December 9, 2014
By Riley McDermid, BioSpace.com Breaking News Sr. Editor
The gay community worldwide is continuing to struggle with a mixed blessing that was originally viewed as a panacea for the HIV/AIDS crisis: How do you get men to engage in safe sex if they are already taking a pill from Gilead Sciences, Inc. that stops HIV infection?
The tablet, Truvada, seemed like a godsend for older gay men who remember the terrifying early days of the AIDS crisis in the 1980s, when infection almost certainly meant death. But to younger men taking Truvada, which has a 92 percent rate of effectiveness at reducing HIV infection, is an insurance policy that can sometimes lead them to forego condoms or engage in other high-risk behavior.
The pill is a cocktail of the drugs emtricitabine and tenofovir. It was approved by the U.S. Food and Drug Administration in 2004 as an HIV treatment, but approved as a pre-exposure prophylaxis (PrEP) in 2009.
Truvada can be expensive: it costs $13,000 annually, but much of that is usually is covered by insurance plans. Gilead release pharmacy records last year that showed that between January 1, 2012, and March 31, 2014, at least 3,253 people in the U.S. began taking Truvada “on-label,” or as prescribed by a doctor.
That’s a good sign, say HIV/AIDS advocates, but no foolproof method against contracting the disease—or infecting someone else.
“You have to be really paranoid about your health to wear a belt and suspenders,” AIDS Healthcare Foundation President Michael Weinstein told the L.A. Times. “If the culture shifts to unprotected sex because of the campaign to promote Truvada, then [HIV] rates will go up.”
Weinstein’s group has launched a campaign to get the gay community to think about Truvada as something more than a “party drug.” It has also urged the U.S. Centers for Disease Control to double down on its efforts to stress condom use is the first line of defense against contracting the virus.
New data from healthcare provide Kaiser Permanente appears to back up Weinstein’s concerns. In a recent survey, Kaiser AIDS prevention program tracked 500 people who have started taking Truvada once a day as PrEP—and found that among that group, sex without condom skyrocketed 45 percent. Still, Kaiser warned that those statistics come with a major footnote: They are only applicable to “self-reported” condom use by a subset of about 90 PrEP patients in the Kaiser program, which means many more people, or very few people, could actually be using condoms in tandem with Truvada.
Still, why people decide to take Truvada—and how they decide to use it—often varies, Kaiser’s AIDS program director Brad Hare told the San Francisco Business Times.
“The reasons people are coming in are different,” Hare said. “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.’ ”
