them with you in the Blade, for anyone who might be interested. They will detail why I endorse a particular candidate. I will not suggest second, third, fourth, or fifth choices. That is for you to decide. No matter who you give your first vote to, even with ranked choice voting, you can still vote for only one person. If you decide to list more choices, make sure the views of your second, and other choices, coincide with those of your first choice.
So here is to an honest election season, one in which we end up with candidates winning who really care about our city, who have proven track records, and who will make us proud. Your job is to VOTE, and I hope everyone will.
Peter Rosenstein is a longtime LGBTQ rights and Democratic Party activist.
-
The White House5 days agoVIDEO: Gay journalist detained for booing Trumps at ‘Chicago’ opening night
-
Movies5 days agoTrans-driven ‘Serpent’s Skin’ delivers campy sapphic horror
-
The White House5 days agoPam Bondi ousted as attorney general
-
Opinions5 days agoD.C. not the place for antisemitic Democratic Socialists of America
