Results form a survey of 90 San Francisco gay men currently taking Truvada seem to echo the sentiments of some of PrEP’s biggest critics — a 45 percent increase in condom-less sex.
Dr. Brad Hare, the program director of a Kaiser Permanente AIDS prevention program in SF, has overseen some 500 patients who’ve begun taking Truvada as PrEP. The 90-person self-surveyed sample group makes up part of the 500.
In Dr. Hare’s entire group of PrEP patients, he reports that the number of sexual partners hasn’t gone up and there have been no new HIV infections.
“It is used to prevent HIV — and that seems to be working,” Hare said.
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However, the 45 percent decrease in condom use has some health organizations troubled, though it’s important to remember that this number came from a study of only 90 men in one city. The pill may stave off HIV infection, but there are plenty of sexually transmittable diseases it does nothing to block.
Then again, it could be argued that things like gonorrhea and chlamydia, which are easily spread through oral sex, would still get passed along even if a condom is used for anal penetration. Try finding a guy who uses condoms during a blow job.
The Los Angeles-based AIDS Healthcare Foundation has openly criticized the FDA for approving Truvada as PrEP, predicting this very scenario. AHF’s president, Michael Weinstein, has called Truvada a “party drug”, adding:
“Why would men take this medication if they intended to use a condom? It’s utterly predictable.”
Still, Dr. Hare has a different take:
“The reasons people are coming in are different. People are seeking PrEP because their friends are on it and they’re sharing stories about it changing their lives. Patients are coming in and saying, ‘It must be for me, too.'”
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via BizJournal
vive
“There were no new HIV infections.”
Isn’t this the point? Case closed.
Talk about whipping up a false panic for no reason.
Trippy
sex-shaming, it would seem
redcarpet30
Was there an increase in infections of HIV during the same peroid in the same group? Was there an increase in any other infections?
If the answer is no, then there isn’t really a problem. If HIV isn’t a threat to them then of course people aren’t going to use condoms! It’s to be expected.
Which isn’t to say I don’t still have my concerns about prep. But this sample doesn’t really tell us much other than people behave predictably. It’s not a damning report on PrEP or vindication for opponents.
JimmyJ
Truvada — gay men’s birth control.
bnard620
I think this is just proving the point of a lot of people and for good reason. HIV isn’t the only thing out there and when you’re not using condoms you’re opening yourself up to a number of other things like Herpes, Hepatitis and genital. Its great that its helping to reduce the number of new infections, but its not great that people are only seem to be worried about one thing which shouldn’t be the case
Cam
“The Los Angeles-based AIDS Healthcare Foundation has openly criticized the FDA for approving Truvada as PrEP, predicting this very scenario. ”
____________________
I’m kind of surprised by that. Their name is AIDS Healthcare Foundation, not AIDS and Clamydia and other STD’s Foundation.
Maybe they get a lot of donations from Condom makers.
vive
@bnard620, I am vaccinated, as every gay man should be, against Hepatitis B (which is the sexually transmitted one) and (most) genital warts, so those are not really an issue for me. Condoms don’t protect against warts anyway, making vaccination even more important. Syphilis, Chlamydia, and Gonorrhea are easily transmitted via oral sex (for which nobody uses condoms), but are also easily cured with antibiotics. As for herpes, condoms don’t offer much protection against that either.
vive
@redcarpet30, according to the piece, “there have been no new HIV infections.”
That would really have been in the title of the piece, if we were living in a sane world.
jason smeds
You’d be stupid to take an unnecessary chemical like Truvada. It’s also not proven as far as I’m concerned. Why add something to your body that does not need to be there? It also may cause you harmful side effects which could devastate the systems of your body.
It’s also a total waste of money. The people who are loving it are the CEO’s of Big Pharma who are notching up one mansion after another as you foolishly seek to add an unnecessary chemical to your bodies.
Merv
Even if there were a vaccine or drug to prevent every known STD, as long as you have an easy pathway for infection, evolution will take over and some new pathogen WILL hitch a ride and infect entire communities before we know what’s happening. If the conditions are right, it’s not a matter of if but of when. We will always need physical barriers and non-promiscuity to prevent a repeat of what’s happened in the past.
cymatic
It’s really unfortunate that the Business Times writer used such sloppy language in the original story and that Dan’s blithely repeated it here. It’s simply not correct to say that respondents to the survey reported a “45 percent increase in condom-less sex.” The correct way to describe the finding of this survey is this: 45 percent of respondents reported a decrease in condom usage.
This doesn’t tell us anything about how much of a decrease there was or what the specific circumstances of those people were. See this article for a more thorough discussion of the survey and what it does and doesn’t tell us: http://www.aidsmeds.com/articles/PrEP_condoms_less_1667_26573.shtml
Kieru
Even the company that makes Truvada recommends you continue to use condoms as an extra barrier against possible HIV transmission. The worst-case scenario here is that we see an incline in other STD infection rates which would lead to a higher chance at treatment-resistant strains developing. Or you know… you could use a damned rubber like a responsible adult.
The blasé manner in which so many of you treat other STDs is appalling. “It’s treatable” should not be a reason to avoid putting a rubber on.
jason smeds
I don’t even use condoms. I don’t like anal sex for starters. I do everything except anal. No need for condoms. I’m completely STD-free, and have been for years.
Kieru
@jason smeds: Anecdotal != Evidence. Your individual experience does not necessarily represent the average, particularly as you do not engage in anal sex. Someone else who practices the exact same sex acts as you may have contracted innumerable STDs, just as someone who practices anal sex w/o condoms may have never contracted an STD.
This is why “Well in my experience…” rarely holds any weight. When discussing things like this you need to use averages; not individual examples. The AVERAGE thus far seems to be that people are willing to forgo condom usage because they think the only reason for a condom is to prevent HIV and they also think (wrongly) that Truvada offers 100% protection from HIV.
erikwm
What about the cost? Without insurance, Truvada costs $15,000 per year. Even with my health insurance, my guess is it would cost hundreds, if not thousands, of dollars per year.
Maybe there are some people with cadillac insurance plans who get it for a $15 co-pay, but what about the rest of us?
bbg372
@Merv: Precisely.
Prior to 1982, gay and bisexual men widely believed that since chlamydia, gonorrhea, and syphilis were curable with antibiotics, there was no need to use a barrier method of STI protection such as condoms. HIV/AIDS, which had been in the United States since 1959, decimated the gay and bisexual community.
Thirty-two years later, gay and bisexual men are starting to believe that since chlamydia, gonorrhea, and syphilis are curable with antibiotics,and HIV-transmission is preventable with a pill, that there is no need to use a barrier method of STI protection such as condoms, leaving the gay and bisexual community vulnerable to the next HIV that is surely lying in wait.
Those who do not learn from history are doomed to repeat it. This is the danger of PrEP.
Saint Law
@jason smeds: “I do everything except anal.”
Everything except sex that is. Who’d asleep with you?
Paco
“In Dr. Hare’s entire group of PrEP patients, he reports that the number of sexual partners hasn’t gone up and there have been no new HIV infections.”
This is very encouraging. I hope to see more concrete stats that supports this in the near future.
Trippy
@jason smeds:
Self-stimulation while watching xtube doesn’t count as sex.
SFOguy
Trying to foretell the “fall of condoms” around the country based upon the self-reported behavior of just 90 men is one of the worst examples of PrEP media coverage this year. Media outlets, including Queerty, need to start educating themselves as to how clinical study data are collected and what data are accurate to interpret and to stop “reporting” erroneous interpretations of an observation made by a healthcare group. Go back to school. Learn some science. Then write responsibly.
And ditto redcarpet30, vive, cymatic, Paco.
SFOguy
@erikwm: Yes, the cost can be difficult to work through for some, but you don’t need the most expensive health plan to get it covered. Depending upon your plan’s structure for copays and other out of pocket expenses, help is available for those without insurance and for those who are low-to-mid income. The maker of Truvada, Gilead, has 2 assistance programs … a medication assistance program (MAP, https://start.truvada.com/content/pdf/medication_assistance_program.pdf) and a copay program (http://www.gileadcopay.com/). They just upped the limit to 500% FPL, which is about $50,000 annual income. It’s worth applying to see how much more help you can get outside of your insurance or Medicaid.
Blackceo
Yeah…others can do what they want but if I were still in the dating scene I’d be sticking with condoms because that it still the only measure that best prevents infection from all the STI’s. Also, why the hell would I want to shove a pill in my mouth if I don’t need to?
Tackle
@vive: Sorry, but this case is not closed. It’s wide open. And this study, and others like it are no proof that Truvada as PrEP is prventing HIV infections. I will believe it prevents HIV infections ,if you or any supporter of PrEP can site, show, or like a document or study where PrEP was effective in preventing HIV
from someones who is newly infective, with a HIGH viral load??
Having gay men take PrEP and matching. them up with, or if their sexual partner is on meds, with the virus under control, or better yet, undetectable, proves nothing in or about effectiveness of PrEP, seeing that the average Joe Smooe , who’s not on
( recreational) drugs, has a high likelyhood of not getting HIV.
This is something we all seem to have forgot.
Aside from gay men being used as guinea pigs for this experiment, this is a big money making scheme from big Pharma…
Aromaeus
I’ll stick to condoms thanks. At least I can have a bit of variety with that. I don’t like pills.
I love condoms
If this is not a disaster waiting to happen, I don’t know what is.
The CDC recently released a report that says ‘Just 30 percent of Americans living with HIV have the virus in check. The report found that 840,000 of the 1.2 million people infected with HIV in 2011 were not consistently taking anti-HIV drugs that keep the virus suppressed at very low levels.’
http://rt.com/usa/209235-americans-with-hiv-under-control/
If people living with HIV are not being compliant with their meds to sufficiently suppress the virus and save their lives, why does anyone think that the larger population, outside of the 90 PrEP study participants in SFO, will be compliant with meds that prevent one from contracting HIV?
Realityis
@SFOguy: You sound like Truvada’s PR spokesman. I take Truvada because I’m HIV-positive but if I had a choice, and I were not HIV-positive, I would not take this drug. These medications have made my body completely not what it used to be. I used to teach fitness and I won’t even walk into a gym these days. For everybody out there who is saying that this pill is so great, and I really hope it is, but you don’t know what it’s doing to your body and you won’t know for a few years.
Instead of putting millions and millions of dollars into big pharma’s pocket, why don’t we demand a cure for HIV, AIDS, lipodystrophy, cancer, etc. There are most likely numerous cures out there that aren’t being put on the market because it would take away money from these greedy a-holes. For all of you guys advocating the use of this drug, how do you feel when you see someone, me included, who have signs of lipodystrophy. Do you stare? Do you feel pity for us? Do you feel sad for us? Well guess what, if negative guys who are taking Truvada start to exhibit these symptoms, then the shoes going to be on the other foot. I really really really don’t want to see this happen. It has been way too hard for me and I don’t want to see a new generation of it.
AlliterationAddict
@vive: As someone who studies epidemiology, I can tell you that it is slightly more complicated than that. Most of the concerns regarding Truvada as a prophylactic measure against HIV infection are centered on the problem of a very small amount of risk being applied to a very large population.
Now, the statistical analysis isn’t in yet, particularly because we have yet to thoroughly study just how consistently people actually adhere to these prophylactic regimens, but lets say for the sake of argument that using Truvada is on average 3% less effective than condoms. In a sample population of 90 people in which 45% report decreased condom usage, the probability of infection would be very low if not nonexistent as seen. But when you apply that very same risk coefficient to a large population, you suddenly see an unacceptably large increase in infections.
It’s kind of like this. If you were to down five or six beers at the bar and then drive home, odds that you get into an accident because of that are actually relatively small. The problem is that if you have tens of millions of people do that every single day, you’re suddenly going to start having problems.
Which is not to say that PREP isn’t an extremely exciting development in AIDS prevention. The reason people like me focus on these issues with PREP is not because we oppose it, but rather because we want to be able to implement it’s use in a way that is safe and effective. And I’m certainly not trying to back up the people who are anti-PREP. The reality is that many of their arguments are simply not scientifically supported. I think that at this point, the scientific community could best be described as cautiously optimistic about PREP. But are there still epidemiological concerns about it’s effectiveness operating in a general population? Yes.
I guess the point that I’m trying to make is that between the people who know nothing but hate PREP and attack it all cost, and the people who know nothing but love PREP and refuse to listen to any concerns over it at all, there are some people who actually study these problems. And it would be nice if other people could make an effort to understand the issues and let that inform what they say as opposed to how they feel about it.
AlliterationAddict
@jason smeds: Okay. First of all, you are aware that everything you have ever put into your body in your entire life has been made up of chemicals, right? I mean, unless that is you’ve discovered a new organization of matter hitherto unknown to science and have been eating it for breakfast every day instead of showing it to the Swedish Academy and claiming your Nobel prize.
And give it a rest with this crap about the ‘side effect’ bogeyman. The FDA put it through extensive human trials before licensing it for prophylactic use. Since which we’ve had two entire years in which no significant problems have emerged. Not to mention that the two active ingredients in Truvada have been used as antiretrovirals for long before they were considered for prophylactic treatment. Do me a favor and try to actually learn about something before you go and spout your mouth off about it.
BigJohnSF
In my experience, HIV-positive men who are undetectable stopped using condoms years ago – they serosort. So far no drug-resistant chlamydia or syphilis. We heard scare stories about drug resistant gonorrhea a few years ago, but those stores have pretty much disappeared. And as another commenter pointed out, condoms don’t offer much protection against herpes or hep C.
Condoms are pretty much pointless by now. Sorry if you have lousy insurance, but that’s bound to get better. Generic truvada should be available in 2017. Then the last argument against PrEP will drop away.
bbg372
@AlliterationAddict: The FDA approved Fenfluramine in 1973 only for it to be recalled 23 years later for causing irreversible heart damage, yet we are to believe that Truvada is safe because it was approved by the FDA based on the results of a two-year study?
To date, there have been no longitudinal studies of the effects of Tenofovir (approved in 2001) and Emtricitabine (approved in 2003). At best, we have 11–13 years of data on the effects of these drugs on persons with an active HIV-infection. We have no idea of its long-term effects when used as a prophylactic on persons with no active HIV-infection to manage.
So perhaps you should take your own advice before trying to correct someone else.
jason smeds
Truvada represents an artificial chemical. There is no reason to put an artificial chemical in your body for prophylactic reasons or for any other reason. The Truvada-pushers are nutty creatures with no ounce of sense in them whatsoever.
ndalum
@JimmyJ: I think gay men’s birth control is being gay.
vive
@erikwm, maybe you could inform yourself before pulling arbitrary dollar amounts out of your ass.
Cam
@jason smeds:
For somebody that trumpets the fact that you don’t like and you don’t have anal sex, you seem very into this topic.
Habit Rouge
The era of antibiotics is coming to a close, in some places faster than others. Globalization has shown how easily infections can travel, you have HIV and Ebola as examples. I am a medical professional and I hav many many reservations about Truvada. It has been shown to reduce the risk of transmission substantially, but there are many caveats. Relevant to this article, some of these STIs are becoming harder to treat because of increasing drug resistance. There are cases in NYC of multi drug resistant gonorrhea, this is some scary shit. But don’t tell that to the folks hailing PrEP as a morning-after pill. This issue is a big onion with many layers, HIV prevention being just 1.
ibernard
Stupid is as stupid does!
Truvada. I’m sure the marketing team had quite the challenge to come up with a “soft” name.
Sorry folks. After I’m monogamously (and regularly testing, as a couple, in a positive status)
then I will consider my options. Condoms? Safe sex? “BareBacking”, or a medical option which
has serious studies behind it, so I, and my partner, don’t end up as lab rats for some “bottom line”
pharmaceutical company. And I happen to know someone very high up on the ladder in a major
drug company, and she explained to me how all the companies (“all”) were pushing to be the first
to have either an anti-HIV injection, or a medical option like Truvada.
Sorry. Safe sex is fucking HOT sex. Fuck the rest of you. Clearly you didn’t live through the first holocaust.
And I’m 54, in great health, look much younger than my age, AND I’M HIV NEGATIVE. Truvada whores, indeed.
Chris
N = 90; and the sample was selected how? Without greater knowledge of the research methods, I consider this little more than a statistical burp.
GayMafiaKingpin
@vive: The point of Truvada is to lower the risk of HIV infection, but with less condom use we’re going to see a rise in other STIs, like herpes, gonorrhea, syphilis, hepatitis, chlamydia, etc. Some of these can go undetected, and spread quite easily, and have major health effect if left untreated.
GayMafiaKingpin
@Trippy: Advising people to use condoms is not sex-shaming. In fact, it’s quite the opposite.
vive
@Habit Rouge, @GayMafiaKingpin, sure, but gonorrhea, etc., are easily transmitted orally too. Herpes and HPV are easily transmitted via frottage, so condoms are less relevant for them. And everyone should get vaccinated for Hep B and HPV anyway.
The people most at risk of undetected chlamydia/syphilis/gonorrhea/etc. are not the ones who use PrEP, because we get frequent STI panels by the doctors who prescribe PrEP to us. Gonorrhea, etc., are frankly more likely to go undetected in someone who uses condoms for anal sex (but not oral) and therefore doesn’t go to get tested for these STIs because he thinks he is protected.
frshmn
Are guys prescribed PREP more or less likely to be tested for STDs regularly? I would assume if you are on PREP you have better access to medical care and are more likely to be screened for STDs than someone without.
M K
You do know that taking PrEP – EVERYDAY – does not necessarily ensure that you will not contract HIV right? It only reduces the potential to 8%-10%! Do you want to risk your long-term health at a 10% level – and need to take (and pay) for a pill everyday forever?
And that is only if you take it everyday and you do so ongoing once you do. it doesn’t prevent you from getting the virus (or other STDs), you still need to use condoms to prevent the transmission of the virus – and other STDs. The med only prevents the virus from establishing a permanent infection. Which means that if you take it everyday – permanently – then you have a chance the virus will not take hold…. what that also means is that if you do engage with those that are positive and get the virus that doesn’t establish itself permanently while you’re taking the med, that if you stop taking the med, the virus is still present within you and will respond as if you are not on meds – thus will then establish itself permanently – and all the regular unprotected/infected results.
Do you really want to be tied to having to take a med everyday for the rest of your life when you could just behave smartly? Don’t start and/or reply on this med as a means of protection from acquiring the virus.
The only people that should really even consider this as an ‘additional’ option, are those who are already in relationships with those that are positive. And even then, should be used in conjunction with other safe practices.
And for you guys who are on the ‘undetectable’ bandwagon… don’t think that engaging with someone who is undetectable is not capable of infecting others…. I have two friends who have been. One was by a guy who was technically tested as undetectable, but wasn’t great about taking his pills everyday, so his viral loads (no pun intended) would fluctuate… too bad for my friend who now himself is tied to taking pills everyday for the rest of his life just to stay non-symptomatic… notice I didn’t say healthy….. after all, the virus is still resident and if you stopped taking a pill to mask it, you would be very unhealthy.
Just play smart guys…. Assume everyone you are with is positive and act accordingly.
bbg372
@vive: @frshmn: I was prescribed PrEP simply because I asked for it, no regular STI-screenings or kidney function tests required. Many metropolitan cities are moving to make PrEP available this way. So no, people who are prescribed PrEP are not required or more likely to be screened for these things.
buffnightwing
I am tired of hearing about OTHER STD’s when having this conversation. We are talking about HIV only here. STD’s are another conversation entirely, because at THIS MOMENT they are TREATABLE.
Sex without condoms is so much better and intimate. The whole point of Truvada is so people can have sex WITHOUT condoms.
Please stop with the… just play smart guys, etc etc. The people that are even reading this stupid website are obviously not in their 20’s.
The nasty judgement coming from my fellow gay commencers is appalling. Stop with all the Catholic sex shaming!
Sex is a great thing, not something to be feared.
Geez Louise!
buffnightwing
@M K: Your information is totally wrong. Do some research first before posting nonsense!
buffnightwing
@GayMafiaKingpin: The WHOLE point of PrEP is so you can get rid of the condoms. Condoms suck.
I am SO HAPPY that you love them, but don’t FORCE the rest of us to use them if we have PrEP.
The condom usage rate is something like 40 percent. That means a majority of us gay men prefer no condoms.
I don’t use a condom for oral, EVER.
Yes Homo
I don’t see this ending well.
Besides the possibility of the virus mutating and becoming resistant due to misuse/overuse of these meds, there’s also the very real threat of diseases other than HIV. HPV is a major cause of anal and penile cancer. These diseases can kill you quicker than untreated AIDS. And let’s not forget Hepatitis B, C, herpes (which is forever), syphilis and chlamydia to name a few. Oh, and Truvada itself can have a number of nasty side effects.
If you were around in the late ’70s/early ’80s, you might remember a not-so-PC epidemic known as “Gay Bowel Syndrome”. Despite the unscientific, offensive name, GBS was a real health problem affecting a majority of gay men in large cities. It included a number of rare infections such as shigellosis and campylobacter and was a direct result of promiscuous unprotected sex. Doctors were concerned about this before HIV entered the picture. (The book “And the Band Played On” discusses this in more detail).
Bottom line: condom-less sex with multiple partners is still dangerous.
Garrett
@buffnightwing: So true! Thanks for saying it. One look on Adam or Manhunt or any other site and almost all you see is guys looking for “raw” or BB. The community needs to wake up and realize that a majority of sexually active gay men have just moved on from condom-based sex (and the rest would love to). Slut-shaming is ridiculous. PrEP, and other options that will soon follow, has given us our freedom. Learn to love it, people. And for those who doubt it, just ask any of us who were around back when the plague started if a pill like PrEP had been available would we have taken it. YES. Now it’s here, and I just don’t understand the freak-out over it. The chains are off, people. Enjoy your freedom!
vive
@M K: “You do know that taking PrEP – EVERYDAY – does not necessarily ensure that you will not contract HIV right? It only reduces the potential to 8%-10%!”
That completely wrong. Please inform yourself before going spreading misinformation all over the internetz.
vive
@bbg372: “I was prescribed PrEP simply because I asked for it, no regular STI-screenings or kidney function tests required.”
That is not the standard of care.
Matt
Any person who takes Truvada and does not have HIV is sick in the head. With all the education on HIV/AIDS in the last 30 years, the rates of HIV in the gay community are higher than ever.