QUESTION: Should PrEP Treatments Like Truvada Be Encouraged For HIV-Negative People?

Welcome to The Queerty Query, where we raise questions and ask you, the readers, to weigh in. Sometimes the questions will be funny, sometimes they’ll be serious—it all depends what the chatter around the water cooler is.

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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.)

Should Truvada Be Given To HIV Negative People?

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.

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  • Chris

    I’m not a fan of PREP, mostly due to the cost, while people in this country go without HIV medications. It just seems wrong!

  • QJ201

    @Chris: agreed…AND

    the recommendation to take Truvada daily makes absolutely no sense unless you are someone who just never knows when you are gonna give up your ass raw to some random guy (oh they exist I’m sure).

    Medication is taken on a schedule to maintain “bio-avialability” of the drug to fight whatever the disease or condition is.

    So you take a pill once a day because yesterday’s pill has already been metabolized out of your system.

    Truvada, according to their own information is fully bio-available in the blood within 1-2 hours. So conceivably you would only need to take it in advance of sex…or use it like PEP and then take it for a week after sex. (They put people on PEP for a month…which also makes no sense given that “seroconversion” happens in 3-5 days after infection).

    Seems just to be another way of getting people to take more pills that they don’t need.

    And also NOT giving full information to avoid comments like I just made.

  • James

    I think that a medication like this sends the wrong message to the community at large. Regardless of wether or not you are “at risk” safe sex should still and always be practiced. This isnt even succesful enough to be considered a vacine, so why is it even on the market accept to generate revenue. its the morning after pill for HIV/AIDS. Its carless and iresponsible. Should be more focused on getting medications and treatment to those people who are truly in need. the ones already living with infection, give them the meds to need to have some quality of life. personaly i think that all HIV/AIDS medications should be free but i also believe that the medical system in my country is broken.

  • Stuart

    Has anyone looked at the side effects, its really not worth it

  • Ruhlmann

    Wow, don’t want to take responsiblity for yourself and make a life and death decision about your health? Rest assured there’s a pill for that.

  • Andrew

    I had to take it for PEP once, and it’s… not pleasant. It’s kind of like being a little bit poisoned all the time. And, in addition to all of the stomach side effects, my skin went all weird. And I found even having one drink to be too much for my system. So, from a harm reduction point of view, I don’t really think it’s a great idea. Maybe for certain situations? Otherwise, condoms are cheaper, safer and just as effective.

  • David

    I would have used PrEP if it had been available when I needed it. I had an HIV+ boyfriend and for psychological and emotional reasons I began topping him without a condom (never the other way around). I knew it was a risk, though much lower than bottoming. But sex and love are really, really complicated and the truth is that condoms simply became a really really difficult thing to contend with. I was lucky, I escaped becoming infected, but it could easily have gone the other way.

    I think it’s easy to have stereotypical views of who would and wouldn’t use PrEP. Frankly, I know plenty of party boys who manage to make it to the gym everyday and to take all of their body-building supplements, so I do think that some could adhere. Also, plenty of people (not just women) end up in relationships with power imbalances and emotional and physical violence, where the person being abused risks harm to insist on condom use by their partner. PrEP can be done in secret. It’s really easy to cast judgement and think, “Hey, just leave the guy.” But domestic violence doesn’t work this way.

    Lastly, I have a medical background, and I know the side effects of Truvada. The upset stomach in the first couple of weeks isn’t pleasant and the risk for a small percentage of kidney and bone issues is real. But the side effects of HIV are a lot worse, as is the fact that you will need to go back on Truvada and other HIV meds for life if you do get infected. I’d just urge all of us to have an open mind and not rush to judgement about PrEP. It could, quite literally, be a life saver for some and if we publicly talk about it in such a negative way we may scare off those who need it most, but are also most ashamed of the struggles they are having with condoms.

  • IzzyLuna

    I don’t think it’s necessary for negative people to take it. If someone is HIV and you’re negative, you DONT HAVE to have bareback sex: in love or not. I can’t imagine someone saying, “Well, I HAVE to have bareback sex because of blah blah blah” so I’m gonna get on Truvada.

  • gattsuru

    It’s not an either-or thing.

    Condoms aren’t 100% effective in preventing the transmission of HIV, what with inconsistent or improper use, breakage, or the simple part where HIV is a damned small thing to try and block. Depending on study and how strongly you isolate for proper use, condoms may reduce the risk of per-act transmission between as much as one-in-twenty to a little as one-in-four — significant and very much worth it, but not so much so that folk in seriodiscordant relationships can feel terribly safe about it.

    Yes, some of the folk that use Truvada probably are going to not wrap things up, even with an FDA-mandated browbeating about correct condom use. That’s not a terrible surprise. If they’re people that already weren’t going to use condoms, it still helps. And programs to try and get them to be better about condom use can keep happening with or without Truvada around. Meanwhile, it’ll help other folk.

  • gattsuru

    For clarification, that’s 5% to 25% of the normal per-act risk, not a one-in-four chance of getting HIV positive from a single sex act.

  • Brent W.

    No people will think that PrEP is a pill that’s a cure for HIV and they’ll use it and bareback instead of using condoms and more people will get infected.

    Then again if they’re doing it bareback I’m sure they don’t care if they get HIV.

    Also HIV meds have horrible side effects including Truvada.

  • Martin

    It seems to me that withholding this drug because you’d rather people behaved more sensibly and used or condoms or behaved responsibly is a bit like the Pope who prefer abstinence (his brand of sensible behaviour), to condom use.
    The result is most likely the same, more infections. Sex-workers are more at risk of contracting HIV why not let them have it? Hardly anyone use condoms for oral, yet it is possible to be infected in this way. You might prefer the sleaze-bags to just drop dead, but its not going to happen. There will always be people who for one reason or another end up having risky sex…

    Sure no one in a stable relationship may ever need this drug, but there might be others who could benefit. Every reduction in spread, means a further reduced potential for spread as the number of cases dwindle, and this drug targets the high-risk group.

  • Trent

    I have also had to take the PrEP. It is like hiroshima for your body. you are sick and feel terrible. It can make your hair fall out and make you lose weight and can make you nauseous. I personally just felt terrible for about 2 weeks and couldn’t wait to be off it.

  • Errr...

    Excluding the idea of unsafe sex people, not just gays, anyone.. Will health care providers need to take yet another drug that may or may not work? And the side effects on pretty much every legal drug out there are sometimes way worse than whatever the condition is you are being treated for.

  • Tony

    Comparing this drug to the pope’s abstinance stance is inaccurate. It’s more like pointing out the obvious that if a woman uses birth control, she’s less likely to insist on condoms. The problem is that while birth control and condoms do a decent job of preventing conception, even under te best laboratory conditions, prep hasn’t begun to approach the effectiveness of condoms. Throw in some serious and unresolved concerns about resistance that weve steamrolled over, and I really think the FDA and advocates of this drug sold a lot of people out.

  • Derek

    @Brent W.: You are seriously f*cking clueless and worse-stupid.

  • adam

    I concur with all of the above reasons NOT to take Truvada, and yet they all seem to proceed on the assumption we can trust the pharmaceutical establishment. They haven’t earned back my trust yet, and it’s going to be a hell of a long time before I let them into my body and into my wallet. This pill seems little more than an attempt to maximize profits via risky stupidity.

  • Mitch

    40% effective. That’s how effective this drug is. Not “80% effective” provided that we get rid of the least adherent people. Not “92% effective” when we only observe people who never vary their dose by more than a few hours, which, for reference, is only like 10% of users. To cherrypick the subjects you want to get the answer you deserve is a high-order act of research fraud, barely better than making things up. Let me restate the fact; PrEP is 40 something percent effective. Period.

    Historically, what we’ve demonstrated is that drugs tend to be much less effective when they’re not administered in trials where patients are handpicked and admonished to adhere by researchers whose job is to prove efficacy, so we can presume that the real world effectiveness of prep will be somewhere in the 30% range. That’s about as effective as some of our HIV vaccine “failures” that we’ve flushed down the toilet, and never heard about again. Glaring issue is that unlike PrEP, these HIV vaccines have the real world possibility of protecting EVERYONE all the time, not just Treasure Island wannabes and yuppies on vacation. Thus, we’ve trashed MORE effective means of prevention in the past, citing their insufficient preventative value, while jamming this garbage down people’s throats. If that doesn’t make everyone, poz, neg, straight, gay, whatever, SERIOUSLY suspicious of the FDA and the people who motioned for this drug, then you’re blind.

  • James

    I’m a 38-year-old gay man who works in public health. I’ve spent most of my career helping people understand the risk associated with all kinds of sex. And for the last eight years I did it from a very “safe” place—I was married to my partner of eight years; we were monogamous and hadn’t used condoms in years.

    Then my husband left me for a man he had being secretly seeing during the final several months of our relationship. He left an STD as a parting gift, along with significant psychological and emotional wounds. I spiraled downward, abused alcohol to numb the pain and had very risky sex with strangers more than once.

    At any given time, any one of us could find ourselves unexpectedly in a situation where condoms go unused. That doesn’t make us bad people. That makes us human. And the more we judge, condemn or isolate people who struggle with condom use, the more we set our movement back.

    The efficacy data on Truvada in clinical trials can be parsed creatively to prove both sides of this argument. FACT: People who took this medication daily in clinical trials found it 90% effective in preventing infection. For me, knowing I would have been protected during my dark period is all I would have needed to take it daily with my morning vitamins. I would have been among that group of people and had a 9 in 10 chance of protection from HIV.

    Make no mistake, this is not a magic bullet. Unfortunately, the ultimate magic bullet – a cure – is years off. In the meantime we need tools like Truvada. It is a big step forward and will help a lot of people in our community. What’s wrong with that?

  • Gato

    I live in DC and I am not monogamous at the moment. I have sex with condoms almost always, I have been having sex for 30 years and I am still negative because of that. When I heard about Prep Truvada I really got excited. I feel I need an extra layer of protection. I have been using it for a month with no side effects. Taking it everyday is part of my routine. No big deal. I have 3 other friends on Prep with no side effects either. My dr. will be monitoring my kidneys and liver just in case. But so far so good. I see taking Truvada as a choice to protect my health from a life long disease. It works for me.

  • Clark35

    Hell no. Truvada is toxic and I have noticed a lot of people who take it who claim to be HIV neg just use it as an excuse to bareback like it’s 1975 with whoever they want, and a lot of these people are either really HIV+ or will become HIV+.

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