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Ken Monteith

Ken Monteith

Ken Monteith was diagnosed with AIDS and 4 CD4 cells in 1997. Ken is a recovering lawyer (it's a process!) living in Montréal, where he obsessively counts his CD4s with equal fluency in English and French, pausing only to glare at those who dare to taunt him with their higher numbers.


Can we talk?

Wednesday, 14 January 2015 Written by // Ken Monteith - Montreal Correspondent Categories // Sexual Health, Health, Treatment, Living with HIV, Opinion Pieces, Ken Monteith

Ken Monteith questions the quality of debate on PrEP- "Everybody take a moment to appreciate that there are two (or more) sides to every argument, calm down, and stop stigmatizing or ridiculing the choices that someone else might be considering."

Can we talk?

No, the title is not a Joan Rivers reference, although I'll offer her a nod for the phrase and try to contain any ghostly compulsions to say mean things about people, no matter how funny they might be. This is a little peek into the quality of our debate around the issue of pre-exposure prophylaxis, about which you have undoubtedly read more than you ever thought you would just a year ago. 

I have rarely heard a reasoned debate on the issue since it began rearing its head in the past few years. The first reaction of the AIDS Healthcare Foundation was indicative of how one side of the debate would act: a broadly shared campaign proclaiming that there is "No Magic Pill". When your argument boils down to one snappy slogan, I have to wonder if there aren't some nuances missing from your talking points. 

Oddly, the anti-PrEP reaction of many is quite strident, with proclamations of looming disaster and a tidal wave of infections coming from the irresponsible barebacking that will surely follow any inkling of acceptance of PrEP. Oh, and the other sexually transmitted infections on the horizon – I was wondering what was blocking out the sun! Again with the lack of nuance. These people need to take a deep breath and a time out to read the results of the studies on PrEP that have been conducted. They will come away from the experience with a few more nuances that might tone down the alarmist rhetoric. 

So is the other side of the argument any more sane and rational? Not from where I'm sitting. I had the occasion over the holidays to ask a question in a post about PrEP that one of my friends had reposted. I asked, maybe innocently, maybe provocatively (you be the judge!) if there was someone out there in Facebookland with a knowledge of statistics that runs more deeply than mine who could say something about the numbers required to affirm that the level of risk reduction of a subset of particularly adherent participants in a PrEP study could be generalized over a study involving thousands of participants. I was delighted to accept a friend request hours later from the originator of the original post, and much less delighted to be having a back-and-forth Facebook argument with him when I wasn't attacking the PrEP concept at all, just asking a statistics question. 

The whole "science supports it" argument also lacks a little nuance. Apart from my innocent statistics question, there seems to be a lot of affirming the results of studies that have not yet reached their defined endpoints, which is something you might not want to do too much if you are claiming the scientific high ground. You might also not want to be loudly insisting on quoting the "real life" condom protection statistics and stacking them up against the "ideal situation" PrEP results. When you do this, the condoms are not the only losers. 

I see the attitude repeated time and again: if you're not raving in favour of PrEP, you're some kind of change-resisting reactionary who just wants to take all the pleasure out of sex. Not really a hat I ever wanted to wear, so I can't let someone else place that on my head. The quality of the debate is, if I might be judgy about it, somewhat lacking. 

Before you assign me to one side or the other, let me be clear about my nuanced position in the middle: PrEP isn't going to go away and it is showing itself to be a useful tool that is appropriate for some, even many, people to use as HIV prevention.

Condoms aren't going away either, and have shown themselves to be useful tools in keeping many people from contracting HIV. There are also other tools in that toolbox, like testing, like effective treatment for HIV-positive people, like serosorting, like choosing sexual activities with lower risks of transmission, to name only a few. All the strategies come with their advantages and their disadvantages, and those are best evaluated by the person who will put them into action, based on all the best information we can all work to provide. 

So everybody take a p… oh, I guess you don't all want to do that. Everybody take a moment to appreciate that there are two (or more) sides to every argument, calm down, and stop stigmatizing or ridiculing the choices that someone else might be considering in their own lives. I'm pretty sure we're all on the same side of the fight against HIV; we could do a better job of looking like we are. 


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