July 30, 2015
Micheal Ighodaro is an AVAC staff member.
Over the past few months I have spent a lot of time talking to LGBT people about PrEP. I have been at meetings that were specifically focused on HIV and meetings where HIV was a very, very small part of the agenda. And while it’s clear that PrEP is needed for LGBT people, it’s also clear that we have a lot of work to do.
Many members of the LGBT community are still struggling with the idea of PrEP, and many do not know about it or how it works. For example, I was at a conference this past June that brought together LGBT and sex worker activists from east Africa and around the continent. HIV was a very small part of the conference agenda. In fact, AVAC, amfAR and IAVI hosted the only HIV-related panel in the conference. I spoke about this new pill that prevents HIV. To some, this was a totally new concept, but to others PrEP sounded good. Others asked whether it would take away ARVs from people living with HIV who still can’t always access them?
But before I answered the questions, one of the panelists who was openly living with HIV as a gay man in Africa—a very brave individual—stood up and said that if there was a pill that could help prevent other members of his community from having to go through the same experience he has had to face as a gay man living with HIV in Africa, he wanted to make sure every member of his community knew about this pill and advocated for it.
But all these concerns are very valid. When the WHO’s recommendation for PrEP as a prevention option for gay men and other men who have sex with men came out in 2014, many LGBT activists around the world had mixed reactions. Some didn’t know very much about PrEP and didn’t pay much attention. For others the recommendation singling out MSM just proved the point that the LGBT community is viewed by many stakeholders primarily as the “carriers of HIV.” To get away from this perception, many LGBT Africans I know don’t want to work on HIV at all anymore. And so they weren’t excited when the WHO recommended this new pill just for gay men.
Now that the WHO seems likely to issue broader recommendations for all people at substantial risk, there is a chance that access efforts will focus on other populations.
Last week when I was in Thailand for several meetings with transgender groups, a very close friend of mine who is transgender asked me, “Why can’t people just use condoms? Why do we have to take this pill?” My answer was short and quick, “Condoms are great but not everyone can use them all the time, just like not everyone will use PrEP all the time. PrEP is just an added HIV prevention option.”
In contrast to my sense of the how gay men in Africa are viewing PrEP, which based on recent conversations is with some skepticism, the question for most gay men I met in Thailand was whether or not to start taking PrEP. Dialogues are happening in Thailand that are moving beyond whether this strategy is a good idea or whether it is stigmatizing a specific community. The Thai LGBT community is talking about this medication and what it can do for them and that should continue, not just in Thailand but in Africa and Europe.