It was once unimaginable: taking a pill once a day that could prevent you from getting HIV. If gay men had heard of it a decade ago there would have been jubilant dancing in the streets. It would have been a freaking miracle.
That miracle is now a reality. It is known as pre-exposure prophylaxis (PrEP), and it comes in the form of a little blue pill called Truvada. It can literally save your life, blocking the transmission of HIV from 90 to 100 percent of the time. Combined with other prevention practices–condoms, serosorting–it has the potential to cute the rate of transmission dramatically. So where’s the dancing?
Instead, there are a few outspoken PrEP critics making all kinds of noise, including iconic AIDS activist Larry Kramer, who called those taking PrEP “cowards” for not using condoms, and AIDS Healthcare Foundation head Michael Weinstein, who referred to PrEP as a “party drug.” In both cases, their level of discourse says as much about them — and their long AIDS history rooted in fear tactics and grief — as it does about this modern medical strategy rooted in research and science.
Somewhere along the last thirty years, the heartache of dealing with HIV has jaded us to good news. We’ve had our hopes raised and then dashed by promising developments many times before. But whatever our hesitations, they do not lessen the very real facts about PrEP.
So let’s take a moment to list ten reasons for a little dancing…
1. PrEP works
In study after study of thousands of couples who did not use condoms consistently and one of them was HIV positive, PrEP has been shown to reduce HIV infection by rates of 90% and above. Ignore the naysayers who use smaller efficacy figures; they are using data that included people in the study who chose not to take the drug at all. Most research has put PrEP efficacy at the same rate or higher them condoms, and one National Institutes of Health (NIH) study found it to be 99% effective when taken every day.
Consider that figure for a moment: 99% effective. When it comes to 50,000 new infections in America per year, mostly among gay men, that figure could mean the end of the epidemic as we now suffer it. But even if it turns out to be closer to 90 percent, how can that not be a huge step forward for the community as a whole.
When was the last time you were in the heat of the moment and couldn’t find a condom? How about the withering effects of a rubber once you got it on? Those are dangerous scenarios that are the perfect environment for HIV infection. Now imagine taking a pill each morning, when sex isn’t even on your mind. Yes, the pill should be taken each and every day for maximum protection. The benefits are worth it.
The Centers for Disease Control (CDC) has stated that inconsistent condom use is as dangerous as never using one at all. Sooner or later, the odds catch up with you. If you are not using a condom each and every time you have sex, why not consider an additional level of protection? There’s little to lose and lots to gain.
3. PrEP protects us all, regardless of how promiscuous you are (or are not)
Much has been said about PrEP giving license for people to become barebacking sluts. The fact is, most HIV infections occur within a “primary relationship,” meaning a lover or regular fuck buddy. New infections generally are not the result of guys gone wild (although there’s plenty of examples of that, too). They often occur among trusting people or simply by accident. And don’t people in positive/negative relationships deserve some additional piece of mind? God forbid monogamous couples might want to enjoy sex without a barrier between them.
Most HIV infections are the result of a singular event. Someone got drunk or trusted the wrong person or fell in love or said yes when they should have said no. We’re human, we make mistakes, we are afraid of rejection. These are factors that confound the message of “use a condom every time,” or else everyone would.
And you might be at greater risk yourself than you believe. In a recent British survey of sexually active gay men about their sex lives and whether PrEP might be right for them, the vast majority of those surveyed met the criteria for PrEP use (80%), based on their reported risk behaviors. Surprisingly, an almost equal number (78%) did not believe their risk to be high enough to warrant using the drug. That disconnect between real and perceived risk is the perfect scenario for HIV infection.
Meaning, a lot more gay men are candidates for PrEP than realize it. When we limit those at risk for HIV to people we consider sluts, we might be ignoring our own vulnerabilities. Take a hard look at your actual sexual repertoire and ask yourself: Do you always know your partner well? Do you sometimes forgo a condom, top or bottom? Honest answers might help you think twice about rejecting PrEP.
4. We’ve been down this road before
Fifty years ago, a different medication was approved. It caused an uproar because people thought it would lead to casual sex galore. But women taking The Pill have long since proven they can protect themselves from pregnancy and not become whores in the process.
By the way, there were plenty of people who railed against The Pill half a century ago because they thought it was too expensive or not studied enough or believed women should just always make their partners use condoms (as if they had that ability). Sound familiar? No wonder half of the initial prescriptions for PrEP were written for women. We might learn something from their willingness to take control of their own bodies.
Speaking of control, PrEP offers the ability to for you to take charge of your own protection without relying on your partner to know their status or use a condom every time.
6. This isn’t as simple as a battle between condoms and PrEP
Feeling threatened that PrEP equates to men throwing out condoms is a false argument. People choose to use condoms now or they don’t. A Truvada prescription doesn’t really change that equation.
We are dealing with a gay population in which condoms are not used consistently among more than half of us. This figure has remained virtually unchanged since condom use among gay men started being measured in the 1980’s. PrEP didn’t create this situation. But it sure can help it.
Fortunately, many of us do use condoms each and every time. For those of us who do, PrEP may not be warranted. That’s great. But simply dismissing men who don’t always use condoms as sluts doesn’t do much to solve the problem. If you think they deserve to be infected because of their condom habits and deny them a new tool to prevent it, you really should check yourself. We can use every tool available to prevent 50,000 new infections every year, or we can have a useless moral debate.
7. Truvada has shown few serious side effects.
Truvada has been used by people living with HIV for many years and has a favorable safety and side effect profile. That’s exactly why it was the first drug chosen for clinical testing for PrEP. Although we can’t say what the long term effects might be for people who are negative, it is believed that they may tolerate it very well over the long term because their bodies are not also fighting HIV. Very few side effects have been reported among HIV negative men using Truvada as PrEP. Obviously, one would rather not take the medicine, all things being equal. But when considering side effects, you also have to consider the alternative in many cases: Treating HIV with Truvada.
8. PrEP has become much more affordable for most gay men.
Insurance companies have woken up to the financial advantages of PrEP and are covering it in most plans (although it sometimes takes coaxing from your physician to point out the benefits). Gilead, the maker of Truvada, also has a fairly generous patient assistance program to cover co-payment or for those who are uninsured. Virtually everyone has access who wants it.
Of course, this does not account for those who do not have access to health care at all, which often includes young gay black men, one of the most vulnerable segment of our community. Check out the new video below produced by the National Minority AIDS Council, which focuses on young gay men of color and their attitudes around PrEP.
9. If you’re considering PrEP you are in very good company
The World Health Organization (WHO) has endorsed the use of PrEP. They join a growing chorus of advocates and agencies, including the CDC, the NIH, the New York City mayor (who included the widespread use of PrEP in his call for an end to AIDS), ACT UP, and virtually every major AIDS service organization in the United States. Informational sites about PrEP are springing up everywhere, but our favorite and most comprehensive is PrEPWatch.
10. Like it or not, we’re all in this together
Okay, so maybe taking a medication that is also used by your HIV positive friends may not make us all soul brothers. But there is something mutually supportive about negative men stepping up and choosing to do everything in their power to remain that way.
These facts about PrEP often unleash a torrent of anger from those who think we should all just use condoms, every single time, period (gay men have been suddenly seized by the woeful spirit of the moral majority for some odd reason). We wish more guys would use condoms consistently, too. But wishing is not a very dependable HIV prevention strategy.
If there’s one thing we have learned from years of dealing with the virus, it’s that when we argue over what people “should” be doing, the only thing that wins that argument is HIV.