An HIV Prevention Tool for a High Risk Environmentby Theodore Miller Patient Expert
Over the last several years working in both HIV-related research and living as a young gay man, I have witnessed both patients and friends become HIV-positive. Despite most people knowing that if condoms are employed during sexual intercourse HIV is preventable; it has become evident that perhaps condoms are not enough. According to the Center for Disease Control and Prevention (CDC) HIV transmission continues to rise among individuals aged 13-34, white men who have sex with men (MSM), Black MSM, and Hispanic MSM.(http://www.cdc.gov/hiv/library/reports/surveillance/index.html#panel1) Thus, new forms of comprehensive prevention are warranted. As of 2012 the Food and Drug Administration (FDA) approved the drug Truvada as a prevention method for HIV, referred to as Pre-Exposure Prophylaxis (PrEP).
What is PrEP?
PrEP is a biomedical approach to HIV prevention. Prophalaxis means to prevent or control the spread of an infection or disease. PrEP refers to HIV-negative persons taking antiretroviral medication everyday prior to being exposed to HIV infection. The goal of this prevention method is if individuals taking PrEP are exposed to HIV the medication work to prevent the virus from chronically infecting the body. The current medication used for PrEP is Truvada which contains two medicines that are used to treat HIV-infection. When someone takes PrEP everyday as prescribed is exposed to HIV, PrEP helps stop the virus from permanently infecting the person. Research has shown that if taken everyday as prescribed, PrEP can reduce the risk HIV transmission by 92%.
Who Should take PrEP?
Within the United States, federal guidelines suggest that PrEP should be considered for individuals at substantial risk for infection. Specifically:
Anyone who is HIV-negative and in an ongoing relationship with an HIV-positive partner
Gay or bisexual men who have had sex without a condom or been diagnosed with an STI in the past 6 months
Heterosexual individuals who do not regularly use condoms during sex with partners of unknown HIV status
Individuals having sex with individuals at substantial risk for HIV infection (such as injection drug users)
Controversy Around PrEP
Many doctors and activitists regard PrEP as a major breakthrough in prevention technologies. Yet others see PrEP as a reckless drug that encourages high risk behavior. Within the gay community for example, there has been a lot of finger pointing as to whether PrEP discourages condom use and in some cases PrEP use has been painted with stigmatizing labels such as a 'party pill.' It should be noted that this new prevention tool is not meant to replace condoms, but be utilized as a component of comprehensive HIV prevention. Dr. Perry Halkitis of New York University an HIV expert remarks that 'We have to accept that 30 years of the epidemic have clearly shown that behavioral approaches are not enough, but perhaps behavioral and biological approaches when combined are better and more powerful. But, ultimately, our greatest tool would be to marry biological approaches such as PrEP, behavioral approaches, and changes in social structure which he refers to as the three prong approach.
Prep Take Aways
PrEP is meant to be taken by people who are at high risk for being exposed to HIV
PrEP is not meant to replace condoms, but as a comprehensive tool for HIV prevention
PrEP is not 100% effective
If you are exposed to HIV and not on PrEP, there is an alternate medication regimen that can be taken within 72 hours of exposure called Post-Exposure Prophylaxis
1- CDC. Estimated HIV incidence in the United States, 2007-2010. HIV Surveillance Supplemental Report 2012;17(No. 4). Published December 2014
2- Grant, R. M., Lama, J. R., Anderson, P. L., McMahan, V., Liu, A. Y., Vargas, L., ... & Glidden, D. V. (2010). Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. New England Journal of Medicine, 363(27), 2587-2599.
3- Weinberg, J., Spinelli, F., Bailey, L., Halkitis, P. N., Jacobs, D., & Daskalakis, D. (2014). Have Condoms Failed Us? A Community Roundtable Discussion. LGBT Health, 1(4), 242-249.