Your future under analism, Pt 1: PREP

Bill Weintraub

Bill Weintraub

Your future under analism, Pt 1: PREP


PREP -- yes PREP -- is all the rage in AIDS prevention these days, and it stands for




It should actually, in my view, be termed





because it was first tested on some hapless monkeys who were subjected to, in the words of the study, "14 rectal challenges of monkey-adapted HIV."

"Rectal challenges" -- that's one way to put it.

Here's the PREP part of the story as reported in this AIDSMap article titled New directions in HIV prevention: circumcision and PREP.

(Please note that a piece of the story on AIDSMap is about the preventative benefits of male circumcision (MC).

If you're an opponent of MC, please don't write to me about it.

I didn't do the research; I didn't write the story.

If you don't like the fact that MC is protective against HIV and HPV, I suggest you write to, in the following order:


the study author -- Quinn T. Circumcision and HIV transmission: the cutting edge. Plenary presentation. Thirteenth Conference on Retroviruses and Opportunistic Infections, Denver, abstract 120, 2006;

God; and, if you can find their address,

the blind forces of evolution.

But don't write to me -- cause I'm not any of those folks, beings, or entities.)

Now, let's get back to PREP and those unfortunate rectally-challenged simians:

Pre-exposure prophylaxis (PREP) involves the use of oral antiretroviral treatment to prevent HIV infection. Although studies of PREP using tenofovir (Viread) have been halted in Cambodia and Cameroon due to local pressure, there has been no suspension of scientific interest in PREP, as this year’s Conference on Retroviruses and Opportunistic Infections showed.

[emphases throughout are mine]

"Halted ... due to local pressure."


What that suggests is that the indigenous populations of small HIV-affected countries are beginning to resist the efforts of AIDS Inc. to use them as laboratories for the extension of the Western sexual revolution.

A revolution which in large part was and is "gay male" -- that is to say, fueled by analism.

That's what happened in Uganda, where an indigenous program, ABC, proved to be far more effective in reducing HIV prevalence than Western condom promotion had been in any other African country.

Despite which, and to this day, the Ugandans have had to fight AIDS Inc functionaries, primarily from UNAIDS and to some extent USAID -- yes, those are your tax dollars at work -- who insist that condoms and CONDOMS ALONE are the answer.

That's a lie.

Truth is that even in Sub-Saharan Africa, where HIV / AIDS prevalence is 7.4% of the adult population, 92% of those adults are practicing "A" and "B" behaviors -- abstinence and fidelity -- and remaining free of HIV.

Nevertheless, and despite the ample documentation of the success of ABC in Uganda, and the also amply documented fact that NO African country has ever succeeded in getting condom use above 5%, AIDS Inc continues to relentlessly insist on the promotion of condoms and of hare-brained schemes like PREP:

In terms of pre-exposure prophylaxis, the study reported here, which successfully used a combination of tenofovir and FTC to prevent infection in monkeys given 14 rectal challenges of monkey-adapted HIV, revived interest in the concept, after a similar trial using tenofovir alone presented at last year’s CROI ended up with all monkeys eventually infected. It should not be surprising that ‘comboPREP’ should be of greater efficacy than single drugs, though using FTC alone in this trial also produced superior results to the 2005 one.

So: last year, all the monkeys who were given tenofovir and then exposed rectally to simian HIV, were infected.

Where have we heard about tenofovir and this sort of prophylaxis before?

Why it was right here on this board, in a post dated 1-2-2006 and titled Depraved Bitches, which discussed how gay men were taking tenofovir -- and tenofovir ALONE -- after unsafe sex.

And how a prominent HIV / AIDS physician in San Francisco, Marcus Conant, was giving them the drug even though, according to a report from LA,

he is troubled by the fact that the drug has not been proved effective for such a use and that his patients may be increasing their risky behaviour while using it, he says that using the drug is better than taking no precaution at all.

Indeed, it has not been proven effective.

In fact, Conant should have known about that monkey study, which showed that tenofovir was NOT effective.

To be blunt, it's difficult to believe he didn't know about the study.

AIDS clinicians of Conant's stature are supposed to pore over the results of conferences like CROI.


"What choice do I have?" he said. "Forty thousand people are still getting infected every year. Everyone knows condoms work, but they're not using them. All I am trying to do is reduce the risk that people harm themselves."

As I remarked in that post:

What choice indeed?

How bout not giving them the drug and counseling them to stop being unsafe?

Conant didn't want to do that.

I sincerely wonder why.

It's one thing to be a pansexualist; it's another to give guys a drug as a preventative when you know it doesn't prevent.

In any case, and getting back to our AIDSMap article, it turns out many people share my misgivings about this sort of prophylaxis:

As a prevention intervention PREP is controversial for two reasons. First is the perception that it will be prohibitively costly as a widely-used prevention measure. A poster by UK researchers (Hill) disputed this. They took the cheapest current annual prices for antiretroviral drugs in the developing world (about $50 for 3TC and $200 for tenofovir), and estimated the average lifetime treatment cost for a developing-world patient at $10,000. Using these figures, they calculated that 3TC PREP would be cost-effective (that is, would cost less than $10,000 per infection averted) in areas where annual incidence was over 1% (as in most of sub-Saharan Africa) and tenofovir/3TC would be cost-effective where incidence was over 3% (as in southern Africa and vulnerable populations in many other areas).

Notice that the UK researchers didn't say how much cheaper PREP would be, suggesting that it wouldn't be cheaper at all.

The second reason PREP has been controversial is due to the perception within communities and community leaders that the approach may do more harm than good, whether through toxicity, resistance, behavioural disinhibition or unethical practice by researchers, and two trials have already been halted because of these perceptions.

Quite a list:



behavioural disinhibition; and

unethical practice by researchers.

And all reasonable concerns:

These are toxic drugs to which HIV develops resistance.

And as we know from studies on condoms, telling people that they can prevent HIV infection through the use of a device or a pill DISINHIBITS:

It encourages them to have more partners, to be less choosy about their partners, and to engage in HIGH-RISK SEX -- specifically, among MSM ("men who have sex with men"), anal penetration.


Why start giving them massive doses of toxic, resistance-prone, disinhibiting medications --

When these same people could be the beneficiaries of a risk elimination practice which among gay and bi men is 100% effective:


Fact is, Chuck Tarver's formulation of ABC for gay and bi men -- Avoid anal, Be faithful, use a Condom only if you won't the first two -- works.

We men of the Alliance know it works because we've stayed negative through these long years of the epidemic by not doing anal.

Were we to move the bulk of gay and bi men away from anal and to Frot, encourage Fidelity, and insist that those who refuse to give up anal use condoms -- the prevalence of HIV and ALL OTHER ANALLY-TRANSMITTED INFECTIONS would plummet.

No one disputes that.

Nevertheless, AIDS Inc's well-funded band plays on:

The largest PREP trial yet to be considered is among 1600 men who have sex with men in Lima, Peru. It will start to enrol this spring after considerable delay.

A poster (Goicochea) explained how the Peruvian Institute for Health and Education, in collaboration with the trial investigators and informed by the failure of previous PREP trials, has engaged in an exhaustive series of consultations with different stakeholders prior to recruitment. These included opinion leaders such as academics and gay and HIV activists, but also every group within the MSM community including men who sell sex, ‘straight-identified’ MSM, transvestites and transsexuals as well as gay-identified men.

Did they really consult "every group?"

Of course not.

They consulted:

"Opinion leaders" -- all of whom in the gay male community are ANALIST;

Academics -- all of whom are married to queer and gender theory;

Male prostitutes -- men who sell their bodies for anal "sex";

Transvestites -- men who defame their bodies for anal "sex";

Transsexuals -- men who mutilate their bodies for anal "sex";

Some gay and HIV activists -- all of whom we may be sure are analist, and many of whom, it's safe to say, are poz due to anal; and

Some "straight-identified" MSM, who, if they're included in this discussion, we may be sure are also doing anal.



The findings are too long to be summarised but revealed divergent opinions among the affected groups. Academics and gay activists, for instance, thought that reimbursement for study participants would distort the results, whereas HIV activists and male sex workers thought payment to trial participants was essential.

Gee -- is that the extent of the divergence?

A disagreement about whether to pay the male prostitutes for prostituting themselves?

Man, that's a real brain-teaser.

Where are the guys who say -- we don't need PREP -- we need CULTURAL CHANGE.

Where is that discussion?

That's the true divergence within the MSM "community."

But it's not a divergence the study organizers want to entertain.

The Lima consultation, especially in its disinclination to view one group as representative of ‘the community’ and its attempt to consult all possible stakeholders, is probably a model for the kind of pre-recruitment community consultation that prevention trials need to undertake.

It probably is a model.

And one from which we're excluded.

I titled this post "Your future under analism."

And that's what this is.

Your future under analism is no different than your past:

You're excluded and ignored, except when you're being denigrated.

The sort of study they're about to undertake in Lima will cost a lot of money.

How much?

I don't know.

$100,000, $1,000,000 -- who knows?

And what will it tell anyone?

That if you fill your body full of toxic meds -- and get fucked up the ass -- you might avoid HIV.

What about other anally-vectored diseases?

Will these anti-virals prevent syphilis?




I don't know.

I doubt it.

Won't prevent mechanical damage.

Won't get rid of the feces.

Won't stop the degradation.

And certainly not the promiscuity.

Nevertheless, vast sums will be spent now and in the future in an attempt to protect and nurture an act which NO ONE anywhere should ever perform.

Which the Surgeon General of the United States has said is "too risky to practice."

While an act which is fully and mutually genital; fully and mutually genitally pleasurable; full-body and extremely intimate; very low risk; and which heightens self-esteem through the exaltation of the male's NATURAL masculinity -- is at best ignored.

For years I've asked you to donate so that we could counter the lies of the analist establishment and AIDS Inc.

You won't do it.


PREP -- that's your future under analism.

That's the future you've made.

Bill Weintraub

© All material Copyright 2006 by Bill Weintraub. All rights reserved.

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