Public health goes normcore.
San Francisco magazine
September 19, 2014
Castro Supervisor Scott Wiener is a deeply boring public figure, far more comfortable engaging in the minutiae of transit funding than clasping arms with a Sister of Perpetual Indulgence and singing "We Shall Overcome" on the steps of Facebook headquarters. Which is what made his announcement this week that he is taking Truvada, the HIV-prevention drug, all the more radical. In coming out of the closet as a PrEP (Pre-Exposure Prophylaxis) user, Wiener did the near impossible: He took what has been maligned as a "party drug" for guys who want to have risky bareback sex, and made it pedestrian, routine, boring. He Wiener-ed Truvada.
Of course, Wiener does not put it in these terms. When we spoke to him, he sounded elated by the public reaction to his disclosure. "I thought there might be a positive reaction, but it has been even more than that." His theory as to why he's received such widespread support: “San Francisco is a public health kind of town.”
It's possible to overstate the importance of the moment, but it's clear that between Wiener's admission and Supervisor David Campos's proposal to allocate city money on increasing use of the drug, something just shifted. The CEO of the San Francisco AIDS Foundation, Neil Giuliano, told San Francisco that Wiener's disclosure was the "oil in the hinge" towards widespread use. The larger context of the announcement is a legislative push by Campos to spend $800,000 in city money towards helping those with insurance qualify to receive Truvada, and in some instances either helping with co-pays or covering the cost of the drugs altogether.
Campos himself is quick to praise Wiener's public story, telling us "Even in the LGBT community, it's hard to talk about." His admiration for Wiener's declaration is even more pronounced when you consider that the two men are far from political allies. Wiener is one of the most prominent members of the moderate faction of the city's Democratic party, while Campos hopes to replace state senator Tom Ammiano as the standard bearer for the progressive wing. And while the differences in substance and style could make the two seem odd bedfellows (try imaging Wiener in this photo instead of Campos), there's a point so obvious that it tends to be forgotten: This is how social movements win, with an outside game, and an inside one.
There's another angle to the story too: Wiener is drawing attention to his personal health in a way that's exceedingly rare for any politician—let alone a gay one. Most of the time we read about an elected's official's sex life, it's because they have been caught schtupping someone they shouldn't have. Wiener, however, has now entered Wendy Davis talking about her abortions territory. Or Debra Bowen talking about her crippling depression. He's used his personal story to spur social change. Only, his admission is different than other politicians, because of the taboo that it's seemingly violated. The politics of gayness now revolves largely around a discourse of marriage—not sex. So much of the LGBT political agenda consciously veers toward family values and steers clear of sex, that it is almost shocking to hear an unmarried gay elected official acknowledge implicitly that, yes, he really does have sex with other men. (This brings up another question—could Scott Wiener even make gay sex boring?)
Indeed, the makers of Truvada, Foster City-based Gilead, could not have asked for a better spokesmodel for their once-controversial pill than Wiener. Talking about the drug—and with it the promise of a massive decrease in new HIV infections—brings out a reflective, emotional side of the supervisor. “There are now three generations of gay men who have had different relationships with the epidemic,” he said. “One that saw the carnage, where half they knew died. Then mine, who were growing up during the heart of the epidemic and came of age with this connection between sex and death. Then there was the generation that came of age after anti-retrovirals where it was chronic and manageable. It’s an extra challenge with young people to convey to them that even though people are living healthy terrific lives with HIV, that we can’t let up our guard.”
If, as seems likely, the Campos plan moves forward, San Francisco would instantly vault into the front ranks of cities advocating for Truvada usage. Through Kaiser, we already have the largest single clinical population of the drug's users, and although cities like New York and Los Angeles are beginning to look at expanding use, no plans have surfaced there yet. Many other countries, including those in Europe, have not yet approved the drugs for widescale use against HIV. San Francisco once again has the chance to pave the way forward.
"There's this idea that if you're on PrEP that you're reckless," said Wiener. And what better person to combat that idea than one whose idea of reckless is to order whole-fat milk in his half-caff latte. Giuliano agrees that the stigma may finally be waning. He recounts a conversation he had with gay friends who, like him, are in their mid-50s. They told him that Truvada was just something for "young guys who want to bareback." Giuliano's response? He told them he was on the drug too.