text: Scott Wiener, a member of the San Francisco Board of Supervisors, made an unusual public announcement on Wednesday: He takes Truvada, a daily antiviral pill, to greatly reduce his risk of contracting H.I.V. 
   
   Taking the pills is a practice known as pre-exposure prophylaxis, or PrEP, and some researchers believe it may reduce the risk of infection by 99 percent if patients take their medication daily as prescribed. Approved by the Food and Drug Administration in 2012, PrEP has increasingly been embraced by public health authorities and is one of three planks of Gov. Andrew Cuomo’s plan in New York to sharply cut new H.I.V. infections. 
   
   But it carries a stigma in some parts of the gay population, and Mr. Wiener appears to be the first public official to disclose that he’s personally on it. ||||| Each morning, I take a pill called Truvada to protect me from becoming infected with HIV. This strategy, also known as pre-exposure prophylaxis, or PrEP, reduces the risk of HIV infection by up to 99 percent if the pill is taken once a day. This makes PrEP one of the most effective HIV-prevention measures in existence. After consulting with my physician, I went on PrEP to further protect and take personal responsibility for my health. I'm HIV-negative, and I want to remain that way. 
   
   I recently decided to be public about my use of PrEP in order to raise awareness about this relatively new tool for preventing HIV. It's important to encourage people at risk for HIV to talk to their medical providers about all the tools and methods available for preventing infection, including PrEP, and to choose the methods that are best for them. 
   
   As an elected official, disclosing this personal health decision was a hard but necessary choice. After all these years, we still see enormous stigma, shame, and judgment around HIV, and around sexuality in general. That is precisely why I decided to be public about my choice: to contribute to a larger dialogue about our community's health. I have the honor of representing a district that includes the Castro -- ground zero for the HIV epidemic. I represent a community that has been profoundly impacted by HIV, with a large number of HIV-positive people -- nearly one in four gay men in San Francisco is HIV-positive -- and an even larger number of people at risk of becoming positive. As an elected official in this role, I have an obligation to do everything in my power to support those living with HIV, increase public awareness about effective HIV prevention, and reduce stigma and shame. 
   
   My journey to PrEP was a long one. I came to terms with myself as a gay man when I was 17 years old in 1987, at the height of the HIV epidemic. Many gay men were getting sick and dying. Like many in my generation, I came of age associating sex with illness and death. That association -- with all the fear, anxiety, guilt, and shame that go along with it -- is still very real for many of us. 
   
   As time has gone by, I've seen people become healthier, and I'm continually in awe of those who have survived the epidemic and thrived. Yet new HIV infections continue -- 50,000 annually in the U.S., and over 2 million annually worldwide. Despite all our prevention efforts, I continue to know people who've remained HIV-negative for 20 or 30 years, only to become HIV-positive. I regularly meet young men, some barely out of high school, who have the virus. 
   
   None of this is preordained. People don't need to continue to get infected, and we know that PrEP has the potential to help stop the epidemic in its tracks by ending new HIV infections. It's one pill a day, with few side effects for most people. 
   
   Condoms remain critically important for HIV-prevention efforts, but they have their limits, as demonstrated by the continuing new infections after 30 years of robust prevention efforts. Only one in six gay men uses condoms consistently and effectively enough to be fully protected from HIV. For those who do use them consistently, condoms offer significant protection but have a failure rate, and condom usage among gay men reduces HIV risk by 76 percent, not 100 percent. 
   
   Given the challenges many gay men have with consistent condom use as well as the continued risk of HIV transmission even for those who use condoms, PrEP provides a powerful additional level of protection. It's not a question of either condoms or PrEP. It's about both important tools. 
   
   PrEP has broad support in the public-health community. The World Health Organization and Centers for Disease Control and Prevention have recommended its use by those at risk for HIV, including gay men. The state of New York and the San Francisco Department of Public Health have adopted PrEP as a core prevention strategy. The HIV advocacy community overwhelmingly supports PrEP. Most insurance companies cover it fully despite its considerable cost, precisely because it is so effective at preventing a serious illness for which there is no cure. 
   
   Some aren't sold on PrEP. Skeptics question whether people will adhere to a daily pill, which is a legitimate concern. Protection decreases if usage is inconsistent. This challenge can be overcome with effective education, and drug adherence is a challenge that isn't unique to PrEP. 
   
   Some critics also view PrEP as a license for people to engage in risky behavior and assert that it will cause non-HIV sexually transmitted infections to increase. No study to date has shown that those using PrEP increase risky behavior -- such as reducing condom usage compared with before using PrEP -- and there is evidence to the contrary. Indeed, this line of thinking -- that promoting an effective prevention method will lead to irresponsible behavior -- resembles some of the phony arguments used to attack the HPV vaccine by suggesting that getting vaccinated will lead young girls down a path to promiscuity. And, since PrEP users are regularly screened for HIV and other sexually transmitted infections, PrEP use will increase opportunities for prompt detection and treatment of STIs. 
   
   PrEP isn't only about gay men. Women can benefit tremendously from it as well. Many women are using PrEP to conceive a child with an HIV-positive partner, a new approach dubbed "PrEP-ception." PrEP can also protect women (and men) in abusive relationships. Too many women -- and gay men as well -- don't fully control how or when they have sex, whether their partners use condoms, and what risks their partners are taking elsewhere. People facing these challenges can take control of their infection risk -- and essentially eliminate that risk -- by using PrEP effectively. 
   
   In addition to lack of education and stigma, another significant barrier to fully realizing PrEP's potential benefits is lack of access. PrEP isn't cheap, and for the many people who are uninsured or underinsured, cost can effectively deny access. PrEP needs to be easily available to all communities and all income levels through public healthcare programs, including Medicaid. Otherwise we risk accentuating health disparities among our diverse communities. 
   
   Many people and organizations have gotten us where we are with PrEP. The University of California San Francisco is responsible for some of the earliest clinical studies of PrEP, and organizations like San Francisco AIDS Foundation, Project Inform, and the AIDS Vaccine Advocacy Coalition have been working on the front lines to ensure that the promise of PrEP is fully realized, including advocating for FDA approval, helping establish expanded access programs from the drug manufacturer, ensuring PrEP is covered by insurance plans, and disseminating information to consumers and clinicians. 
   
   We know how to end HIV infection. We simply need the political will to ensure that the community has accurate information about and access to all prevention methods, including PrEP. I hope my disclosure can play a role in moving us toward these goals. 
   
   Scott Wiener is an elected member of the San Francisco Board of Supervisors. For more information, visit scottwiener.com. ||||| S.F. Supervisor Wiener says he's taking HIV-prevention drug 
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   Photo: Sarah Rice, Special To The Chronicle Image 1 of / 5 Caption Close Image 1 of 5 Supervisor Scott Wiener during the Board of Supervisors meeting in San Francisco, Calif., Tuesday, June 19, 2012. Supervisor Scott Wiener during the Board of Supervisors meeting in San Francisco, Calif., Tuesday, June 19, 2012. Photo: Sarah Rice, Special To The Chronicle Image 2 of 5 Supervisor Scott Wiener, left, and Supervisor Mark Farrell, right, during the Board of Supervisors meeting in San Francisco, Calif., Tuesday, June 19, 2012. Supervisor Scott Wiener, left, and Supervisor Mark Farrell, right, during the Board of Supervisors meeting in San Francisco, Calif., Tuesday, June 19, 2012. Photo: Sarah Rice, Special To The Chronicle Image 3 of 5 Supervisor Scott Weiner listens to members of the public speak during the ethics hearing for Mirkarimi at City Hall in San Francisco, Calif., Tuesday, October 9, 2012. Supervisor Scott Weiner listens to members of the public speak during the ethics hearing for Mirkarimi at City Hall in San Francisco, Calif., Tuesday, October 9, 2012. Photo: Jason Henry, Special To The Chronicle Image 4 of 5 Scott Wiener considers the issue of free fares for low-income youth on Muni in San Francisco, Calif. on Wednesday, July 25, 2012. Scott Wiener considers the issue of free fares for low-income youth on Muni in San Francisco, Calif. on Wednesday, July 25, 2012. Photo: Sonja Och, The Chronicle Image 5 of 5 Supervisor Scott Wiener at Macy's Passport Presents Glamorama at the Orpheum Theatre on September 19, 2013. Supervisor Scott Wiener at Macy's Passport Presents Glamorama at the Orpheum Theatre on September 19, 2013. Photo: Drew Altizer Photogaphy S.F. Supervisor Wiener says he's taking HIV-prevention drug 1 / 5 Back to Gallery 
   
   San Francisco Supervisor Scott Wiener on Wednesday became what appears to be the first public figure in the country to disclose that he's taking a drug that prevents HIV infection - a pill that public health officials said could save lives but has remained largely unused due to stigma and lack of awareness. 
   
   Wiener's announcement is significant because so few people have been willing to talk openly about their use of Truvada, a drug that's been weighed down by controversy. He said he hopes his revelation will lift some of the stigma associated with Truvada and encourage more men to consider taking it. 
   
   Critics have suggested that taking the daily pill could make people more likely to engage in unsafe sex, but that claim hasn't been backed up by research. Still, the idea has persisted, and people have been slow to embrace a drug that public health officials believe could be key to stopping, or significantly slowing down, the spread of HIV. 
   
   Wiener's disclosure, which he made in an online essay published Wednesday evening, comes as San Francisco pushes an aggressive campaign to persuade more gay men to take the drug, which is referred to as PrEP, for pre-exposure prophylaxis. Truvada, an antiviral drug that has been used to treat HIV infection for more than a decade, is the only pill approved for prevention. 
   
   At a meeting Thursday, Supervisor David Campos is expected to discuss a new initiative to make Truvada more accessible in San Francisco and distribute it to any resident who needs it. The initiative includes a plan to help pay for the drug for residents who can't afford it. Truvada can cost up to $14,000 a year, although it's covered by most insurance plans, and the drugmaker will help with the cost for people who need financial help. 
   
   San Francisco city and public health officials said they want to make the drug more accessible, and also normalize it. Wiener said that was his motivation in going public. 
   
   'Elevate awareness' 
   
   "People need to feel comfortable talking about these issues and not think they're going to be stigmatized or denigrated if they talk about using it," Wiener said. "My hope is that talking about it will elevate awareness about PrEP as an available and powerful prevention tool." 
   
   Truvada, which is made by Gilead Sciences in Foster City, is a single tablet that combines the drugs emtricitabine and tenofovir disoproxil fumarate. If taken daily, it can cut the risk of HIV infection by more than 90 percent. 
   
   The drug primarily has been tested in men who have sex with men, which is why they're the focus of efforts to increase use of PrEP, although it appears to also be effective for women and transgender men and women. 
   
   Most people report no side effects from the drug, and about 10 percent of users say they have some gastrointestinal discomfort for the first few weeks after starting. A smaller percentage of users can suffer more serious signs of drug toxicity and will need to stop taking the drug. 
   
   The drug has been widely discussed among health care providers and in the gay community for several years - even before it won FDA approval - but even in San Francisco, where much of the initial research was done, the pill has been slow to gain acceptance. Nationwide, only about 2,000 people are taking PrEP. 
   
   "Nationally, we all - health departments and community groups - need to speed this up, because we could be preventing a lot of infections," said Dan Van Gorder, executive director of Project Inform, an HIV patient treatment and information advocacy organization. 
   
   The slow acceptance of the drug has been due somewhat to the stigma, which is widespread but has dimmed in recent months. But another major barrier comes from doctors, many of whom have been reluctant to prescribe it, especially if they don't regularly treat HIV-positive patients and aren't familiar with Truvada. 
   
   Increase accessibility 
   
   That's where San Francisco can improve access to the drug, public health and city officials said. Thursday's city meeting, organized by Campos, is focused on the idea of ensuring the that drug is easily available to anyone who is interested in it, regardless of their ability to afford it or find a doctor who will prescribe it. 
   
   "The issues we face are in getting what we know is a very effective HIV-prevention tool into the hands of people who need it," said Dr. Susan Philip, director of the STD Prevention and Control Services Section of the San Francisco Department of Public Health. "We've always believed in PrEP as an intervention. Now we're figuring out how to help with delivery." 
   
   Wiener said he was slow to come around to PrEP, even after he'd seen the initial reports about how effective it could be. Like many other men, he wasn't convinced at first that he was the right target for the drug. 
   
   "A lot of us in the past had stereotypes about who should be using PrEP - that PrEP was for sex workers and porn actors and people who hated using condoms. But really prep is much broader than that," Wiener said. 
   
   Now, he said, he likens the drug to the birth control pill - it's just another option for practicing safe sex. 
   
   "There are some people who are convinced PrEP is going to make people reckless, but that's a bogus argument. It's the same argument we've heard around birth control, and it's very antipublic health," Wiener said. "There's always a lot of judgment around sex. 
   
   "There are downsides to being public about my sexual health," Wiener said, adding that the most awkward drawback so far has been telling his mom he was taking PrEP. "Ultimately, I decided that this could play a positive role in moving the dialogue forward and increasing awareness."
target: – A San Francisco official looks to be the first public figure in the country to "come out of the PrEP closet," as he puts it in a piece for the Huffington Post. Scott Wiener—who represents a district he calls "ground zero for the HIV epidemic"—says he takes the daily antiviral pill Truvada to lower his risk of contracting HIV. He's urging other gay men to do the same. "A much larger segment of gay men should be taking a close look" at what's known as pre-exposure prophylaxis, Wiener tells the New York Times. Truvada as PrEP has been very slow to catch on across the country, which Wiener writes sees 50,000 new HIV infections each year. Researchers say PrEP could reduce the risk of HIV infection by up to 99% if taken as prescribed. The World Health Organization made a similar case to Wiener's this summer, but the San Francisco Chronicle calls Wiener's announcement "significant because so few people have been willing to talk openly about their use of Truvada." Though the drug's list price is just over $1,000 a month, Wiener says PrEP is covered by most health insurers (he personally pays $15 a month). For the uninsured or those with high-deductible plans, however, the price can be a problem. Wiener's colleague, David Campos, says he will ask the city's health department to develop a strategy that "addresses the educational and affordability issues" by December. "We have to start somewhere," says Campos, who adds that every prevented infection saves $355,000 in treatment costs.