San Francisco Supervisor Scott Wiener on Wednesday became what appears to be the first public figure in the country to disclose that he's taking a drug that prevents HIV infection - a pill that public health officials said could save lives but has remained largely unused due to stigma and lack of awareness.

Wiener's announcement is significant because so few people have been willing to talk openly about their use of Truvada, a drug that's been weighed down by controversy. He said he hopes his revelation will lift some of the stigma associated with Truvada and encourage more men to consider taking it.

Critics have suggested that taking the daily pill could make people more likely to engage in unsafe sex, but that claim hasn't been backed up by research. Still, the idea has persisted, and people have been slow to embrace a drug that public health officials believe could be key to stopping, or significantly slowing down, the spread of HIV.

Wiener's disclosure, which he made in an online essay published Wednesday evening, comes as San Francisco pushes an aggressive campaign to persuade more gay men to take the drug, which is referred to as PrEP, for pre-exposure prophylaxis. Truvada, an antiviral drug that has been used to treat HIV infection for more than a decade, is the only pill approved for prevention.

At a meeting Thursday, Supervisor David Campos is expected to discuss a new initiative to make Truvada more accessible in San Francisco and distribute it to any resident who needs it. The initiative includes a plan to help pay for the drug for residents who can't afford it. Truvada can cost up to $14,000 a year, although it's covered by most insurance plans, and the drugmaker will help with the cost for people who need financial help.

San Francisco city and public health officials said they want to make the drug more accessible, and also normalize it. Wiener said that was his motivation in going public.

'Elevate awareness'

"People need to feel comfortable talking about these issues and not think they're going to be stigmatized or denigrated if they talk about using it," Wiener said. "My hope is that talking about it will elevate awareness about PrEP as an available and powerful prevention tool."

Truvada, which is made by Gilead Sciences in Foster City, is a single tablet that combines the drugs emtricitabine and tenofovir disoproxil fumarate. If taken daily, it can cut the risk of HIV infection by more than 90 percent.

The drug primarily has been tested in men who have sex with men, which is why they're the focus of efforts to increase use of PrEP, although it appears to also be effective for women and transgender men and women.

Most people report no side effects from the drug, and about 10 percent of users say they have some gastrointestinal discomfort for the first few weeks after starting. A smaller percentage of users can suffer more serious signs of drug toxicity and will need to stop taking the drug.

The drug has been widely discussed among health care providers and in the gay community for several years - even before it won FDA approval - but even in San Francisco, where much of the initial research was done, the pill has been slow to gain acceptance. Nationwide, only about 2,000 people are taking PrEP.

"Nationally, we all - health departments and community groups - need to speed this up, because we could be preventing a lot of infections," said Dan Van Gorder, executive director of Project Inform, an HIV patient treatment and information advocacy organization.

The slow acceptance of the drug has been due somewhat to the stigma, which is widespread but has dimmed in recent months. But another major barrier comes from doctors, many of whom have been reluctant to prescribe it, especially if they don't regularly treat HIV-positive patients and aren't familiar with Truvada.

Increase accessibility

That's where San Francisco can improve access to the drug, public health and city officials said. Thursday's city meeting, organized by Campos, is focused on the idea of ensuring the that drug is easily available to anyone who is interested in it, regardless of their ability to afford it or find a doctor who will prescribe it.

"The issues we face are in getting what we know is a very effective HIV-prevention tool into the hands of people who need it," said Dr. Susan Philip, director of the STD Prevention and Control Services Section of the San Francisco Department of Public Health. "We've always believed in PrEP as an intervention. Now we're figuring out how to help with delivery."

Wiener said he was slow to come around to PrEP, even after he'd seen the initial reports about how effective it could be. Like many other men, he wasn't convinced at first that he was the right target for the drug.

"A lot of us in the past had stereotypes about who should be using PrEP - that PrEP was for sex workers and porn actors and people who hated using condoms. But really prep is much broader than that," Wiener said.

Now, he said, he likens the drug to the birth control pill - it's just another option for practicing safe sex.

"There are some people who are convinced PrEP is going to make people reckless, but that's a bogus argument. It's the same argument we've heard around birth control, and it's very antipublic health," Wiener said. "There's always a lot of judgment around sex.

"There are downsides to being public about my sexual health," Wiener said, adding that the most awkward drawback so far has been telling his mom he was taking PrEP. "Ultimately, I decided that this could play a positive role in moving the dialogue forward and increasing awareness."