Is It Finally Time To Admit That PrEP Has To Be Part Of HIV Prevention?

A new study shows once again that giving people at high-risk for HIV an antiretroviral pill daily cuts their risk of contracting the virus dramatically. In this case, a study of 2,400 Thai drug users over a five-year period found that giving them a once-a-day dose of a tenofovir (marketed in the U.S. as Truvada) cut their chances of becoming HIV positive by 49%.

The study is just the latest in a strong line that shows that the treatment, known as pre-exposure prophylaxis, or PrEP, is a potentially potent weapon in the arsenal of HIV prevention. Previous studies were conducted among gay and bisexual men, heterosexuals, and mothers and children.

“This is an exciting day,” Dr. Jonathan Mermin, director of H.I.V. prevention for the Centers for Disease Control and Prevention in Atlanta told The New York Times. “This culminates a decade of PrEP research.”

The question now is: do pills now become a standard part of HIV prevention strategies? Given the outcomes of the PrEP studies, it’s hard to argue against tenofivir. But, as with all things HIV, the answer may not be that easy. Among the issues that have to be considered:

  • How does PrEP fit with existing prevention tactics, like condoms and needle exchanges?
  • How well will patients adhere to the once-a-day regimen?
  • Will certain sub-populations be more open to a pill than others?
  • Will the cost of treatment crowd out government spending on other prevention methods?
  • How can providers ensure that patients don’t see tenofovir as a guarantee against infection?

One thing is clear: tenofovir opens new possibilities for HIV prevention. In that sense, the questions are a nice problem to have.

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  • Rob Moore

    My first impulse is to “yes, what are we waiting on.” Then, I think about drug resistance. If some people take it oonly when they think of it, some will get infected then take the drugs only occasionally leading to resistant strains. I don’t know whether it is a good strategy to risk creating strains that cannot be treated in the future. This is one disease thatneeds to be ccured whilst simultaneously finding vaccines.

  • Homophile

    Great I can take this and bareback all the time now.


  • hyhybt

    Another consideration: the expense and side effects are not going to be negligible. How do you go about determining how high a risk makes it worthwhile?

  • stfallon1028

    What they fail to mention is how Truvada leaves one feeling constantly nauseous, lethargic, and bloated, while giving you just about the worst nightmares conceivable without taking LSD. And I say that as someone who had one ‘slip up’ and was immediately prescribed this by my MD in NY’s West Village. It’s not a miracle pill by any means. Responsibility in one’s sexual adventures remains what has to come first

  • MikeE

    @stfallon1028: most of those side-effects actually go away after a relatively short while. however, there are long-term side-effects that should be a serious consideration.

  • miagoodguy

    How about you avoid high risk activities?

  • Tommysole

    I take this medication and sustiva because I have to. I have been poz for 20 years, I wish I wasnt but these things happen.
    Now, people are so nonchalant about bare backing and not caring if they contract the virus. It is really frightening.
    Now there is hep c and the drug resistant VD and other things out there that can be a real pain in the ass and life threatening.


  • the other Greg

    Is it finally time to admit that the Gilead pharmasceutical company has some clever advertisers and lobbyists?

    “Will the cost of treatment crowd out government spending on other prevention methods?” YES!

  • Chad

    Just to clear up a couple terminology things. Tenofovir is not Truvada. Tenofovir is Viread. Tenofovir is a component of Truvada along with Emtricitabine. No studies have proven that Tenofovir alone will result in positive outcomes.

  • Jeton Ademaj

    it’s amazing how an HIV-prevention modality be subject to so much disinformation. Truvada as PrEP works fantastically if you take it as directed…FAR BETTER than condoms. the IPREX study found 92% reduction in HIV risk when the drug was taken literally HALF the time…aka 50% adherence. taken 6 days out of 7, the protection rises above 98%, and when taken with elite adherence (95% adherence), the protection is well over 99+%.

    i have seen this before: in the early 90’s when NYC’s Catholic League took out ads on the subway claiming “condoms don’t work” in big bold letters. NOT “condoms don’t ALWAYS work” (which is true), but that they dont work AT ALL (a huge lie).

    i must have torn down literally 500 or so such ads, walking from one end of an IND subway train to the other, and i bet im partly responsible for the changes to ads the MTA made to make them less vulnerable to vandalism.

    just like then, time to tear down the liars and blowhards attacking HIV Prevention because they dont like “the message it sends”.

    the message is simple: WE HAVE A RIGHT TO HAVE SEX WITHOUT GETTING HIV. if you feel differently, shoot yourself dead now please.

    yes, that includes REAL sex, and not just RUBBER sex…if you really hate PrEP, try inventing a better condom n stop pretending condoms dont suck as badly as they do.


  • hyhybt

    @Jeton Ademaj: The thing is, biology doesn’t recognize that right. Medicine is working on the problem, and this looks like a great development, but practically speaking, a right not to catch a disease is impossible to implement.

  • Jeton Ademaj

    @hyhybt: well, you’re parsing words when the clear statement i was making was in regards to those who attack PrEP in the belief that it lessens the perceived imperative for condom use, given the fact that **consistent use of PrEP is far more protective than consistent use of condoms, which don’t offer more than 70% protection at best…compared to over 99% protection for fully-adherent PrEP.**

  • hyhybt

    @Jeton Ademaj: That is indeed PART of what you said. I was addressing the other part.

    (And of course I was parsing words. That’s the process EVERYBODY uses to extract their meaning. It’s a truly bizarre complaint to make that someone actually read and understood your post.)

  • Jeton Ademaj

    @hyhybt: are you seriously trying to lecture about the ruthlessness of nature and the fact that viruses don’t care about human rights, perceived or otherwise?

    thanks. i thought maybe the HIV viral population would read my words online and collectively decide to depart all of its human hosts.

    for more sensible readers: my point is that we must start from the perspective that our sexuality is worth defending from risk, not simply retreating from it and abandoning our sexuality…gay men no longer have to face a permanently limited sexuality to avoid infection.

    THAT point will not be obfuscated by some online nitpicking.

  • hyhybt

    @Jeton Ademaj: Of course not. I typed two sentences. That doesn’t qualify as lecturing by any rational stretch of the imagination, even if the second one was a bit long.

  • the other Greg

    @Jeton Ademaj: If you’re a millionaire and have a spare $1300+ per month to throw around on Truvada just so you can get your dick sh1tty, I mean have “REAL SEX” – by all means, go ahead, nobody is stopping you. It is now an option. I’m sure you can get some doctor who’s in Gilead’s pocket to sign off on it.

    As a practical matter we are discussing whether taxpayers should pay for self-indulgent freaks like you to do that. And the answer is, no, go fuck yourself. (Safe sex, btw!) Now run along and call your meth dealer.

  • the other Greg

    These arch, prissy pseudo-definitions like “high-risk” “sub-populations”: what does that really MEAN?

    With MSM, I can only think of two:

    1) Hustlers who bottom a lot. A minuscule, but probably fairly responsible sub-population that may actually take the med as directed.

    2) “P&P” meth heads. Good luck getting them to take the med as required, even if it’s once a day. They don’t know what day it is for days at a time, or even whether it’s daytime or night.

  • Jeton Ademaj

    @the other Greg: i appreciate your ability to pack so much bullshit into such a short post. Insurers like Aetna and others have stepped up to pay for PrEP, bcuz insurers dont give a flying fuck about your social biases or emotional freak outs…they look at cost/benefit, every time.

    PrEP is FDA approved, and cheaper than full-on HIV care…much cheaper. My care is far more expensive, and i’m delighted to rub it in your face. your attempt at sanctimony is one long, endless fail.

    no meth for me, thanks…i’m a Marinol guy. perhaps you should try rehab.

    consistent use of PrEP works FAR better than consistent use of condoms, bottom line.

  • Jeton Ademaj

    @the other Greg: try not to think, it gets you in trouble. try not to act either. in fact, there must be a hole or burrow you could go sleep in…find it.

  • hyhybt

    @Jeton Ademaj: It’s not an either-or thing, though, and condoms help stoo other diseases too.

  • Jeton Ademaj

    @hyhybt: indeed they do. condoms are an excellent tool…for those who will use them. MOST people either dislike or despise them, however. there is no agit-prop, sisboombah, stern lecture or sarcastic bile that can change that…

    …but some well-funded and open-minded product engineering might. i’m delighted the Gates Foundation decided to take on funding radically better condom design, and horrified it took so long for anyone to offer such funding.

    the sad venom of “the other greg” here is a fine example of the kind of Prevention Messaging that has FAAAAAIIIILLLLLEEEDDDD, utterly. of course, guys like him (millions of them) are not actually trying to help anything but the imperatives of their own very damaged psyches.

  • the other Greg

    @Jeton Ademaj: Sorry, I guessed your situation wrong. I’d thought your real problem wasn’t that condoms supposedly ”suck,” it was that you were whining to your prospective sex partners that condoms suck, but they didn’t buy it and they still wanted you to put one on.

    Now you imply you’re poz – “My care is far more expensive” – and apparently you blame that on the lack of a PrEP option in the past (i.e. you didn’t care about condoms when you bottomed). So why is your care “far more expensive” now when Truvada is a once-a-day pill? You’re throwing around a lot of statistics without any cites. I’ve never heard before, for instance that condoms are only “70%” effective – are you just making this stuff up or what?

    The main drawback of being HIV-positive in the “developed world” is the meds themselves: their insane cost, the sickening side effects, the weird long-term side effects like lipodystrophy etc caused not by the virus but by the meds themselves. Now, kids, you can have all this without even being HIV-positive! Seriously, this is a “breakthrough”? That’s kind of like achieving a 100% reduction in testicular cancer by cutting everyone’s balls off before they can get cancer.

    Yeah, yeah, PrEP is now an option for the kind of guys who would probably get HIV anyway – which is fine with me, really it is, I’m just pointing out that the result is they will now be on the exact same meds that poz guys are, with most of the same problems. What’s the point of all this circular logic, besides the obvious point of making money for Gilead?

  • the other Greg

    @Jeton Ademaj: Really, do “MOST” people either dislike or despise condoms? That’s ridiculous. I’d guess it’s more likely that “most” gay men don’t even engage in anal sex, at all, but I don’t know where there’s a survey on that.

    You seem to be making up creative “statistics” based purely on your personal experience?

  • Jeton Ademaj

    @the other Greg: ah, let’s paint by paragraph numbers:

    1) no, my partners know from the get-go that no meating will take place with rubber involved. i have no problem hooking up thusly.

    2) i enjoy your snide attempt to tell me how i became poz, but it’s erroneous…i discovered the joy of raw after seroconverting….as most do. as for condoms only being 70% effective OVER TIME IF USED WITH PERFECT CONSISTENCY, and that if you do NOT use them with fundamentalist fervor (as MOST do not), their net protective effect is near zero! BEHOLD…and read sloooowly:

    3) the med effects you describe are simply not associated with Truvada, howsoever you may try to parse the drug warnings to the contrary. they are the result of the thymidine analague drugs, AZT, DDI and D4T. your metaphor is more FAIL, of the scare-tactic variety.

    4) all other factors being equal, being HIV- is far better (and cheaper and healthier) than being HIV+, and PrEP is not about Gilead, theirs is simply the best pill for the job at the moment. far more sophisticated PrEP (and HIV Treatment) options are coming soon, including long-acting 30- and 90-day injectable formulations…from various drug makers.

    i like how u embedded that “kind of guys” social stigma about those who benefit from PrEP…it fits with the general poison you expectorate and pretend to call “argument”.

    as before, your aim is the Hate Orgasm. beware the hairy palms, fool.

  • Jeton Ademaj

    @the other Greg: loooool….please show us your studies of how most people love them. i’ll simply point you to the comment sections of every online outlet that reported on that recent Trojan-funded study finding that “most people find condoms make no difference in pleasure”, as HuffPost reported.

    the comments weighed about 50 to 1 in favor of disliking condoms, including most female posters. as for overall condom use, most studies find 50% intermittent usage among gay men and 25% intermittent usage among hets…these stats have remained consistent since the LATE 1980’s. the 2011 George Mason Univesity study on condom use among some 15,000 MSM respondents found 2/3’s did not use a condom in their last anal sex encounter.

    incidentally, i’ve never met a “no-anal-sex” gay man who was NOT a sexually neurotic basket case…very much the same as finding heterosexuals who are “only into oral”…arrested development, meet political correctness.

  • the other Greg

    @Jeton Ademaj: You carry a lot of bitterness that should be properly directed at whoever infected you – perhaps on purpose, maybe he took off the condom for a minute when you weren’t looking. Instead you’re mad at everyone else.

    As someone in a sero-discordant relationship, I’ll say my bf & I have never met anyone who’s into “the joy of raw” (uck) who was not a complete nutcase.

    But to each his own, I guess. As you probably know, if your viral load is undetectable, you are essentially no risk to your barebacking partners (even if they’re neg).

  • Jeton Ademaj

    @the other Greg: yack yack yack, at least u ended with a truthful assertion.

  • the other Greg

    @Jeton Ademaj: You’re being solipsistic, reading way too much into all this from your own idiosyncratic experience, and extrapolating all kinds of “everybody” and “MOST” statements when it’s really just you. It’s funny you think I’m a prude or something, I went thru a wildly promiscuous phase from about age 25 to, um, 40 or so – never barebacked, bottom or top, and the very few guys who ever suggested it seemed insane. (Dementia?) If you think of it as “REAL SEX,” I’m pretty sure that’s just your own weird little corner of the world. Nobody *loves* condoms but yeah, I don’t think most guys see what the big fucking deal is about them. Maybe you should just quit whining.

  • Jeton Ademaj

    @the other Greg: heh…maybe u should quit trolling, and trying to manufacture a false consensus. your second-to-last sentence is a masterwork of obfuscation, indicative of YOUR own little world…thankfully, there’s 25 years worth of studies supporting my assertion that most men disdain condoms and avoid them whenever they think they can afford to do so. hell, that understanding is the very basis behind all the hostility to ALL chemoprophylaxis, from PrEP to PEP to Treatment-As-Prevention…”these meds are gonna mak men think it’s ok to….BAREBACK!! 0H N0003zzz!!

    just cuz YOU have made the decision to “let whole avenues of your sexuality grow dark with cobwebs” (as HuffPost blowhard Mark Adnum has admitted to when JUSTIFYING perspectives like yours), doesn’t mean other gay men should be advised to do the same.

    besides, you probably know that growing numbers of HIV- men in relationships with HIV+ men have decided to use PrEP to fuck safer…so it’s comically ironic that you assert that “yeah, yeah, PrEP is now an option for the kind of guys who would probably get HIV anyway – which is fine with me, really it is” when it obviously is NOT…

    …and then you admit to being in a serodiscordant relationship, which is PRECISELY one of the categories of people PrEP was specifically approved for by the FDA!

    AAHHH, but you’re not “one of THOSE” queers who would get HIV anyway, because you don’t do the Dirty Deed, the ButtMambo, the Ass Lambada…the most intimate sex act gay men can do.

    arrested development, meet political correctness…with sheer denial as the unholy offspring.

    now stop bitching…PrEP is here, PrEP WORKS EXTREMELY WELL WHEN TAKEN AS DIRECTED, and it might just allow you a real sex life.

  • the other Greg

    @Jeton Ademaj: You’re always imagining a lot of stuff I never wrote. I apologize for setting an inflammatory tone at the beginning by just assuming you were a tweaker!

    I never said I don’t fuck – said the opposite in fact #28 – just said that I’ve noticed a lot of guys don’t (they don’t ALL seem repressed to me, etc.) and that another large group don’t see what the big deal is with the condom thing. I’ll look up the Mark Adnum article, didn’t see it.

    Based on the personal info you give, you’re apparently no threat to anyone – and I have to admit, this did vaguely annoy me somehow! I suppose because it doesn’t fit neatly into Condomania. But the thing is – OK, you know and I know that a poz guy who’s undetectable is, in reality, almost no risk. And that the undiagnosed (or lying) guy is a million times more of a threat. But most gay guys don’t know that. And society at large doesn’t know that so unfortunately, in 40+ states you’re at risk for a prison term even if you disclose.

    You seem convinced that – aside from the expense – Truvada has no side effects. Commenter #4 disagreed with you: “Truvada leaves one feeling constantly nauseous, lethargic, and bloated, while giving you just about the worst nightmares conceivable without taking LSD. And I say that as someone who had one ‘slip up’ and was immediately prescribed this by my MD in NY’s West Village.” That’s extreme, but I’ve talked to a lot of Truvada “sufferers” who don’t always think it’s worth it.

    OK, I’ll admit I hadn’t even heard that we (sero-disc’s) were a target audience for PReP. Hmmm… well… can’t say it has a particular fascination for me. Considering the expense & possible (more like probable) side effects, and the fact we’re cool with the condom thing and don’t see what the big deal is… guessing not interested. But I’ll bring it up as a theoretical & see what he thinks.

    There’s still the objection of cost. “Will the cost of treatment crowd out government spending on other prevention methods?” You know the answer to that one.

    And as “hyhybt” points out, condoms protect against a lot of other diseases. You have the usual “HIV tunnel vision.”

    Btw “the most intimate sex act gay men can do” is still c*cks*cking and always will be!

    (Notice that on Queerty you can say “fuck” without getting censored, but “c*cks*cking” needs censorship. Put your sociological skills to work on THAT one!)

  • bearlvr

    @the other Greg:

    And I have to intervene. I’m working with a PrEP DEMO project here in San Francisco as a study member, meaning I’ve been on PrEP for many months now and I’m very familiar with all things related daily oral Truvada PrEP and I talk with the people trying to implementing this in the gay community often.

    I just want to bust this ‘myth’ that is going around that Truvada side effects are horrible like what commenter #4 said. Part of the problem is that people mix up the side effects of Truvada on HIV+ guys, that can’t be taken alone therefore its difficult to isolate if the side effects are of Truvada, and people also mix up PEP with PrEP. On PEP usually people get much more heavy duty drugs during the 30 day post-exposure period.

    What we know is this. On negative guys taking Truvada ONLY, side effects are very mild. About 5% of the people who start Truvada will get some nausea or diarrhea but they go away very quickly and after a week or two there are no obvious side effects. I’m not making this up, all this information come from the placebo controlled studies done through many years with thousands of study subjects(iPrEX study and others). Now, there is some concern about long term side effects like bone density loss and creatinine clearance, and although the drug seems safe, again in negative guys taking Truvada only, it is imperative that people go on PrEP under the supervision of a doctor and follow the protocol.

    Short story long about Truvada side effects is that short term side effects are negligible, longer term it’s sort of a question mark at this point, but you can stop PrEP at any moment if it’s causing problems on you.

    Anecdotally of all the people I know on PrEP, who are plenty, none of them seem to be having any side effects.

  • dwndckd

    @Jeton Ademaj, I only wish you the best…Having said that— fuck as hard, as much and as long (i.e. unprotected) as you want… Hell, if I could pay it forward, I would say that the next NUTT is on me…. Happy trails

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