Thread by @peterstaley

1. Let’s break-down why @prose4321’s “I’m an AIDS historian!” rant is one of the worst (and most dangerous) AIDS op-eds ever to appear in the NYT. I hope we direct most of our anger at the Times, which doubled down on its history of promoting gays who scold gays.

2. Patrick’s subsequent meltdown on Twitter revealed the kid behind the future book deal as he lashed out at actual AIDS historians and experts he’d never heard of before yesterday. We all got schooled in his misunderstood millennial wisdom.

3. He gets an A for knowing what thrills the Times editorial staff – the bad-gays-had-it-coming morality tale as told to you by an actual gay – the brave truth-teller confronting our dirty laundry for our own good.

4. First, the factual errors and intentional omissions. He blames PrEP for falling condom usage, which he’s only able to do by ignoring over 2 decades of data from the early 90’s to 2014 (when he implies our immoral unsheathing began).

5. The advent of “safe sex” did indeed save many lives as annual HIV infections in gay men in the US were quickly cut by almost 2/3rds from 1985 to 1990, but this “condoms always” culture had more leaks from day one than my stack of expired condoms.

6. It seems when our supposedly perfect condom culture was in full force in 1995, annual infections in gay men had already started rising again (pre-HAART!). 20,000 of us seroconverted that year – oops!

7. The CDC doubled down with year after year of ASO funding for condom campaigns. By 2003, our annual infection rate increased 50%, to 30k a year. Syphilis also started up in the 90’s (recent increases track the pre-PrEP trend lines we’ve seen for 25 years)

8. In fact, modeling from CDC & @EmoryRollins show that increased PrEP use will decrease the # of new bacterial STIs – even if people reduce their use of condoms while on PrEP – because increased testing + treatment is very effective prevention for STIs.
cdc.gov/nchhstp/newsro…

9. Bottom line on our plague years condom code – when you go from zero condoms to wide-spread use, you dramatically lower HIV infections (with minor decreases in other STIs), but only in the very short-term (5 years).

10. Barely a majority of gay men were using them 100% of the time (even though we pretended like all of us were), and use started falling in the early 90s even while deaths continued to soar. Our dirty little secret by 1995: condoms were totally failing at ending AIDS.

11. And yet the scolds love to blame PrEP for this. Our “historian” points to PrEP’s 2014 approval by the CDC (since corrected), major red flags for the future publisher of his AIDS history. The Times got so wide-eyed by “carnivorous sexual selves” they forgot what the FDA does.

12. He got the year wrong too. PrEP was approved in 2012. Patrick was even more confused by data showing that those who signed up for PrEP studies had higher rates of STIs than those not on PrEP (and NOT in the studies).

13. If he had linked to the actual study, rather than an AHF press release (OMG!), then he’d find the mega (good news) caveat: “PrEP studies recruited MSM with high-risk sexual behavior, whereas MSM in studies not using PrEP may have had different baseline risk behavior.”

14. Well duh. The slutty boys were the early adopters of this life-saving technology (long live slutty boys!!!). This is exactly what public health officials hoped for. Those at highest risk would lead the way. And in every city they’ve done this, HIV rates have plummeted.

15. One has to wonder why our expert author would ignore the biggest PrEP fact of all – that in cities where PrEP has been used the most, HIV infection rates have crashed. His tweet claiming his op-ed wasn’t “anti-PrEP” was truly Trumpian in its defensiveness.

16. An op-ed that links TWICE to anti-PrEP denialism written by Michael Weinstein for its facts, and then points to New South Wales as a scary PrEP story, failing to mention its crashing HIV stats, is very obviously the most anti-PrEP crap of 2018.

17. In just six months after PrEP was offered to gay men in New South Wales, they saw “a 44% decline in early HIV infections in MSM, to levels unprecedented since the beginning of the HIV epidemic.” Maybe Patrick missed those headlines.
croiconference.org/sessions/rapid…

18. His assertion that PrEP is not effective in women is just unrepentant sexism – two of the largest RCTs studying PrEP in women showed greater effectiveness in preventing HIV than iPrEx did for MSM. His one link to a study on domestic abuse is a vile way to hide this truth.

19. His implication that PrEP has led to PrEP-resistance virus puts him on par with anti-vaxxers and their scary untruths. We’ve known about very low levels of TDF/FTC resistance since the drugs were first tested in the early 00’s. It’s remained low ever since.

20. That’s why scientists picked Truvada as the first PrEP candidate, because of the combo’s very high barrier to viral resistance. They were right, and Patrick’s lie will cost lives by stoking totally unwarranted fears. But hey, he’s “not anti-PrEP.”

21. In fact, the consensus of mathematical resistance modeling is that PrEP is proving better than originally predicted. One of the most sophisticated models showed that PrEP might actually reduce the prevalence of resistance. pnas.org/content/pnas/1…

22. Another fact he missed during his years of research: in every place that has scaled up PrEP, transmitted HIV drug resistance has remained stable or dropped. (Hint: fewer infections lead to fewer on treatment, thus less drug resistance)

23. But nothing is more criminal than using he deaths of a generation of black, brown and white gay men as SOME HOOK for your god-damned morality tale about how gay men were trying to live and thrive in the 70's. FUCK YOU, PATRICK.

24. Do you know how many Moral Majority fucktards told us we deserved what was happening to us as we buried our friends and lovers? Do you know how much you sound like them? Do you really think a virus conducts morality lessons?

25. You basically say lots-of-gay-sex (no mention of straight sex) leads to the next great plague. Question for you: how many pathogens throughout human history have killed millions of people via sexual transmission?

26. Answer: just two (syphilis and HIV, with a 500 year gap between their carnage). But in your world, the third one is just around the corner, and will favor butt-sex as its mode of transmission (because God is obsessed with butt-sex?).

27. In reality, the next plague will most likely be a bird-flu virus transmitted through the air. Shouldn’t we all be wearing face masks now due to this likelihood? Or might it be smarter to work on quickly identifying and responding to future outbreaks?

28. Oh yeah, that’s what didn’t happen with AIDS. Patrick didn’t mention Reagan. He blamed my dead gay brothers instead, who “traded diseases rampantly” while trying to survive a hate-filled world. Do he have a similar morality tale for AIDS in Africa (which predates ours)?

29. Maybe unthinking pathogens don’t use his moral compass. Maybe heterosexual Africans, and gay men in NYC, and kids with hemophilia, and black moms (and their gay sons) in Atlanta, and Latina trans women in LA, were living their very human lives when history dealt its 2nd card.

30. You sent me a tweet saying “don't lecture me about history.” I’ve got HIV antibodies older than you. I wake up every morning feeling blessed to have witnessed that history, and to still be here to fight for the end of this AIDS crisis.

31. We will use science, as we have before, to guide our final push, and while your millennial-historian moment will harm our efforts, we will overcome your arrogant moralizing too, just like we’ve countered Weinstein’s. We will outlast and out-fight you.

Thanks to @jbkrell for some of the stats above, and @MyFabDisease for letting me steal one of your tag lines.