Bottles of antiretroviral drug Truvada are displayed at Jack's Pharmacy on November 23, 2010 in San Anselmo, California. A study published by the New England Journal of Medicine showed that men who took the daily antiretroviral pill Truvada significantly reduced their risk of contracting HIV. (Photo Illustration by Justin Sullivan/Getty Images)
One of the newest strategies to prevent the spread of the HIV virus, pre-exposure prophylaxis (PrEP), has rapidly become one of the most talked about developments in public health. It’s also generated strong opinions among supporters and opponents of the strategy.
PrEP is a once-a-day pill, the HIV drug Truvada, manufactured by Gilead Sciences. When combined with regular condom use, the two strategies almost completely eliminate the chance someone will become infected with HIV.
Last May, the Centers for Disease Control (CDC) issued new federal guidelines urging physicians to recommend PrEP for their patients “who are HIV-negative and at substantial risk for HIV.” The CEO of the Los Angeles LGBT Center wrote a column for a fall newsletter exploring the issue. Last weekend, the Human Rights Campaign endorsed PrEP as part of a “comprehensive preventative care regimen.”
The concept of PReP has its critics. The president of a global HIV/AIDS nonprofit agency referred to Truvada in an AP interview as a “party drug” amid claims it would encourage sex without condoms. Research seems to say no, but a better question is: who does PrEP benefit?
You can talk about PrEP in a clinical sense, but it’s different hearing from a couple who use it daily. I spoke with George and Steve, a gay male couple in the Dallas area (their names have been changed to maintain the couple’s privacy). They have been together for more than two years, and work for the same major Dallas employer. George was diagnosed HIV-positive in 2010, and Steve has been on PrEP since this spring. Serodiscordant couples, or couples where one partner is HIV-positive and one HIV-negative, are among the specific groups the CDC encourages the use of PrEP, as are transgender women and African-American men who have sex with men.
Initially, when Steve approached his healthcare provider about PrEP, he discovered the doctor knew nothing about it. The San Francisco AIDS Foundation, which maintains the PrEP Facts website, says that lack of knowledge means patients may have to directly advocate for the protocol.
“It took me going back to my old physician’s PA. She knew what it was, asked me two questions and looked over my blood work,” Steve says. “She immediately said that I was a good candidate for PReP because [I am] in a relationship with someone who is HIV-positive.”
Steve’s biggest issue is how PReP is portrayed within the community. Many couples do not even consider it as an option, he says.
“You have people who don’t go out to the bars who are in a monogamous relationship, one being positive one being negative, who think [PReP] isn’t for me,” he says. “If your partner is HIV-positive, you can get HIV from your partner and PrEP is a way to prevent that.”
George says that perceived issues of toxicity and stigma contribute to misinformation about PrEP.
“Truvada is most frequently taken by people who are HIV-positive. [For the single person] you wonder, ‘Should I ask what their status is?’ I think that has nothing to do with PrEP whatsoever. I think it’s the ability and freedom to ask…most people in that conversation feel like they are being put on a witness stand and that ends up fueling stigma. I don’t understand how, in a circumstance where you’re single or not, that PrEP is not an option to you,” he says.
Cost has been cited as one reason for the skepticism over PrEP. Truvada costs about $1,300 a month. Steve uses a payment assistance program through Gilead to eliminate the prescription co-payment. George thinks that it may take the release of a second drug that can be used in PrEP therapy to change people’s minds.
“We are a country of options…you end up having the same conversations about medicine that HIV-positive people do,” George says. “As long as there is only one drug, it is a complete and utter target for every single thing people can say about it.”
George added that treatment adherence – hammered home in websites and news articles on PrEP — is key to its effectiveness.
“If you don’t take it every day and you’re not very religious about it, you’re not 100 percent protected. We are still in a sex crisis much as we were in 1984, except we have more tools to fight it, and I think that’s the problem,” he says.
For this couple, adherence is a family affair. Steve takes his PrEP when George takes his daily HIV medicine. Steve goes to his doctor regularly to make sure he’s not having any interactions from the drug, and so far hasn’t reported any side effects.
PrEP is not a one-size-fits-all solution to limiting HIV’s spread. But both Steve and George say the first step is reading up on the protocol and talking with your healthcare provider.
Steve summed it up this way: “We’ve become a health conscious society when it comes to looking out for our own bodies. If you are out there having unprotected sex, then this is something you really need to consider because it does work.”
Rafael McDonnell is communications and advocacy manager for Resource Center. An award-winning former broadcast journalist, he is a native of and lives in Fort Worth.
Editor’s note: Resource Center previously received donations from Gilead Science, but has not since 2007.