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Last month the big news in the battle against HIV was that the FDA had approved the drug Truvada for use by HIV-negative people engaged in high-risk behavior, as a means to prevent infection.
The announcement was met with enthusiasm by the LGBT media and many AIDS advocates and health-care workers, who saw it as a vital tool in keeping people from seroconverting. But as prescriptions start to be written for perfectly healthy gay men, we have to wonder: is this a good idea?
First there’s the psychological hurdle: The idea is that someone who engages in high-risk behavior, like bareback sex, can keep from acquiring HIV by taking Truvada daily. (It’s called PrEP, or pre-exposure prophylaxis.)
But if someone can’t be relied on to use condoms regularly, can they be relied on to take a pill every single day for the rest of their sex lives? Even if they can, how would a potential sex partner know who was actually on PrEP and who was just claiming to be?
Then there’s the scientific concern: We’re seeing strains of gonorrhea that are resistant to almost all forms of antibiotics, in part because of how frequently such drugs are given to people for a host of maladies. And we know HIV is a wily virus—is it too far-fetched to think PrEP might help facilitate a Truvada-resistant strain of HIV?
There’s a host of other concerns. As Lawrence Ferber explains in Next magazine:
According to several clinical trials, Truvada’s success in reducing infections has varied widely between 42%–84% percent. That’s far from 100%. The cost of the medication itself is substantial, ringing in at as much as $16,000 per year, while bimonthly doctor’s office visits and blood work to monitor kidney and liver function are also required.
As with all HIV medications, PrEP can also take a heavy toll on the body in immediate unpleasant side effects (nausea, bloating and abdominal pain, headaches, dizziness) and serious long-term ones (liver and kidney problems/failure, fat redistribution, loss in bone density).
And obviously, Truvada won’t protect you from any of the other STIs that are out there.
We’re uncomfortable with the idea of keeping a medication that could save lives out of the hands of people who need it the most. But will Truvada or other PrEP medications make those who take them think they have carte blanche to have unsafe sex? Should Truvada only be given to people in serodiscordant relationships?
Or should every tool we have at our disposal in the fight against HIV/AIDS be fully available to any who need it?
We have our opinion, but we want to know what you think. Share your thoughts—and experiences—in the comment section.