One of the biggest developments since they first determined that HIV was the retrovirus that causes AIDS, was the development of a prophylaxis that uses two drugs currently used to treat HIV. However, in the case of PrEP, the drug is taken once a day, and everyday to prevent the HIV retrovirus from getting established within the body. I have tremendous concerns about PrEP, however, I also understand the advantages it offers. It is blasphemous to many AIDS activists and HIV positive persons to say anything negative about PrEP, so I won’t be surprised if there is push back. As always, the opinions expressed are my own, and your comments and ideas are always welcome.
Even with concerns, I can see the writing on the wall. A treatment like PrEP is the future, at least until some vaccine or cure is developed. Though I have become resigned to the belief that may never happen. The generic Flu kills thousands every year, and the best we, as a culture can do is a yearly vaccine which isn’t good against all Flu. There is a part of me which is holding fast to the notion that we already know how to prevent AIDS with the use of condoms. But I am starting to agree that the reasons that inhibit condom use will continue to interfere with adequate prevention, and another mode of prophylaxis is required.
I’m not alone in having concerns about PrEP. Adoption within the gay community has been slow. But as more information is released, and more questions answered, that may change.
PrEP and condoms
One of t he biggest concerns many express about PrEP is concern that gay men will use PrEP as it is were an alternative to using condoms. Even the CDC advises condoms to be used in conjunction with PrEP. The research conducted doesn’t, to the best of my knowledge really determine how effective PrEP is, all by itself. In all studies I reviewed, bot the control group as well as the trial group received condoms, counseling, regular testing as well as either the medication or placebo. Being given condoms, counseling, and regular testing in and of itself could have had a positive effect on the study participants.
In addition, PrEP doesn’t stop other STD’s like condoms can, and while other diseases may not be stigmatized like HIV/AIDS, they are nonetheless critical to control.
Those who seek to use PrEP instead of condoms, as if it is a license to be sexually out of control, are a part of the problem. Hey, I’m fine with sexual liberation and abandon. I was extremely sexually active in my youth. But if we fail to recognize the issues with hat mindset, especially while blaming others for stigmatizing AIDS, we have a real problem.
Will guys take their PrEP?
Another concern is that guys won’t take their PrEP as prescribed, and missing does may mean a failure to be protected. In reality, we don’t know what all it may mean, as the medication therapy hasn’t been out there long enough. I think this concern should have everyone worried. As a culture in general, people are often less consistent with self care. It would be a shame to pump all these drugs into your system, but then fail to use it regularly, and still become infected.
John Aravosis and others have written a number of posts at Americablog about an alternative method for this medication, a quarterly injection, which I think makes much more sense, and may be far more reliable. The linked post provides some great commentary about PrEP.
Once, the drug companies were the enemy…
I personally have real trouble wrapping my head around the idea that the solution to the AIDS epidemic involves a daily expenditure which funds big pharmaceutical companies. Once, they were the enemy and groups like Act Up! fought valiantly to bring down drug costs and places lives before profits. Was all of those efforts in vain? The question may be ridiculous, as in general society has made Big Pharma more important than any industry outside Big Oil.
Your daily Death Reminder
An idea that I haven’t thought through entirely is that one reason guys don’t use condoms more is that overtime you touch one, it is a reminder that you are worried about an invisible killer you may be coming in contact with.This ongoing reminder is really a buzz kill and I believe it encourages people to not be very present during sex and therefore, have lots (??) of mediocre sex. Sex is only a phenomenal experience with two people are full present, and become vulnerable to the passion. Vulnerability and remembering the invisible killer are hard to hold in your brain at the same moment. Its possible that a daily does of PrEP may do the same thing.
I suppose it is also possible it will have the opposite effect if used and condoms ignored. You will only have one brief moment a day when the idea might cross your mind, and if you can take the pill with your daily vitamin you could almost be in denial of the specter of AIDS entirely.
Added complexity rather than more simplicity
Going on PrEP requires getting tested every few months which may be more than people are currently tested. This added testing, will no doubt be coupled with a practitioner interaction and potential counseling. Will the counseling including coaching for safer sex? All of this is added complexity but has the possibility for a big pay off. The added complexity may be worth it. My concern however, is that people will often be able to add complexity for a period of time, but be unable to maintain it in the long run.
The bottom line
For me the bottom line is fairly clear. PrEP has major advantages and will play a key role in the battle against HIV/AIDS. There are so many health concerns which now have pharmaceutical interventions but can be minimized by behavior changes. Think about weight issues, diabetes and heart conditions. I know a number of folks who have lowered or eliminated medications through diet and exercise. Doesn’t consistent use of condoms make PrEP irrelevant except in some specific situations such as monogamous relationships of zero discordant partners?
What are your thoughts? Have you considered or are you taking PrEP? How do you consider the pros and cons of this daily drug regimen? Comments welcome.