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Michael Weinstein: ‘We Have A Long Way To Go’ In The U.S.

The president and co-founder of the AIDS Healthcare Foundation tells Joanne Silberner that it is important to keep public policy focused on proven methods for controlling AIDS. A transcript follows.

JOANNE SILBERNER:  Michael Weinstein, there is a real optimism around the conference.  People are saying the end of AIDS is within reach, and it just seems to almost be a happy place. But I gather you feel differently. 

MICHAEL WEINSTEIN:  Well, I feel the possibility of controlling AIDS is definitely there, but I feel like there is not the political will to do so.  We’re talking about cuts to treatment, and that’s certainly not the way to go.

JOANNE SILBERNER:  So on a policy viewpoint, it’s about the money.  It’s: Where is the money going?

MICHAEL WEINSTEIN:  I think it’s not just about the money, but it’s also where do we concentrate?  And I think there are things that are a kind of diversion.  I think concentrating on circumcision is a diversion.  I think concentrating on pre-exposure prophylaxisis is a diversion.  And I think that we really have a very simple formula for controlling AIDS: Promote condom use, test everyone who needs to be tested, link them to care, and then get them on treatment and break the chain of infection.  I don’t see that happening – and I travel the world – and I don’t see it happening in very many places the way it should. 

JOANNE SILBERNER:  And in the U.S. as well?

MICHAEL WEINSTEIN:  Definitely it’s not happening in the United States.  Only 41 percent of the people who are infected with HIV in the United States are in consistent treatment.  So 59 percent of the people either don’t know they’re positive, aren’t seeing a doctor, or are not adherent.  So we definitely have a long way to go here in the United States.

JOANNE SILBERNER:  Looking back historically, are there policies that were around way back when that you’re really glad to see gone?

MICHAEL WEINSTEIN:  I think the abstinence-only ideology was bad.  I think that it is not scientific, and I think that it sent out the wrong message.  But I think at the same time, in the early part of the epidemic, we were more aggressive at promoting condom use than we are now.

JOANNE SILBERNER:  The Food and Drug Administration just approved Truvada as prevention.  That’s a big step for a lot of people, but you’re concerned about it?

MICHAEL WEINSTEIN:  I think it’s a catastrophe for AIDS prevention in the United States.  I think, first of all, that the study data did not support approval: Only 42 percent of the people were protected.  But also, there’s an issue of drug resistance, side effects.  And, most of all, in the study only 50 percent of the people had any medication in their system when the blood levels were taken, and only 18 percent of them took it every day.  So when people are not adherent, they’re going to become infected, and then they’re going to become resistant.  But the bottom line is: You have to be really paranoid about your pants falling down to wear a belt and suspenders, and if people are taking this medication, they’re not going to use condoms.  And I think we’ve had a lot of success with promotion of safer sex – not as much as we’d like – but we have had success and we shouldn’t abandon it. 

JOANNE SILBERNER:  So it’s not a place to spend money?

MICHAEL WEINSTEIN:  Yes, I mean, these medications will be extremely expensive – Truvada is very expensive – and it will wind up having more infections if this becomes widespread, the use of Truvada, because people will relax their safer sex practices. 

JOANNE SILBERNER:  When you look at federal policy over the years, whose policies have been better: Bush’s or Obama’s?

MICHAEL WEINSTEIN:  It’s a mixed bag.  I think when it comes to issues like abstinence-only, the Bush administration was bad and the Obama administration has been better.  But when it comes to access to care – for example, in the AIDS Drug Assistance Program or in PEPFAR – Bush was better. 

JOANNE SILBERNER: Thanks so very much.