December 9, 2019

To the attention of Mark Zuckerberg, Chairman and CEO, Facebook:

As organizations attached to this letter — leaders in lesbian, gay, bisexual, transgender, and queer (LGBTQ) advocacy, public health, and HIV/AIDS prevention — we are urgently reaching out to Facebook and Instagram regarding factually inaccurate advertisements which suggest negative health effects of Truvada PrEP (Pre-Exposure Prophylaxis). The advertisements are targeting LGBTQ Facebook and Instagram users, and are causing significant harm to public health. The signers of this letter, including members of Facebook’s LGBTQ Network of Support, request that Facebook and Instagram remove the advertisements and also publicly address the misinformation that the platforms allowed to spread.

Using Facebook’s and Instagram’s targeted advertising programs, various law firms are attempting to recruit gay and bisexual men who use Truvada PrEP as an HIV preventative to join a lawsuit, claiming that the drug has caused harmful side effects in this patient population, specifically bone density and kidney issues. By focusing on “Truvada” and PrEP — rather than “Tenofovir Disoproxil Fumarate” (or TDF) and HIV positive individuals who use it as an antiviral — the law firms’ advertisements are scaring away at-risk HIV negative people from the leading drug that blocks HIV infections. This is despite numerous studies underscoring the safety of TDF in HIV-negative PrEP users.¹ 

Leading public health officials, medical professionals, and dedicated PrEP navigators and outreach coordinators have shared that these advertisements on Facebook and Instagram are being directly cited by at-risk community members expressing heightened fears about taking PrEP.

This issue goes beyond misinformation, as it puts real people’s lives in imminent danger. The U.S. Centers for Disease Control and Prevention reports that when taken daily, PrEP is highly effective for preventing HIV from sex or injection drug use. The CDC states: “Studies have shown that PrEP reduces the risk of getting HIV from sex by about 99% when taken daily.” The World Health Organization recommends that “people at substantial risk of HIV infection should be offered PrEP as an additional prevention choice, as part of comprehensive prevention.”

In response to a question from Congresswoman Alexandria Ocasio-Cortez during his testimony in front of the House Financial Services Committee on October 23, 2019, you, as CEO, explicitly stated: “If anyone, including a politician, is saying things […] that [are] calling for violence, or could risk imminent physical harm […] we will take that content down.”

By allowing these advertisements to persist on their platforms, Facebook and Instagram are convincing at-risk individuals to avoid PrEP, invariably leading to avoidable HIV infections. You are harming public health.  

LGBTQ and HIV prevention groups reached out to Facebook about this situation, giving Facebook’s Ad Policy department ample time and opportunity to address the harmful spread of misinformation about Truvada PrEP on Facebook. As directed by Facebook, community organizations also contacted third party fact checking agencies regarding the misinformation. Facebook’s Advertising Policy regarding misinformation in ads, however, states that: “Facebook prohibits ads that include claims debunked by third-party fact checkers or, in certain circumstances, claims debunked by organizations with particular expertise.”

We are the organizations with “particular expertise.”

Given the history of how our community was met by deadly indifference during the early years of the AIDS crisis, the refusal to take action is deeply concerning. Since a resolution was not reached, immediate action must be taken by Facebook to ameliorate the harm which has already been caused to those who may be seeking preventative treatment against HIV.

The co-signatories of this letter demand that:

• Facebook and Instagram immediately remove the advertisements outlined above that are harming public health.
• Facebook and Instagram be transparent with users and the LGBTQ community on their advertising policy around misinformation which states that “in certain circumstances” Facebook prohibits ads that include “claims debunked by organizations with particular expertise.”
• Facebook commits to a review and potential update of current advertising policies to prevent false or misleading public health statements from reaching users.

These concerns of the LGBTQ community, AIDS activists, and public health professionals need to be prioritized by Facebook, especially since lives and public health are at stake.

Signed,

ACT UP New York
AIDS Action Baltimore
AIDS Foundation of Chicago
AIDS Project Rhode Island
AIDS United
amfAR
Amida Care
APLA Health
AVAC
Black AIDS Institute
Cascade AIDS Project
Chicago Center for HIV Elimination
Community Research Initiative (CRI)
Desmond Tutu HIV Foundation (South Africa)
End AIDS Now
Esperanza Health Centers, Chicago
GLAAD
GMHC (Gay Men’s Health Crisis)
Health GAP
HealthHIV
HIV Dental Alliance
HIV Medicine Association
Housing Works
Howard Brown Health
Human Rights Campaign
JustUs Health
Latino Commission on AIDS
Let’s Kick ASS NY (AIDS Survivor Syndrome)
Mercy/Michael Reese Care Program, Chicago
NAM Aidsmap
NASTAD (National Alliance of State & Territorial AIDS Directors)
National Coalition for LGBT Health
National Coalition of STD Directors
National Working Positive Coalition
NMAC (National Minority AIDS Council)
Nyanza Reproductive Health Society (Kenya)
NYC’s LGBT Community Center
PrEP4All Collaboration
Prevention Access Campaign
Prism Health
Provident Hospital Prevention Program, Chicago
Rhode Island Public Health Institute
San Francisco AIDS Foundation
Sinai Infectious Disease Center, Chicago
Southern AIDS Coalition
Tennessee Association of People With AIDS
Tennessee Community Outreach Initiative
Test Positive Aware Network, Chicago
The American Academy of HIV Medicine
The SERO Project
The Trevor Project
Treatment Action Group
University of Chicago Medicine

(If your organization would like to sign on, or to receive more information, please contact [email protected])

¹

• Yacoub R, Nadkarni GN, Weikum D, et al. Elevations in Serum Creatinine With Tenofovir-Based HIV Pre-Exposure Prophylaxis: A Meta-Analysis of Randomized Placebo-Controlled Trials. J Acquir Immune Defic Syndr. 2016;71(4):e115–e118.
• Mills A, Workowski K, Campbell T, et al. DISCOVER Trial: Renal and Bone Safety Profile Data Among Participants Switching from Truvada to Descovy for HIV Pre-exposure Prophylaxis. Oral Abstract 1962. IDWeek 2019. October 5, 2019.
• Wohl D, Ruane P, Hosek S, et al. Bone Safety Outcomes with F/TAF vs. F/TDF for PrEP in the DISCOVER Trial. Abstract 1288. IDWeek 2019. October 4, 2019.