Thread by @MaeleighT

As a young researcher in the field of HIV and AIDS, I am uniquely positioned to bring attention to the recent season of the Netflix Original: 13 Reasons Why (originally based off of Jay Asher’s book 13 Reasons Why, 2007). @13ReasonsWhy
A THREAD:

Netflix released the first season of 13 Reasons Why in 2017; like the book, it focused on Hannah Baker’s suicide and the cassette tapes she left behind for classmates to listen to – the 13 reasons why she ended her life. #13reasonswhy

The original release of the first season stirred up controversial issues surrounded by the stigma of depression and suicide.
npr.org/2019/07/16/742…

Netflix continued to air the series, inserting suicide helplines at the end of every episode.
Helpline: 1-800-273-8255
13reasonswhy.info

Following the first season (and its solid ratings) Netflix continues the story! All the plots are serious, but timely. Some of the controversial topics include rape, school shootings, drug and alcohol abuse, and underlying mental health issues. #13rw

I want to bring attention to the drug abuse & addiction storyline and Justin Foley, a fictional character. #opioidcrisis

The audience is introduced early on to Foley’s drug problem, as it was first presented in season 2 as a coping mechanism to previous actions of “letting” his best friend, Bryce Walker, rape his girlfriend, Jessica.
#sexualassult
Helpline: 1-800-656-4673

Foley is found homeless and addicted to heroin and from season 2 onward, Foley’s drug abuse and recovery was an underlying focus.

In Foley’s first attempt at recovery, the series does a great job at showing the audience the process of weening someone off drugs – the nausea, vomiting, excessive sweating, fatigue, etc – and the temptation and relapse.
#opioidcrisis

At the end of season 3, Foley’s drug issue is taken seriously, with Justin reaching out to the Jenson’s (who adopted him) to support & admitting him in a rehab facility.
samhsa.gov/find-help/nati…

SPOILER ALERT: Season 4’s finale takes a very serious and detrimental turn for Justin Foley. For lay individuals it may have come across as a very unexpected twist to the series; #13reasonswhy

However, researching in the field of HIV prevention, I was quick to notice the subtle hints of Foley’s soon-to-be HIV/AIDS diagnosis. Foley's red flags: progressive neck lesion & previous homelessness, sex work, & use of needles to inject drugs. #opioidcrisis #EndtheHIVepidemic

There are always going to be critics of how the producers go about providing this information and unfortunately @13ReasonsWhy has gotten HIV wrong. The show really missed the opportunity to educate viewers on HIV prevention, HIV, and AIDS
@HIVGov @talkHIV @CDC_HIVAIDS

A few things the series does right in the final minutes of the season finale: 1) a scene where Foley’s former sexual partner & her current partner go get screened for HIV themselves 2) a very minimal and brief mention of PrEP (pre exposure prophylaxis) #HIVpevention #PrEP

Who knows what PrEP is? Not tons of people. The scene does not even explain the concept of PrEP and its abilities.
@GileadSciences
whatisprep.org

Additionally, PrEP uptake has been relatively low with one barrier being perceived susceptibility to HIV – which was highlighted by Jessica disregarding her need to look into the benefits of PrEP..

As I reflect on the series as a whole, there are a few areas the producers could have introduced more HIV prevention information – especially if this was the series finale plan all along. #13reasonswhy #HIVprevention #EndtheHIVepidemic

1) When the Jenson’s take Justin into their home, knowing he was homeless, a sex worker, and addicted to heroin, wouldn’t it make since for him to go through a health check-up – including an STD/HIV screening?

cdc.gov/std/prevention…

2) Foley reveals to Jessica his struggle with sex work for heroin, this too would have been again a time for someone to lead him to get a sexual health screening!

3) In both instances mentioned above, those could have led to a scene of Foley being informed about his risk of HIV, an HIV diagnoses & his choices of treatment – if positive, his ability to start ART / if negative, his ability to start PrEP.
helpstopthevirus.com/hiv-testing?ut…

4) The previous seasons had helplines in the episode credits and even had times where cast members themselves paused the show to give information about the resources available for crisis (suicide/sexual assault/mental health), where was the HIV/AIDS infomercial? PrEP infomercial?

HIV/AIDs questions?: justanswer.com/sip/hiv-and-ai…

PrEP Questions?: greaterthan.org/prep-faq/?gcli…

5) And back to PrEP for a second, the show had numerous MSM (men who have sex with men) characters. What about their risk of HIV?? – PrEP is for them too!

health.harvard.edu/blog/prep-prev…

FINALLY: No matter the HIV/AIDS ending, PrEP could have been incorporated in the series to educate the audience on HIV prevention for those at highest risk of HIV – MSM and PWUD, both of which identified in the show. #13reasonswhy #HIVprevention #PrEP #EndtheHIVEpidemic