On May 7th, GMHC will host the first of four community forums to discuss HIV Pre-Exposure Prophylaxis (PrEP). The Centers for Disease Control defines HIV PrEP as an “HIV prevention method in which people who do not have HIV take a daily pill to reduce their risk of becoming infected. When used consistently, PrEP has been shown to reduce the risk of HIV infection among adult men and women at very high risk for HIV infection through sex or injecting drug use.”
In July 2012, the U.S. Food and Drug Administration approved the combination antiretroviral medication Truvada or tenofovir disoproxil fumarate plus emtricitabine (TDF/FTC) for use as PrEP among sexually active adults at risk for HIV infection. The use of antiretrovirals (ARV’s) as pre-exposure prophylaxis (PrEP) has been shown to be effective in reducing the risk of HIV transmission among men who have sex with men and heterosexual couples. Adults should consult with their doctor to see if PrEP is right for them. PrEP is not intended to be used alone but in conjunction with condoms to help prevent the spread of HIV.
The first forum, entitled, Have Condoms Failed Us? Will focus on men who have sex with men (MSM) and will take place at GMHC, located at 446 West 33rd Street, NYC at 7PM on May 7th. The panelists include Demetre Daskalakis, MD, HIV/AIDS Services, Mt. Sinai Hospital, Lloyd Bailey, MD, The Spencer Cox Center for Health, Mt. Sinai, Perry Halkitis, PhD, MPH, Center for Health, Identity, Behavior and Prevention Studies at NYU and Damon Jacobs, LMFT, private practice psychotherapist. I will be the moderator.
The second event will be held on June 4th and will focus on sero-discordant couples and fertility. The third will take place on September 10th and the topic is PrEP in people of color and the final event will be a large scale debate on October 8th.
According to the CDC there are about 50,000 new cases of HIV every year, but since 2013 there have only been 1400 people on HIV PrEP. Opponents to PrEP include Michael Weinstein, President of the AIDS Healthcare Foundation, who called Truvada a “Party Drug,” stating that “Men don’t need more excuses not to use condoms,” and adding that PrEP would be “A catastrophe for HIV prevention.”
Research shows that Truvada is up to 99% effective in preventing new HIV infections if it is taken daily and used with condoms. One reason why more people don’t know about PrEP is that Gilead Sciences, the manufacturers of Truvada, have chosen not to promote the drug as a preventative measure. The controversy surrounding the use of Truvada for PrEP has many people arguing that this will lead to unsafe sex despite studies that suggest PrEP doesn’t lead to riskier sex. Researchers at the Gladstone Institutes, an affiliate of the University of California, San Francisco, built upon their three-year 2010 Global iPrEx clinical study of Truvada as PrEP. Publishing their findings in PLOS ONE, they re-examined data of the nearly 2,500 HIV-negative gay men and male-to-female transgender women in six countries who participated. “Our results suggest that HIV prevention strategies such as Truvada don’t result in risk compensation because they provide an opportunity for participants to actively engage in and reduce their risk of HIV infection,” said Gladstone Institutes’ Robert Grant, MD, MPH. “Engagement, which also includes counseling, provision of condoms and management of other sexually transmitted infections, leads to motivation, which comes at a time when motivation for preventing new HIV infections is vital to curbing the spread of this worldwide epidemic.”
There are many who feel the cost of Truvada is a deterrent. A month’s supply is approximately $1,000. Gilead does have an assistance program to help underinsured patients or patients with no insurance as well as a copay assistance program.
The intention of the four part forum is to raise awareness about HIV PrEP in the hopes of having an informative and interactive discussion. While Truvada alone isn’t the answer to halting the AIDS epidemic, we have to acknowledge that condom usage has dropped among gay men and that looking forward we must consider a variety of safe-sex practices to protect gay men from contracting HIV.