End-of-summer celebrations at Fire Island's gay community kicked off on an unusually sober note this weekend, with a forum focused on a breakthrough HIV-blocker that has drawn controversy.
The pill -- if taken daily -- prevents HIV from taking hold in about 90 percent of high-risk individuals, including gay and bisexual men, people whose partners have HIV, and adult drug users.
Truvada, which hit the market about two years ago, has been heralded as a key to eradicating HIV. Critics fear the drug creates a false sense of security that can encourage risky behavior, reduce condom use, and spike sexually transmitted diseases and hepatitis C cases.
"I think that if you are on it, it carries a stigma," said David Atia, 25, of New York City, who was visiting The Pines with friends.
About 55 people attended the Saturday afternoon forum at Whyte Hall hosted by Gay Men's Health Crisis, a New York City nonprofit, to learn about the daily HIV-prevention strategy and a monthlong therapy for accidental exposures.
Though now healthy, Osvaldo Perdomo, secretary to the GMHC board of directors, said he reserved a cemetery plot years ago, after he proved resistant to some of the first AIDS drugs.
"I'm here today to make sure that doesn't happen to you," he told the audience.
For some, however, Truvada use is a red flag, suggesting multiple sex partners or other high-risk activities. Experts advise also using condoms, and studies show that users of the drug often skip so many doses that they lose the drug's protection.
Those are some of the obstacles New York State must overcome to achieve its 2020 goal of ending the HIV epidemic by reducing the number of new infections to about 750 a year -- the number of people tuberculosis strikes each year.
About 3,000 people statewide contracted HIV this year, down from 14,000 in 1993, according to Gov. Andrew M. Cuomo. But the ranks of those with HIV and AIDS are rising because many are living longer.
People accidentally exposed to the virus can get the same anti-HIV medicine prescribed for daily use from hospital emergency rooms, the experts said.
The pill works best if taken within 36 hours of exposure, but must be taken within 72 hours. Experts say the deadlines are missed all too often.
"It breaks our heart each and every time we hear that," said Lynnette Ford, a GMHC official who works out of a Chelsea intake center.
Truvada costs about $13,000 a year; health insurance usually picks up the tab. In New York, Medicaid will pay. A generic version is sold overseas.
"This is a new option; we already know people aren't using condoms 100 percent of the time," said Kelsey Louie, GMHC chief executive.
Younger people -- especially men of color -- have the highest rates of contracting HIV, partly because they lack the caution of their elders, having grown up in an era when AIDS was treatable, not lethal.
"I want everybody here to think about who you're going to talk to this weekend about PREP," Louie said.
He was using the acronym for the daily therapy: pre-exposure prophylaxis. The emergency treatment is PEP, post exposure prophylaxis.