Meet The Man Who Stopped Thousands Of People Becoming HIV-Positive
February 25, 2017 9:08 AM   Subscribe

A few days before Christmas 2016, a phone call took place that no one could have predicted. One of the world’s most esteemed HIV doctors, Professor Sheena McCormack – whose life’s work as an epidemiologist has been to track and fight the virus – picked up the phone to deliver a message that would make headline news: In the space of 12 months, the number of gay men in London being diagnosed with HIV had dropped by 40%. The man McCormack credited with this unprecedented reduction in HIV transmissions was not a fellow doctor, nor the head of a charity, nor even a politician. Greg Owen is unemployed, a former sex worker, and homeless.

PrEP use has been rising in other countries, and some cities have also seen drops in new HIV diagnoses. San Francisco saw a 17 per cent fall in infection rates in 2015.

But this decline has generally been attributed to a mix of better prevention, diagnosis and treatment methods, without singling out PrEP. In the UK, however, the use of PrEP was low until it suddenly surged over the past year. This increase coincided with the launch of I Want PrEP Now and PrEPster, and ongoing publicity over an attempt to sue NHS England to provide the medication on the NHS.
posted by cynical pinnacle (50 comments total) 52 users marked this as a favorite

 
PrEP is a miracle and I am very glad for this post!! Spread the word!
posted by tristeza at 9:10 AM on February 25 [2 favorites]


PrEP is a great example of how quickly a new treatment can spread faster than the public health folks can keep up. There's still clinical evaluation going on and it's terribly expensive, but most of the gay men I know are taking it now.

I have one friend in Ireland and another in London taking PrEP. Both of them are importing it from dodgy sources and can't really afford it. One of them has been reading up on alternate dosing regimens. The standard is daily dosage, but if you can't afford that or don't have a reliable supply then taking pills less frequently or only when you expect to be sexually active is tempting.

Life saving drugs should not be a capitalist commodity.
posted by Nelson at 9:17 AM on February 25 [44 favorites]


I just read this and thought "this needs to be on Metafilter." Greg Owen is a goddamn hero.
posted by deludingmyself at 9:30 AM on February 25 [4 favorites]


This thought fused with the need to rid himself of the endless inquiries, or “these fucking bastards asking me about PrEP”, as he puts it.

...so he devoted his life to saving their lives, working full time x2 unpaid and going without food to make sure the work got done.
posted by justsomebodythatyouusedtoknow at 9:33 AM on February 25 [28 favorites]


PrEP is a great example of how quickly a new treatment can spread faster than the public health folks can keep up.

I posted something about it here in 2013 after seeing a post on a blog about gay issues. The overwhelming response seemed to be that either it couldn't possibly work as well as it was supposed to, or that even if it did, there were still a bunch of reasons it was a bad idea.

I forgot all about this until about a year ago when PrEP posters started showing up in the subway. Now that it's becoming more well known I feel slightly vindicated but mostly I'm just curious about why it got such a negative reaction before.
posted by showbiz_liz at 9:51 AM on February 25 [12 favorites]


My dad is (very successfully) on PrEP.

One of the challenges of fighting this administration is to make sure that PrEP is still available and affordable to people who need it most. It is a miracle for many people.
posted by roomthreeseventeen at 10:03 AM on February 25 [5 favorites]


mostly I'm just curious about why it got such a negative reaction before

On the outside looking in (L.A. and WeHo not London and SoHo) I think there were roughly two kinds of concern:

1. The decent kind, that a return to a more permissive attitude would end up (a) inflating HIV infection rates, because likely to be used instead of condoms rather than as a backstop, and not perfect, and (b) likely to result in a spike of other STIs from abandoning condoms.

As per the article, that hasn't really happened.

2. Gays are diseased/evil/sinners/wrong, butt sex is an abomination, anything that helps gay people have butt sex without dying is bad and wrong and part of our moral decay. Paying for that with tax dollars is like the worst thing ever (except all of the other offensive uses of Our Money to help Those People).
posted by snuffleupagus at 10:05 AM on February 25 [12 favorites]


"Not only can you do this; you must do this. We’ve been waiting for someone to do this."

.. said the nameless man at the sexual health clinic.
posted by the Real Dan at 10:08 AM on February 25 [2 favorites]


20-40 paragraphs before you even know what the heck the story is actually ABOUT. I hate this style of "writing." Trying to read it reminds you of clicking on one of those stupid list-cicles...Interesting character and history though, once you get to the bottom of it.
posted by jackbrown at 10:12 AM on February 25 [6 favorites]


20-40 paragraphs before you even know what the heck the story is actually ABOUT.

Referred to in the trade as "burying the lede".
posted by heatherlogan at 10:30 AM on February 25 [1 favorite]


Wonderful news, amazing man. I hope his personal life improves for him
posted by SLC Mom at 10:32 AM on February 25 [1 favorite]


On the outside looking in (L.A. and WeHo not London and SoHo) I think there were roughly two kinds of concern:

The most legitimate-sounding concern I've heard is that it could lead to increased drug resistance. I don't know how true that is in reality.
posted by atoxyl at 10:33 AM on February 25 [4 favorites]


One of the challenges of fighting this administration is to make sure that PrEP is still available and affordable to people who need it most.

This is a huge issue. Across the globe there are massive disparities in HIV rates and access to HIV care. In the US, HIV is very much a disease of marginalized groups: POCs, MSMs, transwomen, sex workers, injection drug users, people living in poverty. For Black men who have sex with men, the lifetime risk of acquiring HIV is 1 in 2. For Hispanic MSMs, it's 1 in 4 and rising. I'm not making this shit up, it's straight from the CDC. And it matters. The groups who are disproportionately affected by HIV are exactly the groups who are least likely to have access to PrEP.

Currently in the US, people with HIV who a) have low income and b) do not have any prescription drug coverage are eligible to receive their HIV meds through ADAPs (AIDS Drug Assistance Programs) operated on a state level. There are lots of problems with how these operate (long processing times, high burden of documentation), but they provide medication access for a few hundred thousand people. This serves a vital humanitarian purpose, but also a public health one: decreasing the community viral load by treating HIV positive individuals decreases the rate of transmission. We absolutely need a similar program for PrEP access, because it fundamentally makes sense in the same way. You help individuals on PrEP, and you also help everyone else in the community by decreasing the likelihood that they will be exposed to HIV.

Unfortunately, government funding of PrEP access hits the magical intersection of gay people and state-funded health care. It's hard to think of an area where the Republican Party would be less inclined to act.
posted by bookish at 10:35 AM on February 25 [18 favorites]


This is great news. I wonder why he couldn't work out a deal with the foreign drug makers for some sort of referral fee? Or become a paid adviser to some clinic or some AIDS prevention organization. He clearly did not do it for the money, but he should be rewarded with at least a living wage. Heck, if I were the insurance companies, I would pay him. The cost of AIDS treatment is much higher than PrEP. He saved lives and saved the insurance companies or the NHS a lot of money.
posted by AugustWest at 10:37 AM on February 25 [1 favorite]


Unfortunately, government funding of PrEP access hits the magical intersection of gay people and state-funded health care. It's hard to think of an area where the Republican Party would be less inclined to act.

I disagree in theory. If it can be explained to them that the cost of prevention is much cheaper than the cost of treatment, they will vote their wallets. They always do.
posted by AugustWest at 10:39 AM on February 25


If it can be explained to them that the cost of prevention is much cheaper than the cost of treatment, they will vote their wallets. They always do.

Ha. Not on these subjects, they don't.
posted by Shmuel510 at 10:58 AM on February 25 [52 favorites]


If it can be explained to them that the cost of prevention is much cheaper than the cost of treatment, they will vote their wallets. They always do.

Ohmygod I just laughed so hard I peed a little. You are funny!
posted by sexyrobot at 10:59 AM on February 25 [32 favorites]


I disagree in theory. If it can be explained to them that the cost of prevention is much cheaper than the cost of treatment, they will vote their wallets. They always do.

You gotta be kidding. Also, you're forgetting option 3, the cost of just letting people die, which is free and perfectly acceptable for them.
posted by LionIndex at 10:59 AM on February 25 [47 favorites]


I'm just curious about why it got such a negative reaction before.

Sex negativity and homophobia.
posted by Automocar at 11:06 AM on February 25 [7 favorites]


Keep in mind the alternative framing: if it can be explained to them that the profit from prevention is much lower than the profit from treatment, they'll vote with their wallets.

They always do.
posted by Riki tiki at 11:16 AM on February 25 [3 favorites]


I wonder why he couldn't work out a deal with the foreign drug makers for some sort of referral fee? Or become a paid adviser to some clinic or some AIDS prevention organization. He clearly did not do it for the money, but he should be rewarded with at least a living wage. Heck, if I were the insurance companies, I would pay him. The cost of AIDS treatment is much higher than PrEP. He saved lives and saved the insurance companies or the NHS a lot of money.

What about just a short book on the project, or a co-written teleplay & consultant gig on a miniseries?
posted by snuffleupagus at 12:02 PM on February 25


If it can be explained to them that the cost of prevention is much cheaper than the cost of treatment, they will vote their wallets. They always do.

if you take out the "omg ew buttsex" factor out of it, this has been true in my experience. My blood pressure medication is free, presumably because they'd rather pay for that than treatment after a stroke. My CPAP supplies are free, again because they're much cheaper than heart attack/stroke treatment. Insurance companies are totally in favor of prevention; my company offers wellness coaches to help you quit smoking.

So, I don't understand why insurance companies wouldn't cover it, unless they are banned from doing so?

On the outside looking in (L.A. and WeHo not London and SoHo) I think there were roughly two kinds of concern:

3. Personal responsibility. If people would stop sleeping around, or at least use condoms, they wouldn't need PrEP. While technically true, obviously a subset of the population is not doing these things no matter how much they're admonished.
posted by AFABulous at 12:38 PM on February 25 [4 favorites]


I tend to read that (3) as an obfuscated version of the homophobic/religious objection, but I guess it can be explained by pure sex-negativity and the whole opposition to a "culture of permissiveness" thing.
posted by snuffleupagus at 1:17 PM on February 25 [2 favorites]


Yeah, there are plenty of sex-negative people within the gay community and have been since the virus was discovered. Slut-shaming: not just for religious nuts!
posted by AFABulous at 2:03 PM on February 25 [2 favorites]


After a relationship breakdown and a suicide attempt, Owen was sleeping on friends’ sofas and sliding into full escapism mode.

“I’d gone through enough risk-taking,” he says in his soft Belfast accent. “I was like, ‘You know what? I just need to do this – I take GHB and smoke crystal [meth] all weekend.’”


To just even get past this point in your life is, honestly, brave enough. To be at that point and do what he's done makes him a new personal hero.
posted by MCMikeNamara at 2:09 PM on February 25 [11 favorites]


If it can be explained to them that the cost of prevention is much cheaper than the cost of treatment, they will vote their wallets. They always do.

Republicans have demonstrated repeatedly that they are delighted to vote for things that will cost more money - like making people pee in cups before getting any form of state assistance - where the cost of enforcement outstrips the basic program costs and that's just because poor people are icky. Poor AND gay? And people of color? Of course they don't give a shit about economics when it comes to us if they can get in some shaming and disapproval.
posted by rtha at 2:11 PM on February 25 [20 favorites]


if you take out the "omg ew buttsex" factor out of it

The hateful people don't do that. They are obsessed with buttsex.

The US cost is about $1300/month. OTOH five minutes of Googling suggests most private US insurers will cover PrEP; is that really true?! Amazing. Not so helpful if you don't have health insurance, particularly if the GOP succeeds in gutting the ACA.

In the UK they're a little more adult and less hateful (albeit not perfect). The NHS is doing a PrEP trial now. There's been a lot of drama about it. There's a definite concern about cost, licensed drugs are £5000/year. Generics are a lot cheaper but I assume are patent infringing? Although the patent may expire in Dec 2017.
posted by Nelson at 2:21 PM on February 25 [1 favorite]


He sounds like the kind of guy Jesus would have liked.
posted by The Underpants Monster at 2:26 PM on February 25 [9 favorites]


Yes, PrEP is covered by most health insurance companies, as well as most (I think all?) state Medicaid programs.

I've spent much of my professional life advocating for increased funding for HIV services and programs, and the fiscal argument about cost effectiveness carries essentially NO water in my experience. Republicans don't care -- these aren't people they care about and their moral objections outweigh their wallet every time.

The most legitimate-sounding concern I've heard is that it could lead to increased drug resistance. I don't know how true that is in reality.


Not true -- that's based on a misunderstanding of how PrEP works. It's taken by people who are HIV-negative and therefore have no virus which could mutate to be resistant.
posted by gingerbeer at 4:20 PM on February 25 [5 favorites]


What an incredible person.
posted by biggreenplant at 4:24 PM on February 25


For people in the US who want more information about PrEP or how to get on it, here's a good place to start.
posted by gingerbeer at 4:27 PM on February 25 [1 favorite]


Yes, PrEP is covered by most health insurance companies, as well as most (I think all?) state Medicaid programs.

Maybe it's changed, but about a year ago, my health insurance would cover it if you had *contracted* HIV, but not as a preventative. So unbelievable. My friend who was trying to get it was having conversations with the insurance company like "So.... As a sexually active gay man, you're going to pay for this medication eventually, we're just haggling about when, really." Ugh.
posted by greermahoney at 4:28 PM on February 25


It's not PrEP if you get it after you have HIV; it's just Truvada. Anyone having trouble getting their insurer to cover it should use the links in the site I just posted to get some assistance. Gilead is covering a good chunk of the cost for people who can't get it elsewhere.
posted by gingerbeer at 4:59 PM on February 25 [3 favorites]


I'm just curious about why it got such a negative reaction before.

Sex negativity and homophobia.


Not amongst the gay men I know. I found out about it from my best friend, who is gay, and loves Grindr, and he was vociferously opposed to PrEP at first. Here's why: condoms work.

When you have an existent solution to this problem, one which works well (for him), and then someone comes along and says "take this magic pill and everything is fixed!" then the bullshit detectors go off. He was convinced that there had to be a downside, because this brand new solution appeared to good to be true. Like, no, you can't just fuck without a rubber, we remember how much that decimated our communities.

Thank god it is turning out to be true!!!! This is like a miracle, which is why it's taken a few years of data to give proof to these incredible claims.
posted by juice boo at 5:07 PM on February 25 [5 favorites]


He sounds like the kind of guy Jesus would have liked.

He started with serving drinks? Then healing people, in a way that juice boo's friend sees as a mircale? Working all hours without getting paid? Media appearances, responding to questions and reaching out to the rejected and disempowered? Let's just say this Owen guy had better not get arrested in his thirties when the media and political establishment are looking for a scapegoat.
posted by sy at 5:51 PM on February 25 [6 favorites]


I'm going to print it a photo of him for my wall. He's just- to take that pain and hurt and go fuck it and turn it into action is beautiful. I love what he said about going home and working at his mother's kitchen table and her support.
posted by dorothyisunderwood at 5:55 PM on February 25 [3 favorites]


I am continually blown away by the long history of people with HIV being left to die by the government, saying oh hell no you don't, and then doing their own impressive projects, with some help from non-HIV positive allies, to fight the disease and its effects. You see it with ACT UP (and the Treatment Action Group which broke off from ACT UP to do its own advocacy.) You see it with hospice organizations like Maitri in San Francisco and Joseph's House in DC. Now Greg Owen. You're a hero Greg, and you're joining a fucking amazing lineage.

Any legislator who wants to blabber on about "personal responsibility" in regards to HIV transmission and treatment would do well to look at the networks that HIV positive people have had to make for themselves.
posted by ActionPopulated at 6:04 PM on February 25 [7 favorites]


The most legitimate-sounding concern I've heard is that it could lead to increased drug resistance. I don't know how true that is in reality.

IAMADr, but I've done a fair amount of research about PrEP/Truvada for personal reasons.

On its own it would lead to drug resistance. Truvada is good at preventing a new HIV infection, but it's not enough to treat an existing one. If someone is inconsistent in their dosing (skipping or severely delaying) then there's a chance they won't be protected during an encounter and could contract HIV. Since Truvada can't suppress HIV on its own, the virus would gain resistance in this individual and potentially infect other PrEP users.

This has already happened several times. There are three cases I'm aware of where guys on Truvada and compliant with the instructions still caught HIV. Even though they did what they were supposed to, one of the guys they slept with didn't and infected them with a resistant dose.

This is why regular HIV testing is crucial to the success of PrEP. It limits the spread of Truvada resistant HIV by catching guys before they can infect too many more. 4th gen HIV tests have a window of about 2 weeks, which is really great considering just 5 years ago it was 12 weeks; we can find these infections early. And I read one article that claimed guys with Truvada resistant strains regained their sensitivity to Truvada after starting other drugs, so it's not the end of the world. Treatment as Prevention -- the other side to the HIV battle -- is also very successful.

Additionally, a lot of people look at the three infections and jump to the conclusion "PrEP doesn't work!" This couldn't be further from the truth. Condoms fail all the time, arguably at a higher rate than PrEP, but no one makes a big deal of it. Three infections in compliant individuals over the last 18 months (when I started paying attention) is still a wild success for the drug.
posted by The Supreme Dominar at 6:55 PM on February 25 [11 favorites]


Like, no, you can't just fuck without a rubber, we remember how much that decimated our communities.

Thank god it is turning out to be true!!!! This is like a miracle, which is why it's taken a few years of data to give proof to these incredible claims.


Hopefully people aren't discarding condoms? The article explains the advantage of PrEP over condoms but in addition to condoms is even better. Also, not to sound like an old public service announcement, but there are other STDs as well.

And I read one article that claimed guys with Truvada resistant strains regained their sensitivity to Truvada after starting other drugs

I hadn't heard that, this is very good news.
posted by mark k at 8:17 PM on February 25


I thought the whole article read like PR Propaganda from Truvada itself. The NHS has to make difficult decisions on cost-effectiveness for all drugs. Should they really be funding a barely proven drug-based condom? £500 per month? That seems a lot for a prophylactic.
posted by mary8nne at 11:49 PM on February 25


What a fantastic article, thank you for posting. Owen is a hero.
posted by ellieBOA at 12:23 AM on February 26


Should they really be funding a barely proven drug-based condom? £500 per month?
posted by mary8nne at 1:49 AM on February 26


Nope, they should really be funding the generic.
posted by dancestoblue at 3:31 AM on February 26 [1 favorite]


When you have an existent solution to this problem, one which works well (for him), and then someone comes along and says "take this magic pill and everything is fixed!" then the bullshit detectors go off.

Yeah, that was my experience as well. A lot of queer men I was talking to at the time were worried it would be less effective than reported, or that it would turn out that commonly prescribed antibiotics or weed or whatever lessened its effectiveness, or that it would only be effective against certain strains. I had one dude tell me he thought it was a trap - that PrEP didn't work at all and that it was a trick by homophobes to get gay men to kill themselves.
posted by Jilder at 4:22 AM on February 26 [2 favorites]


> And I read one article that claimed guys with Truvada resistant strains regained their sensitivity to Truvada after starting other drugs

I hadn't heard that, this is very good news.


I believe this was the study I originally found: Drug resistance acquired during HIV PrEP rapidly disappears after medication is discontinued.

“Multiple studies have now shown that the risk of developing resistance from PrEP is very low, but is an important concern for those who initiate PrEP during unrecognized acute infection,” comment the authors. “Our data show that resistance selected in these cases decays rapidly to levels below detection of even highly sensitive assays.”
posted by The Supreme Dominar at 9:27 AM on February 26 [1 favorite]


I thought the whole article read like PR Propaganda from Truvada itself. The NHS has to make difficult decisions on cost-effectiveness for all drugs. Should they really be funding a barely proven drug-based condom? £500 per month? That seems a lot for a prophylactic.

I wouldn't say it's "barely proven". It's been used to treat HIV since 2004, and studies for PrEP began in 2007 with FDA approval in 2012. Every study of daily Truvada use has returned extremely encouraging results. This is the real deal.

That being said, the price is pretty high. In the US it's about $1300/mo, although insurance or discount programs from Gilead can greatly reduce that. That being said, the cost of HIV treatment is ~$20,000/yr in the US. Assuming people only take Truvada for a period of their lives, and that these drugs are near their patent expiration date, my gut feeling is that the prevention cost is probably worth it.
posted by The Supreme Dominar at 9:37 AM on February 26 [1 favorite]


The Illinois Department if Public Health is running PrEP programs in the state. If you want it, or engage in at risk activity get it!! PrEP is HERE!!!
posted by AlexiaSky at 10:41 PM on February 26 [1 favorite]


Thing is many HIV transmissions aren't through sex, but through needle sharing.
posted by AlexiaSky at 10:43 PM on February 26 [2 favorites]


I asked an AIDS activist friend of mine about PrEP and folks whose primary risk factor is needle sharing. There's a specific 2013 study that found Tenofovir was effective in preventing HIV for drug injectors. Also the CDC mentions injection risk as one reason to consider PrEP.

He also points out that needle exchange, etc are also effective in helping prevent HIV transmission. I just thought it was interesting that PrEP was a possible option.
posted by Nelson at 12:35 PM on February 27


Yes, PrEP works to prevent transmission through sharing injection equipment. There's a complex set of issues related to people who inject drugs and PrEP, including that much of the US still doesn't provide decent access to sterile syringes, and that needs to happen first, but PrEP absolutely works just the same in that population.
posted by gingerbeer at 2:45 PM on February 27


This was a really great story.
posted by klangklangston at 3:44 PM on February 27


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