AHF Doctor Discusses PrEP Support

A doctor who works for AIDS Healthcare Foundation, the Los Angeles-based nonprofit that's railed against PrEP, discussed his support for the prevention method during a visit to San Francisco.

Dr. Adam Zweig, who's AHF's western region medical director, is serving as interim medical director of the nonprofit's clinic at 518A Castro Street in San Francisco until the new medical director for the health centers in San Francisco and Oakland, Dr. Emanuel Vergis, starts December 1.

AHF has run an advertising campaign against PrEP that was published in the Bay Area Reporter and other outlets. The nonprofit has argued that the scientific evidence does not support widespread use of Truvada, the drug taken for PrEP, for prevention.

AHF's president, Michael Weinstein, has said, "We want the public to know that the government-sanctioned widespread scale-up of PrEP appears to be a public health disaster in the making."

But Zweig, 51, a gay man, said in an interview last week that many people have mischaracterized AHF as "anti-PrEP."

He said when Truvada as PrEP appeared about four years ago as an option for HIV prevention, the nonprofit's advocacy arm was worried about "unanswered" questions, such as whether there would be an increased risk of transmission for other sexually transmitted infections, a spread of resistant HIV, and whether patients could be counted on to be compliant.

AHF supported PrEP use for HIV-negative partners in discordant couples, and intravenous drug users who shared needles.

But the nonprofit wanted its doctors to promote regular condom use, rather than Truvada, when HIV-negative gay men engaging in anal sex didn't use condoms or used them inconsistently.

Zweig, who confirmed that he's a proponent of PrEP, said, "Our advocacy arm is separate from the health care provider, and therefore if a doctor or nurse practitioner" or other provider "wanted to prescribe Truvada to a particular patient, we're always allowed to do so and encouraged to do so."

He said, "Our official stance has softened over the past few years, especially with the availability of efficacy data" showing that resistant strains of HIV aren't being seen Zweig said.

AHF hasn't given him any trouble for prescribing PrEP, Zweig said.

"Michael Weinstein as an individual is not as positive on PrEP as providers are, and that's his prerogative as long as he doesn't push his view on the health care provider," he said.

Zweig, who lives in San Diego, where AHF has another health center, said, "We only see HIV-positive patients in San Francisco and Oakland," although there are a couple of local people the clinic sees that are on PrEP.

Because of its small staff - one doctor alternates between Oakland and San Francisco - "Our availability is limited so we want to save our spots for HIV-positive patients," Zweig said. He said he hopes that changes when Vergis arrives.

He said that a lot of data show that Truvada "is very effective in preventing men and women who are at risk for HIV transmission from acquiring HIV."

However, he said, "We want to use it correctly."

"In general, the medical community has our idea of PrEP versus some patients who come in and want PrEP," Zweig said. He and others want PrEP to be used as part of a "package" to prevent transmission of HIV and other STIs.

That mix may also include using condoms as often as possible, being "smart when choosing their partners," and using Truvada "to provide backup if condom use is inconsistent," among other factors.

Zweig said some patients "want to use Truvada as a means to having only bareback sex." But he's not going to deny those patients PrEP.

In those cases, he said, "I will do my best to get him to use condoms," but "I would rather this guy have bareback sex on Truvada than not on Truvada."

AHF has sued the city of San Francisco and gay Supervisor Scott Wiener over its efforts to move its pharmacy to the clinic location in the Castro being blocked. City officials have argued that the move would violate local retail rules.

Nicholas Clements-Lindsey, an AHF spokesman, said in an email, "AHF Pharmacy still plans to be in the same location."

As for the status of the lawsuit, Clements-Lindsey said, "I do not have any information to comment."