In US, gay men clash over HIV prevention pill

May 17, 2014 by Kerry Sheridan

A single daily pill may help prevent HIV. And in America, gay men who have lost countless loved ones to AIDS can't stop fighting about it.

Much of the debate has played out on the Internet and social media as tempers flare over promiscuity, erratic condom use and the potential to either eliminate or worsen the stubborn HIV/AIDS epidemic, which has killed 36 million people worldwide in the past three decades.

The drug in question is Truvada, an oblong blue pill that combines two antiretroviral medications—tenofovir and emtricitabine.

"In the medical community, this is more of a controversial, divisive issue than I ever thought it would be," said Ray Martins, chief medical officer at the Whitman-Walker Clinic.

Martins told AFP a month's supply of pills costs between $1,200 and $2,000, which is usually covered by health insurance. Side effects are rare but can include nausea, bloating and diarrhea.

Made by Gilead Sciences in California, Truvada was already available as a medication for HIV-positive patients when it was approved by US regulators in 2012 as a prevention strategy for people who are HIV-negative but engage in sex with HIV-positive partners, or who inject drugs.

On Wednesday, the US Centers for Disease Control and Prevention issued its first formal guidelines for doctors, urging them to recommend the prevention pill for patients at substantial risk of getting HIV.

The daily pill should be used in conjunction with condoms as a way to cut back on new HIV infections, which have stayed steady at some 50,000 new annual cases in the United States in recent years, officials said.

'Truvada whores'

"This is a position I fear the CDC will come to regret," said Michael Weinstein, president of the Los Angeles-based AIDS Healthcare Foundation (AHF).

Weinstein predicted the guidelines "will likely have catastrophic consequences in the fight against AIDS in this country."

He has also described Truvada as a "party drug," sparking a fresh wave of angst among supporters of pre-exposure prophylaxis, or PrEP, whereby healthy people take antiretrovirals as a way to prevent HIV infection.

AHF spokesman Ged Kenslea said Truvada is available in AHF's pharmacies, and that the group does not oppose PrEP if a doctor and patient agree it could be useful in a given situation.

"The government's wholesale endorsement, we believe, is dangerous and will result in needless new infection," Kenslea explained.

Human nature, the inability to take pills daily even among the most responsible adults, and the rise in syphilis among gay men are all reasons cited for concern.

The backlash against Truvada—the only pill presently approved for HIV prevention—has led some gay men to speak out in favor of it, even describing themselves online as "Truvada whores" in a tongue-in-cheek gesture.

One of them is Bradley, 28, a San Francisco technology worker who tweets as @TruvadaWhore and asked that his last name not be published.

"I am adamantly against slut shaming and policing of people's consensual behavior," he said in an interview.

"PrEP may not work for or be accessible to everyone, but I want to celebrate its effectiveness and fight stigma."

Science of 'risk'

Studies have shown that when taken regularly, Truvada is effective against HIV transmission by up to 92 percent, the CDC said. However, when patients failed to take it daily, its effectiveness dropped steeply.

As to whether PrEP encourages riskier sex, Whitman-Walker clinical research director Richard Elion said studies on thousands of people have shown it does not.

"The evidence is quite clear. There is no documentation of increased risk behavior," he said.

"We are not seeing more syphilis in the people on PrEP studies."

Still, relatively few people are taking Truvada for prevention. A Gilead spokeswoman said that as of September 2013, reports from half of US retail pharmacies showed 2,319 people had started taking it for PrEP.

If Truvada goes mainstream and the CDC guidelines are followed, experts believe prescriptions could increase to 500,000 a year.

Already, some small changes are evident. Those who frequent gay dating sites may now list "PrEP" as their HIV status, adding a new category to the old standbys of "Positive," "Negative" or "Ask Me," according to Cyle Durkee, 34, an actor and author who lives in the US capital.

Durkee said he decided to enroll in a one-year study of Truvada after he went for an HIV test—which was negative—and his doctor told him about Truvada.

"Just being sexually active in DC can be incredibly risky," Durkee told AFP.

"I have literally never met a guy who gives head with a condom on. Technically, that is risky behavior."

Washington's HIV crisis is among the worst in the nation, with some three percent of residents infected, or triple what the World Health Organization considers an epidemic.

A recent survey issued by the mayor's office also found that only about half of used condoms.

Durkee said he has been taking Truvada for several months now and only experienced some bloating initially.

He was also only slightly aware of the backlash.

"I have not gotten a single negative word about it from anybody," he said.

"If this will help eradicate HIV, then I will happily take some pills."

Explore further: US backs expanded AIDS therapy for prevention

Related Stories

US backs expanded AIDS therapy for prevention

May 16, 2014
US health authorities are recommending the daily use of anti-retroviral medication to prevent HIV infection for high-risk groups.

CDC urges anti-HIV pill for people at high risk of infection

May 15, 2014
(HealthDay)—People deemed to be at high risk for contracting HIV, the virus that causes AIDS, should take anti-HIV medicines that seem to cut transmission risk, the U.S. Centers for Disease Control and Prevention announced ...

Gay men divided over use of HIV prevention drug

April 6, 2014
A drug hailed as a lifesaver for many people infected by HIV is at the heart of a rancorous debate among gay men, AIDS activists and health professionals over its potential for protecting uninfected men who engage in gay ...

High-risk heterosexuals should take HIV prevention pill, too

August 10, 2012
(HealthDay) -- Doctors should consider prescribing the HIV prevention pill Truvada to their heterosexual patients who are at high risk for the virus, not just high-risk gay and bisexual men, experts from the U.S. Centers ...

UNAIDS welcomes US approval of drug to stop HIV

July 17, 2012
The UN agency tasked with fighting AIDS on Tuesday welcomed the decision by the United States to allow the use of an HIV prevention pill for the first time.

HIV answers raise new ethical questions

July 31, 2013
The Food and Drug Administration's approval last year of the drug Truvada for prevention of HIV infection was a milestone in the fight against HIV/AIDS, but experts are cautioning that it is only the beginning of new ethical ...

Recommended for you

War in Ukraine has escalated HIV spread in the country: study

January 15, 2018
Conflict in Ukraine has increased the risk of HIV outbreaks throughout the country as displaced HIV-infected people move from war-affected regions to areas with higher risk of transmission, according to analysis by scientists.

Researchers offer new model for uncovering true HIV mortality rates in Zambia

January 12, 2018
A new study that seeks to better ascertain HIV mortality rates in Zambia could provide a model for improved national and regional surveillance approaches, and ultimately, more effective HIV treatment strategies.

New drug capsule may allow weekly HIV treatment

January 9, 2018
Researchers at MIT and Brigham and Women's Hospital have developed a capsule that can deliver a week's worth of HIV drugs in a single dose. This advance could make it much easier for patients to adhere to the strict schedule ...

New long-acting, less-toxic HIV drug suppresses virus in humanized mice

January 8, 2018
A team of Yale researchers tested a new chemical compound that suppresses HIV, protects immune cells, and remains effective for weeks with a single dose. In animal experiments, the compound proved to be a promising new candidate ...

Usage remains low for pill that can prevent HIV infection

January 8, 2018
From gritty neighborhoods in New York and Los Angeles to clinics in Kenya and Brazil, health workers are trying to popularize a pill that has proven highly effective in preventing HIV but which—in their view—remains woefully ...

Researchers find clues to AIDS resistance in sooty mangabey genome

January 3, 2018
Peaceful co-existence, rather than war: that's how sooty mangabeys, a monkey species found in West Africa, handle infection by SIV, a relative of HIV, and avoid developing AIDS-like disease.

1 comment

Adjust slider to filter visible comments by rank

Display comments: newest first

not rated yet May 22, 2014
This is comical. It reminds me of conservatives insisting that sex education and free condoms will increase teen pregnancy.

It's true that gay men need to take STDs a lot more seriously than they do. I know some who never get tested, who give and receive oral from random people in parking lots, etc. It's like they think you can't get the crud from oral or something.

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.