Health
AIDS groups, activists cautious over ‘prevention’ pill
Anti-retroviral drug reduced HIV infections by 44 percent
Leaders of AIDS advocacy organizations joined researchers in expressing both optimism and caution over a study released last week showing that the use of a daily anti-retroviral pill significantly lowered the chance of becoming infected by HIV.
The study found that a sample of mostly gay men who were assigned to take a daily tablet of the widely used HIV medication Truvada experienced an average of 43.8 percent fewer HIV infections than participants who received a placebo pill.
Findings of the study were published Nov. 23 in the New England Journal of Medicine.
The study, which began in 2007 and included a total of 2,499 participants in the U.S., Brazil, Ecuador, Peru, South Africa and Thailand, was funded by the National Institutes of Health and the Bill & Melinda Gates Foundation. It was coordinated by the Gladstone Institutes, an arm of the University of California at San Francisco.
Participants were limited to mostly men who have sex with men and a smaller number of transgender women who have sex with men. Researchers conducting the study said the sample was chosen to represent a population group considered at high risk for contracting HIV.
“All study participants received a comprehensive package of prevention services designed to reduce their risk of HIV infection throughout the trial, including HIV testing, intensive safer sex counseling, condoms and treatment and care for sexually transmitted infections,” the Gladstone Institute said in a statement.
NIH official Dr. Anthony Fauci triggered a wave of optimism over the study findings when he told the New York Times last week that the Truvada pill was more than 90 percent effective in preventing HIV infections among a smaller number of study participants who faithfully adhered to the prescribed daily regimen.
The 43.8 percent reduction figure for HIV infections was based on findings from all 1,251 participants who were given the Truvada pill, including many who did not take the daily pill consistently, according to a detailed summary of the study released by the Gladstone Institutes.
The summary says 1,248 participants received a placebo pill as part of what Gladstone officials called a “double blind” study, in which both participants and employees dispensing the pills did not know who received the drug or the placebo.
In addition to interviewing participants to obtain their own accounts of whether they took the pills every day, researchers conducting the study administered regular blood tests of all participants and were able to confirm which ones took the Truvada pill as directed.
Dr. Kenneth Mayor, medical research director of the Fenway Institute in Boston, an HIV treatment facility that was one of two U.S. sites involved in the study, called the findings “a tremendous step forward” in the quest to lower the rate of HIV infection.
“For more than 15 years, the rate of new infections in the U.S. has been stuck at about 56,000 per year,” Mayor said in a statement. “There has been no downward movement in this number, which has meant that we desperately needed a new approach.
“It’s now possible that within the next few years, we can significantly reduce the number of new infections,” he said.
Other AIDS specialists, including Dr. Ray Martins, medical director of D.C.’s Whitman-Walker Clinic, expressed caution over the implications of the study and the widespread use of a prevention pill approach that researchers call “pre-exposure prophylaxis” or “PreP.”
Martins said the average reduction rate in the study for HIV infections of fewer than 44 percent was lower than he expected and shows a tendency of non-compliance by a large percentage of participants.
Similar to other AIDS specialists assessing the study, Martins expressed concern that a lack of adherence to a daily pill regimen of Truvada or other anti-retroviral medications could result in strains of the HIV virus that are resistant to Truvada or other HIV drugs.
The study showed that just a few participants developed resistant viral strains; they were believed to have become infected before they joined the study, with their infections undetectable at the time.
Martins called Truvada “the major backbone to almost all our current HIV regimens” for treating people with HIV and AIDS.
“So if we increase resistance to those meds and people start transmitting more resistant virus, this could be very bad for the HIV community as a whole,” he said. “To me, that was the most worrisome thing.”
He said Whitman-Walker has no immediate plans to dispense Truvada as a prevention pill for D.C.-area residents who might request it. However, he said the Clinic does prescribe Truvada to people who come to the Clinic for “post-exposure prophylaxis” – a short-term drug regimen used for people who seek treatment immediately after engaging in unsafe sex.
“I think more studies have to be done before we would recommend this as a kind of generalized use,” he said.
Martins said the Clinic would welcome the chance to participate in another study that might offer pre-exposure prophylaxis for patients at its sexually transmitted disease clinic program, who are considered to be among the highest risk group for HIV.
Longtime AIDS researcher and physician Dr. Joseph Sonnabend of San Francisco, where the other U.S. site for the prevention pill study was located, said the reduction rate for HIV infections was far too low to make a Truvada prevention pill useful for large populations.
“Daily Truvada reduced new HIV infections by only 44 percent,” he said in a statement. “This is useless, so how on earth can this be construed as a triumph?”
He said the far higher reduction rate for study participants who adhered to the daily pill regimen was meaningless in drawing conclusions for widespread use of a prevention pill “in real world conditions.”
Some AIDS advocacy organizations also expressed concern that the availability of an HIV prevention pill could result in less adherence to condom use and other safer sex practices.
Jose Zuniga, president of the International Association of Physicians in AIDS Care, called the study “an important first step in validating biomedical prevention of HIV in adults.” However, he pointed to a number of potential drawbacks to the use of Truvada as a prophylaxis in addition to the concern over viral resistance to the drug.
Possible side effects to the medication include kidney-related problems with the potential of forcing people to stop taking the medication, Zuniga noted. He said the average cost of $10,000 or more per year for the drug, which likely would not be picked up by health insurance, is also a major concern in considering its widespread use for prevention.
“The bottom line message is that condoms, clean syringes and behavioral interventions must remain our first line of defense against HIV transmission,” Zuniga said.
The study’s organizers at the Gladstone Institutes say the findings show participants increased rather than curtailed safer sex practices during their involvement in the study.
“In fact, self-reported HIV risk behavior decreased among participants in both arms of the study and condom use increased,” Gladstone said in its summary statement.
Among the groups expressing optimism over the study’s findings is Project Inform, a San Francisco-based advocacy organization for the development of effective HIV treatment and prevention options.
“A study showing that a daily pill reduces HIV risk in gay men is reason for great hope,” the group said in a statement. “U.S. agencies should waste no time in assessing the ability of pre-exposure prophylaxis to slow the HIV/AIDS epidemic.”
The group’s four-page analysis of the study is available here.
Health
Developing countries to receive breakthrough HIV prevention drug at low cost
Announcement coincided with UN General Assembly
Philanthropic organizations on Wednesday announced two agreements with Indian pharmaceutical companies that will allow a breakthrough HIV prevention drug to become available in developing countries for $40 a year per patient.
The New York Times notes Unitaid, the Clinton Health Access Initiative, and Wits RHI reached an agreement with Dr. Reddy’s Laboratories to distribute lenacapavir. The Gates Foundation and Hetero brokered a separate deal.
Unitaid, the Clinton Health Access Initiative, Wits RHI, and the Gates Foundation announced their respective agreements against the backdrop of the U.N. General Assembly.
Lenacapavir users inject the drug twice a year.
UNAIDS in a press release notes lenacapavir in the U.S. currently costs $28,000 a year per person.
“This is a watershed moment,” said UNAIDS Executive Director Winnie Byanyima in a statement. “A price of USD 40 per person per year is a leap forward that will help to unlock the revolutionary potential of long-acting HIV medicines.”
The State Department earlier this month announced PEPFAR will distribute lenacapavir in countries with high HIV prevalence rates. A press release notes Gilead Sciences, which manufactures the drug, is “offering this product to PEPFAR and the Global Fund at cost and without profit.”
Health
Don’t just observe this Suicide Prevention Month
Crucial mental health are being defunded across the country
September is Suicide Prevention Month, a time to address often-ignored painful truths and readdress what proactivity looks like. For those of us who have lost someone they love to suicide, prevention is not just another campaign. It is a constant pang that stays.
To lose someone you love to suicide is to have the color in your life dimmed. It is beyond language. Nothing one can type, nothing one can say to a therapist, no words can ever convey this new brand of hurting we never imagined before. It is an open cut so deep that it never truly, fully heals.
Nothing in this world is comparable to witnessing someone you love making the decision to end their life because they would rather not be than to be here. Whether “here” means here in this time, here in this place, or here in a life that has come to feel utterly devoid of other options, of hope, or of help, the decision to leave often comes from a place of staggering pain and a resounding need to be heard. The sense of having no autonomy, of being trapped inside pressure so immense it compresses the will to live, is no rarity. It is a very real struggle that so many adolescents and young adults carry the weight of every day.
Many folks in our country claim to uphold the sanctity of human life. But if that claim holds any validity or moral grounding, it would have to start with protecting the lives of our youth. Not only preventing their deaths but affirming and improving the quality of their lives. We need to recognize and respond to the reality that for too many adolescents and teenagers, especially those who are marginalized and chronically underserved, life does not feel so sacred. It feels damn near impossible.
Today, suicide is the second leading cause of death for Americans ages 10 to 24. That rate has almost doubled since 2007. Among queer-identifying youth, the statistics are crushing. Nearly 42 percent have seriously considered suicide in the past year, and almost 1 in 4 have attempted it. These are not just numbers. These are the children and teens we claim to care for and protect. These are kids full of potential and possibility who come to believe that their lives are too painful or meaningless to go on.
For our youth who identify as both queer and BIPOC, the numbers soar to even more devastating heights. Discrimination, housing insecurity, trauma (complex, generational, or otherwise), and isolation pile on the already stacked mental health risks. Transitional times like puberty, continuing education, coming out, or even being outed can all become crisis points. And yet, the resources available to support these youth remain far too limited, particularly in rural and underfunded communities.
We must also call out a disheartening truth. Suicide is not just a mental health issue but also a political one. Despite years of advocacy and an undeniable increase in youth mental health crises, funding for prevention is barely pocket change in regard to national budgets. In 2023, the federal government spent an underwhelming $617 million on suicide prevention efforts. To provide some perspective, that’s less than what we spend each year defending the border wall.
Meanwhile, school-based mental health services, one of the most effective means of reaching children and teens early, are being decimated. A $1 billion mental health grant program, which began after the Uvalde school shooting aiming to increase school counseling services, was recently pulled from hundreds of school districts. In some places, that left over 1,000 students for every one mental health provider. And in others, it left entire counties with zero youth therapists.
This rollback is not an isolated agenda. It operates in tandem with a cultural and legislative attack on the LGBTQ community and our access to affirming education, healthcare, and visibility. Programs that create safe spaces and lifelines are being wiped away. The LGBTQ line of the 988 suicide hotline, created to offer identity-affirming, culturally competent crisis support, was recently defunded, despite having provided help to over 1.3 million callers. The political message here is unmistakable. Only some lives, some pain, and some needs of a select group are worth the money and care.
I can’t help but contrast this with how our country controls the process of childbirth. Over the last decade, particularly following growing awareness and resulting concern around maternal mortality rates, the U.S. has consistently increased investment in maternal health. Federal funds now support initiatives like Healthy Start, safety improvements in birthing facilities, and dedicated maternal mental health hotlines. In 2022, the Into the Light Act was passed, allocating $170 million over six years for screening and treatment of postpartum mental health conditions. These are great and necessary efforts. But even here, we fall short. A study published in “JAMA Psychiatry” in November 2023 examined drug overdose deaths among pregnant and postpartum women in the U.S. from 2018 to 2021. The findings revealed that suicide and overdose were the leading causes of death during this period.
Yet even this limited progress for new parents shows us an undeniable contradiction. As a nation, we have shown we are capable of legislating support for life when we are politically and morally motivated to. We can pass bills, allocate funds, and create crisis hotlines. What’s missing is the motivation to extend that same urgency to the mental health and well-being of young people before they become statistics.
At the same time, astonishing amounts of public money have been directed toward restricting reproductive freedom. Since the overturning of Roe v. Wade in 2022, states have collectively spent hundreds of millions of dollars enforcing abortion bans, funding legal battles, surveillance infrastructure, and crisis pregnancy centers that often provide misleading information.
In 2023 alone, Texas allocated over $140 million to the Alternatives to Abortion program, while at the same time slashing funding to health providers that offered comprehensive reproductive care. Nationwide, anti-abortion lobbying and litigation have received sustained state and federal backing, often at the expense of preventive care, contraception access, and the very maternal health supports that claim to be prioritized. Only the willful can ignore the blatant contradiction here. While suicide and overdose silently claim the lives of mothers post-childbirth, far more political and financial energy is funneled into controlling whether people can become mothers in the first place.
Real prevention should not be limited to easy words and good intentions each September. Real prevention should be about intrenching mental health support into the daily lives of young folks. It means funding school counselors and social workers so that every child has someone to talk to. It means restoring services that center the needs of queer, Indigenous, and BIPOC youth, who are far too frequently left behind. It means guaranteeing that crisis lines are open. It means creating and nurturing environments where vulnerability is not discouraged but invited.
We also have to stop criminalizing mental health crises. Way too often, suicidal and struggling youth are met with handcuffs or hospitalization that adds layers to trauma rather than with compassion. Prevention must be proactive, not punitive. We need peer support groups, trauma-informed teachers, and trusted adults who are trained to notice the signs before the worst happens.
We are also overdue for a culture shift. A society with the alleged aim to value life does not shame those who are struggling to hold onto it. Contrary to popular unsaid belief, strength is not stoicism. Strength is connection. It’s knowing when to ask for help.
If we as a country actually and honestly cherish life, we have to prove it. We have to prove it not with words but with resources, policy, and compassion. Suicide prevention cannot begin and end with simple slogans and annual awareness. It has to mean a continuous investment in systems of care that affirm life, especially for those who are most vulnerable.
This September, as we recognize Suicide Prevention Month, I dare us to do more than to just memorialize those lost. Let’s start fighting for those living. Let’s create a world where no child, teen, or young adult feels that their only way out is to stop living. They are not expendable. They are not alone. And their lives are sacred. If only we had the heart to act like it.
I am almost ashamed to say that it wasn’t until I lost someone I love to suicide that I began volunteering my time to the American Foundation for Suicide Prevention. The work that the AFSP does is not only needed, it’s imperative today more than ever. If nothing else, please hit this link and donate.
Health
GLP-1s can help address LGBTQ healthcare barriers: experts
Queer people more subject to body dissatisfaction
Dana Piccoli tried everything to lose weight.
She frequented the gym, went on and off diets and hired a personal trainer. When Piccoli decided to get on a GLP-1, it wasn’t a “short cut” to drop weight – it was a way for her to live her life comfortably.
“When I told someone I was on it, they were like, ‘I’m going to the gym because I want to do it the right way,’” said Piccoli, managing director of queer media collaborative News is Out. “Obviously that kind of stung because for me, this is the right way.”
GLP-1 drugs have caused quite a stir since becoming more integrated into mainstream medicine. The newness of some brands, like Ozempic, have led to stigmas and mistrust surrounding them. These stigmas disproportionately affect the LGBTQ+ community since queer people are more subject to body dissatisfaction and have more trouble finding accessible healthcare.
Through all the noise, however, experts say taking GLP-1s are safe with the right counseling, and LGBTQ+ people could largely benefit from them.
So, what’s all the ruckus about? Are GLP-1s an “easy way out” to lose weight? And how do they really impact the LGBTQ+ community?
How GLP-1s work
GLP-1s, or glucagon-like peptide-1, mimic the actions of a GLP-1 that is released by the gut after eating. It can help people with Type-2 diabetes by lowering blood sugar through the release of insulin, and can help those with obesity by slowing down digestion and, in turn, reducing one’s appetite.
Like any medication, there are some side effects to consider. Sangeeta Kashyap, assistant chief of clinical affairs at Weill Cornell Medicine, said symptoms like nausea, diarrhea, and vomiting can occur. However, Kashyap said these side effects are less severe than past GLP-1 brands – a reason that contributes to their newfound popularity – and can be better managed with proper guidance.
Since the drug causes a loss of both fat and muscle loss, she said doctors should inform patients to do strength training to maintain any deteriorating muscle, and to eat high-protein diets, since fatty foods increase the risk of vomiting or nausea.
Getting on a GLP-1 isn’t just about shedding a few pounds. Kashyap said it’s a commitment to your health and body, which is why talking with a doctor and understanding the risks are crucial.
“We give patients appropriate guidelines,” Kashyap said. “We do blood tests, we monitor things, and give a lot of counseling to these patients. I don’t think you could just give the medicine out like candy.”
Piccoli, who started her GLP-1 journey with her wife, said the medication helped turn off “food noise.”
“Your motivation for things, your reward system with food is kind of disabled,” Piccoli said. “That really helped me understand my relationship with food.”
Turning down food noise
Losing weight isn’t as easy as getting on a GLP-1 and eating less. Piccoli said turning off the food noise in her brain led to a complete lifestyle shift.
“I had to completely change everything about the way I eat, everything about the way I approach food,” she said about her experience taking Mounjaro. “This has been one of the hardest things I’ve ever done.”
Kashyap said the lifestyle change that comes with taking a GLP-1 is why it’s important to consult a doctor first to understand how it could affect you not just physically, but also emotionally.
Kashyap said she sees higher rates of mental health disorders in transgender women, a community that already faces more barriers in finding accessible healthcare.
This could lead to someone getting on the drug for the wrong reasons, Kashyap said. She noted that those with eating disorders or body dysmorphia could face more severe side effects. Body dysmorphia and body image concerns are already an issue for the LGBTQ+ community, Kashyap said, so prescribing GLP-1s needs to be handled with care.
One way to ethically prescribe a GLP-1 to a patient would be to conduct a mental health screening, according to Kashyap. Mental health screenings aren’t required to get on a GLP-1, but Kashyap said they would be beneficial to patients who may be prone to negative effects by taking the drug.
Although some people may see more severe side effects, Caroline Apovian, co-director of the Center for Weight Management and Wellness at Brigham and Women’s Hospital, said GLP-1s are a completely safe and rigorously tested drug.
If a person faces negative side effects from taking a GLP-1, it’s more about how their body or brain is reacting to it than the drug itself being unsafe.
“Any kind of weight loss is going to affect your mood, either positively or negatively,” Apovian said.
With the queer community already facing increased barriers to healthcare, there’s another issue to consider: GLP-1s aren’t cheap.
Depending on where you get it from and whether or not insurance covers it, you could pay hundreds or even thousands of dollars for a limited supply.
Piccoli said she paid out of pocket and had to make sacrifices for her and her wife to both get on a GLP-1.
“I didn’t renew my car lease,” Piccoli said. “We decided to go down to one car so that we had some extra income monthly to be able to pay for it.”
On the other hand, Matt, who requested to be identified only by his first name due to the sensitivity of the topic, said he was shocked at how easy it was to get the cost of his GLP-1 covered by insurance. He had been warned by his doctor about the difficulty of getting it covered, and expected an “uphill battle.”
“[My doctor] wrote out the prescription for me, and on my way home, I got a text message from the drugstore saying it was ready to go,” said Matt, who’s lost 48 pounds on Ozempic since June 2024.
Matt said experiences like his, although not the standard, are why it’s important to talk with your doctor about getting on a GLP-1 and see for yourself rather than taking advice from social media stigmas.
Kashyap said the drug is also becoming more accessible through websites like Lilly, which provide vials for about $300-500. While that isn’t pocket change, it’s significantly cheaper than retail pharmacies.
You may have to make sacrifices like Piccoli did, but getting access to modern GLP-1s for weight loss isn’t only for the Hollywood elites like it seemed to be a few years ago.
Through all the social stigmas and uncertainty, Kashyap and Apovian agreed that GLP-1s are a major benefit for the queer community.
Trans women have increased rates of obesity, Type-2 diabetes and metabolic syndrome, according to Kashyap. Estrogen treatments increase fat mass and insulin resistance, leading to higher obesity rates in trans women. Kashyap said GLP-1s could be helpful in mitigating those effects.
GLP-1s also reduce alcohol cravings, so Kashyap noted that anyone struggling with alcoholism may see improvements with that condition upon getting on the drug.
Getting on a GLP-1 isn’t the walk in the park some may make you believe it is – it’s a lifestyle change and health commitment.
But it’s also a change that can provide good and healthy results if you seek the appropriate guidance from a professional.
While social stigmas in the queer community may lead to misinformation on who should use it and what it should be used for, GLP-1s are safe and can be a much-needed relief for a community facing significant healthcare obstacles.
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