The FDA has approved Truvada, an HIV treatment medication, to be taken by uninfected people as a pre-exposure prophylaxis, or "PrEP" -- that is, to protect against HIV. The PrEP drug is intended for those individuals who engage in high-risk sexual behavior and is prescribed to be used in conjunction with safe sex practices. So are these "high-risk" folks actually using the drug as the doctor prescribed?
Two studies were conducted with Truvada as PrEP. In the iPrEx study of 2,499 HIV-negative men and transgender women who have high-risk sex with men, those who took Truvada had 42-percent fewer HIV infections than those who did not. There was no evidence that taking Truvada increased unsafe sex, although study participants did not know for sure whether they were getting Truvada or an inactive placebo. The Partners PrEP study enrolled 4,758 heterosexual couples in which one member was infected with HIV and one was not. Truvada reduced the risk of HIV infection by 75 percent.
If a couple is in a relationship where one is HIV-positive and one is HIV-negative, then this just might be the right answer for them. Taking Truvada will decrease the risk of infection as well as decrease the intensity of the stress caused by the fear of infecting your partner. It's also important to state that infection is much less likely to occur if the HIV-positive partner is on a regime of antiretroviral therapy and has a undetectable viral level of the HIV strain. When used responsibly, and for the right reasons, this PrEP makes sense.
So who's getting Truvada prescribed? Here's my issue. In my experience, it seems that a good number of those running to get the prescription are gay men who prefer to engage in unsafe practices. Some will argue that regardless of Truvada, such men will continue to have unsafe (including bareback) sex, and that taking this pill will help decrease their chances of being infected. So instead of educating and promoting safe sex practices, the FDA is encouraging the continuation of unsafe sex and most likely contributing to the spread of other sexually transmitted infections.
Figures like 44 percent and 75 percent just don't convince me that using Truvada and having bareback sex is worth the risk. I think these are amazing studies that will hopefully lead the way to more discoveries about HIV prevention, and hopefully they will charge forward to an eradication of the disease. For legit couples who are in monogamous relationships, this might be something to consider. But for men who engage in unsafe sex with other men, this is just an excuse to continue to be irresponsible.
I'm not a prude. I enjoy sex just as much as anyone else. I just personally enjoy sex more when I know that I am doing everything to prevent myself from ending up with a sexually transmitted infection. Having a "there's a pill for that" attitude is absolutely disgusting. Don't get me wrong: Thank goodness for the free clinic or the neighborhood pharmacy that will prescribe whatever lotion or pill or ointment you need to get rid of whatever you picked up from that random stranger, but HIV is not a "whatever." Instead, it's something that has lifelong consequences, and I sincerely hope that Truvada PrEP is not encouraging the "there's a pill for that" attitude.
Gay youth are not as afraid of HIV as many of us were in the past. That's a good thing. HIV is not a death sentence anymore, and the stigma surrounding HIV has declined, as it should. But having unprotected sex and willingly taking that risk because you're on an easy, preemptive treatment regime is just plain stupid.
So is PrEP actually helping reduce the spread of HIV, or is it just opening the doors for others to engage in risky behavior? Again, this potentially works for committed couples, sex workers or drug addicts who remember to take the pill daily, but for gay men who just like bareback sex, Truvada is just an excuse to do what they want to do.
UPDATE: The reason I write these controversial pieces is not only to engage my community and start a conversation but to learn. After this article was published, I was alerted that the figures I provided regarding Truvada's efficacy do not tell the whole story. Dr. Robert M. Grant, a UCSF professor and researcher with the Gladstone Institute of Virology and Immunology and the lead researcher on the iPrEX study, has informed me that among the participants in that study who consistently took Truvada, the risk of HIV was reduced by more than 90 percent (99 percent among those whose blood samples showed drug concentrations consistent with daily use). Among those who were offered Truvada but elected not to take it, there was no reduction in risk. The 42-percent estimate of efficacy that I gave above is the average of the 90-plus-percent benefit among those who took Truvada and the 0-percent benefit among those who did not.