FEEDBACK: Be above petty squabbles; Open letter to Elba Garcia; Know the facts on PrEP

Posted on 24 Mar 2011 at 5:03pm

Be above petty squabbles

I have followed with much interest the recent joint endorsements of municipal candidates by the Stonewall Democrats of Dallas and Dallas Stonewall Young Democrats. A spirited debate is always healthy, and it is good to see this happening, especially with the race for City Council District 14 which features the Stonewall-endorsed candidate, James Nowlin, and current City Councilmember Angela Hunt. However, I have been disheartened by the direction that some voices in the debate have taken. As members of the LGBT community, we should be inherently sensitive to the inappropriateness of comments that personally judge an individual and call into question their motives for running for office, or the legitimacy of emotion shown in public. We are above this!

James Nowlin is a member of this community and has served this community since first moving to Dallas. Now is the time to get behind candidates that are a part of our community, such as Mr. Nowlin and Cassie Pierce (City Council District 7 candidate), not because they are simply LGBT individuals, but because they are both qualified for the job and represent the much needed change we need on City Council in having representatives that can build consensus and take issues that impact not only us, but their entire constituency, through to the finish line. I encourage all in this community to contact the campaigns of those that support us and see how they can get involved.

Jared A. Pearce,
president, Dallas Stonewall Young Democrats

 

Open letter to Elba Garcia

On behalf of Resource Center Dallas, we wish to thank you and the court for voting to expand the county’s nondiscrimination policy to include sexual orientation.

This effort is long overdue and demonstrates a commitment to fairness and equality. We believe the policy should also specifically enumerate protections for gender identity and gender expression. I’d like to discuss this issue with you at your earliest convenience.

I read the post on [the March 22] vote on the Dallas Voice’s website. Sexual orientation, gender identity and gender expression are three separate characteristics. As subject-matter experts who offer diversity training as part of our mission, these are the definitions the center uses:

• Sexual orientation: A person’s enduring physical, romantic, emotional and spiritual attraction to another person.

• Gender identity: A person’s internal and personal sense of being a man or a woman. Gender identity and sexual orientation are not the same; transgender people may be heterosexual, lesbian, gay or bisexual.

• Gender expression: External manifestation of one’s gender identity, usually expressed through “masculine,” “feminine” or gender-variant behavior, clothing, haircut, voice or body characteristics. Typically, transgender people seek to make their gender expression match their gender identity.

The center and others in the LGBT community assert that a policy would need to specifically enumerate all three characteristics for maximum effectiveness and protections. It simply makes business sense. As you know, both the cities of Dallas and Fort Worth already offer these protections for their LGBT employees, as does DFW International Airport. Also, a better understanding of the LGBT community will aid Dallas County in employment recruiting and retention, and in serving your diverse public.

You may have seen some of the stories in the Dallas Morning News last summer about the center’s work with Dallas Area Rapid Transit (DART) as it added gender identity to its nondiscrimination policies. This is part of our ongoing work with businesses, universities and governmental agencies including Dallas ISD, DFW International Airport and TABC as they strive to make their workplaces more inclusive.

I look forward to hearing from you soon.

Rafael McDonnell, strategic communications and programs manager, Resource Center Dallas


Know the facts on PrEP

A robust public debate is underway about the potential use of anti-HIV drugs to prevent HIV infection (also known as pre-exposure prophylaxis or PrEP). Our study, called iPrEx, provided the first conclusive evidence that the daily use of PrEP with the FDA-approved HIV treatment Truvada® can significantly reduce HIV infection risk in gay, bisexual and other men who have sex with men (MSM) and transgender women, when delivered as part of a comprehensive package of prevention services, including condoms.

The protection provided by PrEP and condoms together could have a substantial impact in reducing new HIV infections among MSM worldwide.
Recently, a private healthcare provider has begun a paid advertising campaign urging the FDA not to even consider approving the use of PrEP — charging, among other things, that MSM will stop using condoms if PrEP is permitted. The pros and cons of PrEP use should be vigorously debated — but that debate should be based on facts, rather than the assumption that MSM will not act to protect themselves and others from infection.

Here are the facts about the iPrEX study:

• A diverse group of 2,499 HIV-negative MSM and transgender women on four continents with a range of sexual practices participated in iPrEx. All participants received a comprehensive package of HIV prevention services. Half also received Truvada, while the other half received a placebo (blank pill). Neither the study participants nor the investigators knew which pill they received during the study.

• The group that received PrEP with Truvada in addition to condoms had 44 percent fewer HIV infections. This protective effect was seen across different groups in the study, including those of different age, ethnicity and education level.

• Men in both study groups reduced their risk behaviors and increased their condom use — demonstrating that MSM can use PrEP and condoms together. PrEP does not protect against other sexually transmitted infections and should never be considered as a substitute for condom use or other safer sex precautions.

• Ensuring daily pill use will be critical to the success of PrEP. While many iPrEx study participants used the pill consistently, about 50 percent did not — which impacted the effectiveness of PrEP in the study. Among those who took the medication consistently, the level of protection PrEP provided reached 72 percent to 95 percent. A second phase of the iPrEx study will begin soon, in which all participants who want PrEP will receive it. We are hoping to learn whether knowing that PrEP works will help participants achieve higher rates of pill use and protection in this phase of the study.

• Truvada is widely used for HIV treatment because it is generally well tolerated. Rates of side effects were very low in the iPrEx study. A small amount of bone loss was seen among those receiving PrEP, a finding commonly seen in HIV-positive individuals starting anti-HIV treatment; these changes had no apparent negative health impact.

Studies to date also show no evidence of HIV drug resistance associated with PrEP use. HIV testing and medical evaluation before starting PrEP and while using PrEP are important to prevent resistance.

• A daily PrEP dosing regimen was used in the iPrEx study. It is not known whether PrEP can be taken less frequently to prevent HIV infections. Additional studies are underway or being planned to look at whether different dosing regimens (e.g., taking PrEP before and after sex, or on a regular schedule several times a week) would be safe and effective.

• The iPrEx study was paid for by the U.S. National Institutes of Health and by the Bill & Melinda Gates Foundation, and was not organized or run by any drug company. iPrEx requested and received a donation of study drug from Gilead Sciences, but Gilead had no other input into the study.

Much more work lies ahead to determine whether PrEP can help stop HIV infections in other populations, such as heterosexuals and injection drug users, to better understand possible side effects of PrEP, to support consistent pill use among people who want to use it, and to ensure that PrEP is seen as one element of an HIV prevention strategy that includes regular condom use.

It will also be critical to address issues of cost, and to determine how to ensure that PrEP will be available to MSM in the United States and around the world who need it most.

Additional studies are also underway to test whether other anti-HIV medicines (including pills, gels, and other formulations) are safe and effective for HIV prevention.

We believe that MSM and all communities working to protect themselves and reduce the impact of the HIV epidemic have the right to full information about PrEP, and can make informed, intelligent decisions about whether or not to utilize PrEP as one component of a comprehensive HIV prevention strategy.

The iPrEx study investigators are committed to providing complete information about the study findings tohelp ensure that those decisions are made based on the facts about PrEP. We thank the volunteers who participated in this important study, including volunteers in San Francisco, and the more than 20,000 participants in PrEP trials worldwide for their commitment to advancing HIV prevention.

More information about iPrEx and PrEP is available at iPrexNews.com.

Robert Grant, MD, MPH, iPrEx Protocol Chair
Albert Liu, MD, MPH, iPrEx Medical Officer and San Francisco Site Researcher
Susan Buchbinder, MD, iPrEx San Francisco Site Researcher
Kenneth Mayer, MD, iPrEx Boston Site Researcher
Pedro Goicochea, MSc, MA, iPrEx Investigator
Jeff McConnell, MA, iPrEx Investigator

This article appeared in the Dallas Voice print edition March 25, 2011.

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