More than four decades ago, Pope Paul VI predicted in Humanae Vitae that the emergence of the new reproductive technologies—especially the birth control pill—would lead to a “lowering of moral standards … and a rise in infidelity.” Today, with the emergence of Truvada, a pill that has been shown in clinical trials to be up to 99 percent effective in preventing the spread of AIDS through sexual activity, some in the gay community are beginning to echo these same kinds of concerns.
In a July, 2014 cover story in New York Magazine, writer Tim Murphy captures the paradox such a pill presents to the gay community in possibly changing what he calls “a mind-set of sexual prudence that has governed gay-male life since the early ’80s.” Pointing to the proliferation of T-shirts and Instagram captions reading “Truvada Whore,” Murphy presents both sides of this issue—pointing to the benefits of a pill that will surely save lives, but at the same time encourage the self-destructive promiscuity of the past. Interviews published in Murphy’s article reveal the fears held by many who have spent their lives working to end the scourge of AIDS that “reverting to pre-condom habits might be tempting fate again.” In a conversation with Dr. Martin Markowitz, a veteran of the Aaron Diamond AIDS Research Center, the AIDS researcher warned: “Mother Nature’s a bitch. Don’t underestimate her.”
Playwright Larry Kramer, a long-time leader in the gay community who has been HIV positive since the 1980s, has been especially critical of Truvada. He is particularly concerned about the health risks of the drug. Originally designed ten years ago as an HIV-treatment pill, Truvada “quietly became the first drug to be approved by the FDA for a new use: to prevent HIV infection.” Renamed PrEP (short for “pre-exposure prophylaxis), the drug has been welcomed—even celebrated—by many. But, in an interview published in the New York Times, Kramer said: “Anybody who voluntarily takes an antiviral every day has got to have rocks in their heads. There’s something cowardly about taking Truvada instead of using a condom. You’re taking a drug that is poison to you.”
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Likewise, Sean Strub, the HIV positive founder of Poz, a magazine published for those “affected by HIV and AIDS,” was quoted in the New York Magazine article as saying that “Rather than giving HIV negative people the life skills teaching them how to be healthy about their sexuality … the idea is unbelievable that we are going to put tens of millions of gay men on PrEP and bankrupt the economy to spray people with Raid.” Murphy points out that Truvada has been linked to kidney damage “in a small percentage of those who take it as part of their HIV treatment regimen.”
Indeed, these are many of the same kinds of concerns that Pope Paul warned of in 1968 when he said that the widespread use of the birth control pill would diminish the relationship between men and women. The pontiff also pointed to the possibility that governments would coerce the use of such technology to control population growth. Mary Eberstadt’s 2012 book, Adam and Eve After the Pill: Paradoxes of the Sexual Revolution documents these costs including the degradation of women through what she calls the “consumerization of love,” as well as the proliferation of pornography, cohabitation, and the emergence of the “hook-up culture” on college campuses and beyond.
At the same time, just as Pope Paul predicted, governments and private foundations like the Gates Foundation, have promoted all forms of birth control on a global scale—sometimes through coercive means. In the United States, we continue to be embroiled in the controversy over the Obama administration’s requiring all institutions—including Catholic ones—to provide insurance coverage for contraception, labeling it as a type of “preventive care.” Murphy’s New York Magazine piece predicts that similar kinds of government mandate controversies may emerge around coverage for Truvada as a form of preventative care:
Most insurers—both private and public, such as Medicaid—have covered the cost of Truvada-forPrEP (as they generally do once drugs are FDA approved for specific uses) and the potential controversial issue has flown under the public radar. Some bloggers have wondered if the Supreme Court’s Hobby Lobby ruling which says that private employers can block contraceptive coverage for workers on the grounds of religious belief, might lead some bosses to block Truvada reimbursement on their plans.
In an attempt to address the dramatic increases in AIDS rates within the gay population in his state, Murphy writes that New York Governor Andrew Cuomo vows to make the drug even more widely available and will begin a public-information campaign for PrEP in an effort to “eradicate the AIDS epidemic in the state by 2020.” While the drug is for both men and women, the reality is that the highest HIV rates continue to be among young gay men. Murphy points out that in 2010, the Centers for Disease Control reported that 20 percent of U.S. gay men had HIV compared with about .3 percent (not 3 percent) of the total population. In 2012, the CDC reported that HIV rates in gay men between ages 13 and 24 rose 22 percent in recent years. “[I]f HIV infections continue at current rates, half of all young gay men will have HIV by age 50.”
Coverage is already expensive for insurers—which likely pass the expense on to consumers. Taxpayers are already paying for coverage for the preventative drug for gay men through Medicaid—but the drug will save the lives of young men who engage in high-risk same sex behavior so most are grateful for that. Murphy credits Gilead, the drug-maker for Truvada, as showing “surprising restraint, given the potential size of the new market.” In interviews with Murphy, a spokesperson from Gilead said that, Truvada is “an important public-health intervention and not a commercial opportunity.” He points out that the company has a program to make the drug available to eligible patients with no health insurance or with unaffordable co-pays. But, Murphy also points out that “some HIV activists feel that Gilead is quietly funding a surge in HIV negative takers of Truvada—whose list price is about $1,300 a month—while not having to take flak from PrEP opponents for implicitly promoting condom-less sex.”
In Veritatis Splendor, the 1995 encyclical on truth and morality, Pope John Paul II reminds us that, “The negative precepts of the natural law are universally valid. They oblige each and every individual, always and in every circumstance.” We cannot help but be reminded of these words when we read the statements from gay men and AIDS researchers in Murphy’s courageous essay in New York Magazine. AIDS researcher Dr. Martin Markowitz is simply echoing a coarsened re-construction of this papal encyclical when he pronounces, “Mother Nature is a bitch.” Faithful Catholics—and all students of natural law—have known this forever.