There's a Wonder Drug That Prevents HIV Infection. Why Haven't You Heard of It?

[n2doc]

Two weeks ago, when the Centers for Disease Control and Prevention issued its Mortality and Morbidity Weekly report, many outlets were quick to jump on one specific statistic: that unprotected anal sex among men is up nearly 20 percent from 2005 to 2011. In the New York Times, Donald McNeil said that the statistic was “spurring HIV fears” and was “heightening concerns among health officials worldwide.” In Slate, Mark Joseph Stern argued that the “case against barebacking with a non-monogamous partner remains as strong as ever,” and cited monogamy as "clearly the gold standard of sexual health.” And in The New Yorker, Michael Specter wrote, “If unprotected anal intercourse is rising among gay men, the rates of HIV infection will surely follow.” He concluded the piece by quoting Larry Kramer’s landmark 1983 New York Native article, “1112 and Counting”: “Our continued existence depends on just how angry you can get… Unless we fight for our lives we shall die.”

Reading these and other reactions to the report, one has to wonder if the mainstream media has developed an almost Pavlovian response to gay men's sexual habits. Certainly a rise in unprotected sex among men is cause for concern. But as the face of HIV and the AIDS epidemic changes, our responses to these statistics need to change as well, demonstrating the nuance and complexity necessary to reflect the current landscape. The conclusions above read much like they would have two decades ago: HIV infections are certain to rise. Young gay men don't get it, or don't care. Monogamy is the solution. People need to be scared into using condoms again.

And yet, not a single one of those articles mentions another aspect of the CDC report: PrEP, or Pre-Exposure Prophylaxis, arguably the biggest breakthrough in HIV prevention medication to come out in the last two years. Truvada, the first PrEP drug, was approved by the FDA last summer. When taken daily, it can prevent transmission of HIV 99 percent of the time if taken every day. Even if taken only four times a week, its effectiveness remains as high as 96 percent. One would think that a statistic like that would be widely reported and celebrated, and yet there are few people outside of the LGBT community who have even heard of PrEP.

It's easy to understand why PrEP hasn't been heavily publicized by certain institutions involved in HIV prevention. Thirty years into the epidemic, the CDC still says oral sex can result in the transmission of HIV, despite enough evidence showing that the risk is “extremely low.” The agencies play it safe, and PrEP opens them to another kind of risk. There is also the issue of adherence: People are not always good at sticking to a daily regimen of pills, and doctors worry that using Truvada on occasion, rather than as directed, might lead to the emergence of drug resistant strains.

more

http://www.newrepublic.com/article/115934/gay-men-having-more-unprotected-sex-truvada-has-changed-game

[uppityperson]

1. Thank you for this article. Here is more info on the drug, cost ($1200/month, ins may cover)

http://www.cdc.gov/hiv/prevention/research/prep/
http://www.healthline.com/health-slideshow/hiv-prevention-truvada

http://miamiherald.typepad.com/gaysouthflorida/2012/07/newly-approved-preventive-hiv-drug-truvada-costly-brings-own-risks.html

http://www.out.com/news-opinion/2013/09/09/hiv-prevention-new-condom-truvada-pill-prep

http://www.newyorker.com/online/blogs/elements/2013/10/the-battle-over-truvada-and-the-first-treatment-to-prevent-hiv.html

[XemaSab]

2. People who are too flaky to have protected sex

are too flaky to take a pill every day.

The only people I could see this working well for are hookers and pron stars.

[La Lioness Priyanka]

5. not necessarily. people may be drunk/high at night, but sober during the day

a lot of drugs change our impulse control/inhibition, which may lead to harmful behaviors. however, the same person can take a pill in the morning when not under the influence of alcohol/drugs

[XemaSab]

6. Planning to bareback in the first place is flaky

[La Lioness Priyanka]

7. no, it may not be. there are multiple reasons why people bareback and its not easily dismisse

as flakiness

1. The Boyfriend loophole
2. HIV being high in a community, already increased the chance of people in that community to encounter HIV
3. Internalized homophobia
4. Drugs/Alcohol
5. The feeling that HIV is inevitable as a gay man
6. Young people do flaky things all the time. We exist to protect them in some ways from themselves (like giving them more access to stuff that prevents them from dying later)

[XemaSab]

8. These are all failures of responsibility

n/t

[La Lioness Priyanka]

9. yes, but nothing to say they won't take medication.

oh and i forgot a very important thing: CONDOMS SUCK. most people who have sex with them acknowledge so.

i really think you are being way flippant about an issue that kills a large number of people in my community.

if you don't care about protecting young gay men why weigh in at all?

[XemaSab]

11. I care enough about gay people to say

ONLY DUMBASSES BAREBACK.

[La Lioness Priyanka]

15. LOL. so much privilege and so little knowledge. nt

[XemaSab]

16. Same goes for straights and lesbians

You fuck someone without "safer sex" practices, you're a moron.

For anal sex, "safer sex" means wearing a rubber or being LTR monogamous only when both people have been tested.

[La Lioness Priyanka]

19. except it's not the same, since straights dont have the same social stigmas. nt

[XemaSab]

20. As a straight woman, I have more skin in the game than you do

I think maybe you're the one asserting your privilege here.

[loli phabay]

14. this, condoms do suck, its one of the reasons people dont use them

also there are other reason that people dont use them. in the end it up to consenting adults to make the call.

[Yo_Mama]

17. You've got to wonder, don't you?

I do think it would work well for those in the sex trade.

What the studies have shown so far is that it will work well especially in combination with other preventive measures.
http://www.cdc.gov/hiv/prevention/research/prep/

But then, condoms work well too, if used consistently.

Truvada provided 44% additional protection:
http://www.cdc.gov/nchhstp/newsroom/iPrExMediaStatement.html

This approach is called pre-exposure prophylaxis, or PrEP; trial findings showed that a once-daily pill containing tenofovir plus emtricitabine (brand name Truvada®) was safe and provided an average of 44 percent (95% CI 15 to 63%) additional protection against HIV infection to men who have sex with men (MSM) and transgendered women who have sex with men, who also received a comprehensive package of prevention services. These services included use of condoms, monthly HIV testing, counseling, and management of other sexually transmitted infections. The level of protection shown varied widely depending on how consistently participants used PrEP. Among those whose data (based on self-reports, bottles dispensed, and pill counts) indicate use on 90 percent or more days, HIV risk was reduced by roughly 73 percent (95% CI 41 to 88%), while among those whose adherence by the same measure was less than 90 percent, HIV risk was reduced by only about 21 percent (95% CI, from a 52% reduction to a 31% increase).

It has been shown to be pretty safe, which is important.

[FreakinDJ]

3. It will make want to run out and have Gay Sex

We had to keep it secret to protect the Christian Youth

[KurtNYC]

4. If you believe the stat that PrEP is 99% effective then the word "unprotected" seems misapplied.

If a condom equals "protection" then a pill with 99% effectiveness should also. No?

[Yo_Mama]

18. It's not

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6003a1.htm?s_cid=mm6003a1_w

If you read through that, it works quite well for those who actually stick to the regimen plus go through the rest of the risk-modification protocol. This is a very good finding, but the risk reduction for those who did stick to the regimen also came from behavioral modification.

Participants in both arms reported lower total numbers of sex partners with whom the participants had receptive anal intercourse and higher percentages of partners who used condoms than reported at baseline.

There is no one magic silver bullet, although this is a very good for mixed couples and for those who are going to have a lot of unprotected sex or just a whole lot of sex.

Here's a statement about it:
http://www.cdc.gov/nchhstp/newsroom/iPrExMediaStatement.html

Condoms protect against a whole range of infections, and only regular testing for STDs and intensive treatment of those other infections really lowers the risk of HIV transmission. So condoms have a dual protection built in. But they have failures too, and then there will always be some times when they aren't used.

Also, the guidances that have been issued on Truvada stress that regular testing is necessary, and there have been indications that usage of Truvada in those already infected with HIV can lead to drug resistance, so the CDC has told doctors that it should only be responsibly used in combination with regular testing.

PrEP should only be used among individuals who have been confirmed to be HIV-negative. Initial and regular HIV testing are critical for anyone considering using PrEP. All individuals considering PrEP must also be evaluated for other health conditions that may impact PrEP use.
PrEP should never be seen as the first line of defense against HIV. It has only been found to be partially effective when provided in combination with regular HIV testing, condoms, and other proven prevention methods. PrEP does not protect against other sexually transmitted infections. Men who have sex with men should continue to:
Use condoms consistently and correctly
Get tested to know their HIV status and that of their partner(s)
Get tested – and treated if needed – for other sexually transmitted infections that can facilitate HIV transmission, such as syphilis and gonorrhea
Get information and support to reduce drug use and risky sexual behavior
Reduce their number of sexual partners

Taking PrEP daily is critical. This study found that PrEP provided a high level of protection only to those who took the pills regularly; protection was very low among those who did not rigorously adhere to the daily regimen.
PrEP must be obtained from and used in close collaboration with health care providers to ensure regular HIV testing, risk reduction and adherence counseling, and careful safety monitoring.

Patients who are heavy drug users may have low creatine clearance, and Truvada is not indicated for those individuals, because it can kill them.

[sibelian]

10. Because if straights don't get to fuck around they're DAMNED if the gays get to, the selfish little

insert expletive here.

[Ian David]

12. If compliance is such an issue, then why not make it in the form of a skin implant? n/t

[darkangel218]

13. Truvada can have quiet few side effects:

http://www.rxlist.com/truvada-side-effects-drug-center.htm

This medication may cause lactic acidosis (a build-up of lactic acid in the body, which can be fatal). Lactic acidosis can start slowly and get worse over time. Get emergency medical help if you have even mild symptoms of lactic acidosis, such as:

muscle pain or weakness;
numb or cold feeling in your arms and legs;
trouble breathing;
feeling dizzy, light-headed, tired, or very weak;
stomach pain, nausea with vomiting; or
fast or uneven heart rate.
Call your doctor at once if you have any of these other serious side effects:

signs of liver damage - nausea, stomach pain, low fever, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);
increased thirst, urinating more or less than usual or not at all;
swelling, rapid weight gain, feeling short of breath; or
signs of infection such as fever, chills, skin lesions, or cough with yellow or green mucus.
Less serious side effects may include:
diarrhea, mild nausea;
headache, tired feeling;
dizziness, depressed mood;
sleep problems (insomnia), strange dreams;
mild itching or skin rash;
runny or stuffy nose, cough; or
changes in the shape or location of body fat (especially in your arms, legs, face, neck, breasts, and waist