Is Truvada As Effective At Preventing HIV Infection As We Thought? Maybe not.

uptown-hivA few months ago, the New York Times published an op-ed piece hailing “HIV-preventing miracle drug” Truvada as a new “sexual revolution” for the gay male community, likening it to the invention of birth control and wondering if it has the power to lower the “viral load of a city.”

Sounds pretty great, especially given that “99 percent” effectiveness number that gets thrown around. New York Magazine recently published a cover story about the drug, examining how it could “revolutionize gay life.”

Except this week the Times published another piece on the little blue pill (not an op-ed), this one called “Is Truvada, the Pill to Prevent H.I.V., 99 Percent Effective? Don’t Be So Sure.”

The article focuses on how that magic 99 number was reached, notably remarking that:

“The 99 percent figure isn’t a study finding; it’s a statistical estimate, based on a number of assumptions that are reasonable, but debatable.”

Based on tangible research data, Truvada’s effectiveness at preventing HIV infection when taken as prescribed — that is, every day — is somewhere between 90-99 percent.

And even if you consider the low end — 90 percent — it’s still a breakthrough tool to combat the spread of infection.

But the Times piece points out a big psychological gap between 90 percent and 99 percent.

The failure of a 90-percent effective method is terrible luck; the failure of a 99-percent effective method is verging on a freakish accident. Putting too much weight on the 99-percent figure may lead some PrEP users to perceive virtually zero H.I.V. risk when they should really be thinking about very low risk.

So while some see PrEP as a gateway to the sexual liberation our community celebrated in the pre-AIDS world, the reality is, like most things, more complicated.

Tim Horn, H.I.V. Project Director at the H.I.V. think-tank Treatment Action Group, said:

“Though it is possible that efficacy can approach 99 percent — language in the lay literature seems to be growing increasingly casual as to what this really means — the data supporting this currently exist in a vacuum.

Head to the Times to read the full article.

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  • Ihadtosayit

    Agreed people should be sure to wrap it up, do not assume that PrEP is going to spare you from a disease (yes I know that the advocates of the program are not abandoning condoms) at this point and/or use a condom in conjunction with PrEP…I think this combination is AWESOME for those casual encounters…one can use the condom and one can be on PrEP

    Seriously, I want everyone to have as much of a fighting chance to stave off diseases such as: syphilis, gonorrhea, hepatitis, chlamydia and other sexually transmitted diseases out there…some of these are prevented with a condom and one has been known to assist with HIV and possibly herpes.

    Once your immune system is comprised by other sexual transmitted diseases and/or drugs such as meth it can weaken the effectiveness of Truvada and make you susceptible to HIV infection…so BE CAREFUL

    Here is my truth and I hope it is true for many others…do what you want to do as I am ALL for PrEP…bring it on because I do believe that it can help reduce transmission of HIV…but understand that I will insist upon a condom if we have sex (especially casually)…your word that you are taking PrEP effectively slaps in the face of my personal responsibility…my mindset increases the odds that I will remain HIV-. I think that is what has been lost in this fight over the years and that is YOUR personal responsibility.

    BTW: I can not tell you how many straight men who have been caught up with the following: the girl says she is on the pill, he does not use a condom and well fast forward nine months later….now this same logic extends to taking the word of a casual hook-up….you have to take responsibility for yourself and NEVER trust another person that you casually meet and even sometimes that you are committed to…I am sure we all have stories about that…

    EACH PERSON must do what is right for themselves to reduce risk and NOT take the word of a virtual stranger.

  • DistingueTraces

    There was way too much of a rush to embrace Truvada. Of course all tools for prevention are worth using, but it’s silly to treat any single method (yes, the same goes for condoms) as a magic bullet.

  • masc4masc

    I can already hear guys changing their stories from the usual “I got infected by my partner of 5 years” (it’s always 5 years) to “I was part of the 1 to 10 percent PrEP didn’t work for”.

  • Ihadtosayit

    @DistingueTraces: more choices will reduce transmission of HIV and other diseases is my hope and my belief

  • Kieru

    Like any other pill its effectiveness is maximized not by taking it ‘daily’ but by taking it at roughly the same time every day, without fail.

    Condoms offer about the same level of protection, unless you believe the CDC results that suggest gay men who always use condoms are only 70% less likely to contract HIV than those who never use them. Personally; I think a lot of men lied about their condom practices on that survey.

    Truvada is clearly DESIGNED to be merely a part of your line of defense against HIV – not the only part of said defense. That DOESN’T seem to be how it’s been treated though; it seems to be promoted within our community as a contender for a condom alternative.

    So buyer beware; and if you’re going to use Truvada as a condom-alternative make sure you know your partners status and their viral load if they are positive. At least then you can make a more informed decision on whether barebacking is worth the risk.

  • Qjersey

    why is Truvada still so expensive in the US when it’s available generically elsewhere?

  • gskorich

    my doctor explained it to me like this. truvada as a preventative is best used by hiv negative guys who have unprotected sex with positive guys who know their status and are at undetectable levels, he told me when there are undetectable virus in the blood, 93% of the time you are undetectable in your semen. the truvada is for the other 7% of the time the virus is present. btw, he mentioned that with this 7% the viral load was very low roughly 200 copies.

  • vive

    It is well know that vaccines don’t have to be anywhere near 100% effective to cause a disease to vanish, as long as enough people are vaccinated. Transposing this to the case of PrEP and condoms, it would seem to be a good argument for getting as many people as possible who don’t currently use condoms on PrEP.

  • vive

    As for the estimate here, in the largest PrEP study, not a single person who took PrEP every day (as confirmed by blood tests) was infected.

  • Kieru

    @Qjersey: Because patent and copyright law prevent generics from being sold in the United States for X years. I say ‘X’ because it’s common practice to modify the formula JUST ENOUGH that the protection is renewed because the drug is now considered ‘new’.

    That’s the whole problem with prescription drugs in this country. The United States brags that they’ve helped push HIV treatment in Africa to a $1 a day per person … yet the treatments here cost anywhere from $6,000 to $10,000 per person per prescription every 3 months.

  • DB75

    @Kieru: True. The same situation with Atripla.

  • michael mellor

    It’s dangerous to keep putting pharmaceutical drugs into your body. Such drugs create chemical imbalances. They are not natural. They also make drug firms very rich.

  • BeachGuy2014

    Did I miss something or did they stop making condoms? They are a whole lot cheaper!

  • vive

    @Qjersey, HIV drugs are so expensive in the U.S. because the U.S. population allows them to be so.

  • Billy Budd

    I *always* use condoms. I won’t pay 1000 bucks per month just to be a little bit safer.

  • ggreen

    The Josh Barro Upshot column in the New York Times is hardly 100 % objective, it’s really an op-ed in the form of “analysis”. “Don’t be so sure” is hardly language for straight news story but it goes great with slut shaming hit piece.

  • JDean

    some truvada hoe on Grindr was telling me all about this “condom pill” and how I should go over there pop a pill and fuck her bareback.

    in a few years all the stupid queens who took this poison will be dropping like flies 6 feet under

  • JDean

    @masc4masc: and then the whining will start about nobody wanting to have seks with them and how people like me who wouldn’t shag em are bigots


  • Merv

    Even 99% effective is not as great as it sounds. If your car or computer worked 99% of the time, you would be very annoyed at how unreliable it is.

  • Evji108

    One big point to keep in mind, is that Big Pharma is not here to cure you or prevent disease. Big Pharma is here to make money by selling you expensive drugs. Their most advantageous position is to get people started on a drug that neither cures you nor allows you to die, but keeps you “hooked” on their overpriced drug in perpetuity. A pill that prevents HIV infection would cut into their bottom line. Better to have us believe that it does so, get infected and then go on a lifetime supply of their drugs. It’s pretty simple: The Drug Companies are Not your Friends, they only pretend to be interested in our health to make money for their shareholders.

  • vive

    @Billy Budd, nobody pays $1000 a month for it. I pay $10.

  • Dr. Mo

    It is true that pharmaceutical companies are in the practice of “evergreening” their blockbusters. But to be clear: that does not extend patent protection for the original formulation. It goes generic 17 years from the date of patent approval, unless the patent holder gets it approved for a new indication (such as a pediatric indication) in which case patent protection may be extended by 6 months or longer.

    There is no such thing as “copyright” for pharmaceuticals or biologics.

    Finally, it is untrue that Truvada was “designed” to be only part of a treatment against HIV. Truvada is a combination of two reverse transcriptase inhibitors that work in slightly different ways. Each inhibitor was developed separately and only later found to be an effective therapy when taken together. And even more effective when something else is added on top, as in Atripla.

  • Hank

    I have a question about the dosage of Truvada. Did should be taken daily regardless of the number of sexual relations? Or did would have the same effectiveness if taken only on days that would have sexual relations?

  • Merv

    @vive: And the insurance company pays $9990. That contributes to higher insurance costs.

  • vive

    @Hank, it should be taken daily regardless of sexual relations, otherwise it doesn’t offer as much protection. In the largest study, nobody who took Truvada daily got infected, but some people who skipped doses did get infected. There is a French study underway investigating whether a specific (and rather complicated) “as-needed” protocol will work, but the results are not in yet.

  • vive

    @Merv, I disagree. The insurance costs of Truvada for PrEP are MUCH lower than the insurance costs for lifelong treatment of HIV, which is why the insurance companies are covering PrEP.

  • Tackle

    @Dr. Mo: @vive: Maybe one of you, or anyone can answer this. What are the long term affects on the body? I heard the longest they looked at was three yrs.And I heard stories of people having adverse reactions from these drugs within a year. With big-pharma
    covering this up…

  • Fang

    I’m on truvada and have had nothing but positive (hehe) experiences. I’ve had a lot more bareback sex than I used to and I’m still negative. Of course, I’m at a significantly higher risk of contracting other STDs, but so far, I’m left unscathed and I understand the risks associated with my behavior. I also get tested regularly for other diseases to decrease the likelihood that I pass diseases to my partners. Truvada is more effective then condoms (>90% versus around 70% effective) in preventing HIV and HIV is the disease I’ve always found most concerning. I’m sure lots hateful commenters will label me as irresponsible and a slut, etc. However, those same people fail to realize that the majority of the stigma surrounding bareback sex is a direct product of the HIV/AIDS crisis. On a more personal note, Truvada has liberated me from my fear of sex. Before, I would stress about what would happen if the condom broke or wonder if it slid off inside of me, and instead of enjoying the sex I was having, it was causing me anxiety during and after the fact! Now, I am confident that I will remain negative!! It’s been truly liberating. It’s amazing how close minded those people most at risk are about its potential benefits. I recommend it without hesitation.

  • Billy Budd

    @Fang: FANG, you are completely wrong. Please read:

    Soc Sci Med. 1997 May;44(9):1303-12.
    Effectiveness of condoms in preventing HIV transmission.
    Pinkerton SD, Abramson PR.

    The consistent use of latex condoms continues to be advocated for primary prevention of HIV infection despite limited quantitative evidence regarding the effectiveness of condoms in blocking the sexual transmission of HIV. Although recent meta-analyses of condom effectiveness suggest that condoms are 60 to 70% effective when used for HIV prophylaxis, these studies do not isolate consistent condom use, and therefore provide only a lower bound on the true effectiveness of correct and consistent condom use. A reexamination of HIV seroconversion studies suggests that condoms are 90 to 95% effective when used consistently, i.e. consistent condom users are 10 to 20 times less likely to become infected when exposed to the virus than are inconsistent or non-users. Similar results are obtained utilizing model-based estimation techniques, which indicate that condoms decrease the per-contact probability of male-to-female transmission of HIV by about 95%. Though imperfect, condoms provide substantial protection against HIV infection. Condom promotion therefore remains an important international priority in the fight against AIDS.


  • Billy Budd

    I think that a person who stops using condoms just because he is taking truvada is very ******. You should use BOTH as a way of being safer. There is no reason why condoms should not be used (they are not that bad), and the evidence in favor of Truvada is still very young and subject to change. As this article in the Times proves.

  • BeachGuy2014

    I don’t get people who think this is an excuse to not use condoms! This seems like something that should be taken daily just in case a condom breaks or something!

  • Fang

    @Billy Budd: No, I’m not completely wrong. I take Truvada every day and am therefore >90% protected from HIV, 99% according to statistical models. Before Truvada, I used condoms inconsistently (as do MANY other people) and I am now more protected taking the once daily pill. That’s where I got the 70% ballpark figure–from inconsistent condom use. It’s actually lower as you noted. I’ve read the studies and I know the information. Most people do not use condoms consistently and Truvada is, therefore, an invaluable tool to mitigate HIV infections rates. It’s a question of idealism versus reality. Yes, ideally most people will use condoms all the time. It wasn’t until I started taking Truvada did I realize how many people easily forego them. Out of curiosity, I’ve actually asked people in advance whether or not they will use a condom (they invariably said yes), but between the sheets, they *almost* invariably did not pull the rubber out. Condoms are great. I really think that. But are they being used consistently among high risk groups? Not even close. And there’s both anecdotal evidence and formal research to back me up.

  • Billy Budd

    @Fang: If you are/were an inconsistent condom user, you are an ******. Seriously, dude.

  • Billy Budd

    @BeachGuy2014: Yes, of course.

  • Fang

    @Billy Budd: That’s fine that you feel that way. I don’t care! But shaming people who don’t use condoms consistently does nothing to help the situation. On the contrary, it’s actually harmful because you feed into the larger cultural trope that somehow the most natural state of sexual relations between gay men is inherently shameful and irresponsible. And when such a large percentage of gay men DON’T use condoms consistently (read: your friends, your family, probably you at some point) and you dismiss all those people as ***** or whatever, you offer nothing productive to the dialogue. So thanks for the 2 cents, but no thanks. You can keep it!!!

  • Fang

    @Billy Budd: But you are right about the general efficacy of condoms when used correctly. I wasn’t clear about condom efficacy in preventing HIV and inconsistent use, which interpreted in the way that it’s stated in my original post would be misinformation. I apologize for that.

  • vive

    @Billy Budd, well, according to your figure condoms are 95% effective, while Truvada is 99%+ effective if taken daily. So who is the bigger sl*t and who puts their partners are more risk, the person who uses Truvada without condoms or the person who uses condoms without Truvada? The numbers say the latter. :)

  • vive

    @Fang, exactly! Truvada takes away so much stress. Even when I was using condoms consistently, I would still worry all the time: Should I have sucked the guy after accidentally biting my tongue earlier in the day? Was there precum on the finger he put in me after touching his d*ck? Did he get precum on the outside of the condom? Was I exposed the couple of times the condom broke when I topped? Or the time it broke when I bottomed and I only found out afterwards when I had the guy’s cum coming out of me?

    A couple of times I panicked I did PEP, but you can’t really go through the whole ER hassle for PEP every couple of months something happens that panics you. So PrEP is perfect for me. I have no side effects and NO MORE STRESS! It’s wonderful.

  • michael mellor

    Stay away from pills. Stay away from drugs. These things are chemicals. You don’t need to add chemicals to your body. Your body’s fine balance is harmed by chemicals.

    Don’t make Big Pharma even richer than what it is. It wants your money. You’d be better off spending it on a healthy meal.

  • DistingueTraces

    @vive: who is the bigger sl*t

    I don’t undertand why you would characterize either of those people as a thin, narrow piece of wood, especially one of a series that overlap or fit into each other, as in a fence or a Venetian blind.

    That’s just a hurtful thing to say.

  • Billy Budd

    In MY opinion, if you hate condoms or doesn’t have self discipline to use them, it is better to stay away from penetrative intercourse and satisfy yourself with kisses, body contact, blowjobs and toys. It is a compromise, but it is better than poisoning your system with dangerous drugs.

  • vive

    @Billy Budd, the evidence refutes your false claim that these drugs are “poisoning your body” to any significant extent when used for PrEP. I wish people would stop using harmful fear tactics out of some pathological need to try to control other people’s behavior. Kisses, body contact, and toys, really? Do you have any concept how useless that kind of advice has been in reducing the epidemic, or did you just land here from Mars? In any case, HIV will poison your body much more than PrEP ever could.

  • Billy Budd

    @vive: I said you should restrict yourself ONLY if you are incompetent, ******, or refractory in using condoms.

  • vive

    @Billy Budd, how well do you think that advice has worked for HIV prevention? A majority of gay men are still refractory in using condoms despite all the messaging over the past three decades. In fact, they are becoming more refractory. They are beyond being told to kiss and cuddle instead. Did you just drop in from another planet?

  • Billy Budd

    I’ve had sex with dozens of people in the last 10 years and NO ONE, NO ONE ever asked me not to use a condom, and nobody ever forgot to use a condom when I bottomed. Nobody. Ever. I guess we live in different circles. I guess addicts and uneducated people are more difficult to convince and/or discipline.

  • Billy Budd

    Also, the vast majority of HIV+ people live in Africa. More than two-thirds (70 percent) of all people living with HIV, 25 million, live in sub-Saharan Africa. Will they get Truvada every day? Or is it better if we continue distributing condoms and teaching and convincing people of the need to use condoms? Are we going to donate Truvada to the 25 million people who really need it? I don’t think so. Truvada is a drug, with an efficacy that was calculated based on projections/simulations and not on hard empirical data, and with potentially dangerous side effects. it is also expensive.

    Condoms are efficient and cheap. If you have discipline to take a pill EVERY day (and you MUST take it every day otherwise youre fucked), why can’t you have discipline to open a packaging of a condom from time to time?

  • Billy Budd

    When I say from time to time, I mean, whenever you fuck or get fucked.

  • vive

    @Billy Budd, maybe because sex with condoms sucks compared to sex without them, for most people.

    And yes, there are already pilot PrEP projects in Africa. And in the U.S. half the people on PrEP are not men but women, most of them poor.

  • Fang

    @vive: I’m right there with ya! There are always going to be people like Billy Budd that just don’t get it. Is it really so audacious that we wish to liberate ourselves from the fear of sex? And is sex without condoms, in itself, morally impermissible? For me, anti-prep zealotry is a very specific kind of denial rooted in self-loathing. When condoms were all gay men had to prevent HIV, yes, they should be used whenever possible if the person in question was interested in being as safe as possible. But we are now living in a time when medical technology precludes such conservatism and we can enjoy the kind of sex we want to have. With all the resources we have available, saying that any penetrative sex without condoms is morally unacceptable or irresponsible is to say that gay sex is inherently bad and it’s most natural form should be avoided. I will not apologize for finally enjoying sex without fear. I view myself as a responsible person and I care about my health and the health of my partners. Science is on prep’s side and that’s enough for me.

  • Dr. Mo


    Hi Tackle,

    Big Pharma can’t quite cover things up. By law all adverse effects have to be reported to the FDA. Usually the first person notified of an adverse effect is the prescribing doctor. Reports of adverse effects usually bypass the pharmaceutical company and go directly to the regulatory agency.

    Look for this information in the FDA’s webiste. This is all public information.

  • Riverhog

    I have been on this medicine since it came out and I proud to say my viral load is undetectable and T Cells back to normal. I take good care of myself but due to being a trucker it is very hard with the hours and stress I have. I am a 14 year survivor and plan to keep going.

  • junior818

    @vive: hi can you please email me i want to know your story and see if truvada reallt works

Comments are closed.