Op-Ed: Why Are We Not Talking About PrEP?
A month ago, I began taking a blue pill each day, called Truvada.
It's a combination of two of the three antiretroviral medications that form the cocktail used to treat people with HIV. Last year, the FDA approved the prescription of Truvada for the preventing of HIV in people who are uninfected. The term for this is pre-exposure prophylaxis (PrEP).
I'm HIV negative.
My choice to begin taking a highly-potent HIV drug wasn't an easy one. And the decision to come out publicly as someone who's on PrEP is not one that I take lightly.
But the more I learn about PrEP, the more shocked I'm becoming that gay men are not shouting from the rooftops about this potential game changer in the fight to prevent new HIV infections, which we're losing badly.
I'm ready to shout about it.
Here's what helped convince me: Dr. Robert Grant of UCSF, the researcher who led the multinational study on PrEP, was quoted at an AIDS conference as saying that “No one in iPrEx [the PrEP study] acquired HIV infection with a drug level that would have been expected with daily dosing.”
Was this really possible? Whether they used condoms or not, people who took Truvada, as prescribed, were protected from the virus? Before writing this column, I reached out to Dr. Grant to make sure I understood correctly.
While emphasizing that PrEP is still "very new," Dr. Grant confirms that "we have not seen anyone become infected that indicated daily use." He explained that the people in his study were among those at highest risk of becoming positive: gay men whose partners were already positive, and other men who frequently had unprotected sex.
Before I go any further, I do realize that I'm committing heresy. I'm certain there are safe-sex advocates in our community who are reading this right now, and whose heads are about to explode. Am I telling people to pop a pill and go have bareback sex?
I'm not. I am advocating that we look at both the social and medical science, and begin responding accordingly. And I too am angry.
In the past month, eight people I know have told me that they've tested positive for HIV. A couple of them had boyfriends who cheated on them. These friends, who didn't know about PrEP, are now unfortunately among the 50,000 Americans newly infected with HIV each year — one in four of whom is under 24 years old.
Whether we want to admit it or not, safe-sex education has been an epic failure. In a recent national survey, the majority of gay men—58%—admitted to not using a condom the last time they had anal sex. Is PrEp better than condoms? Dr. Grant won't go that far, but here's what he did say in a phone conversation: "That actual use of PrEp is more effective than saying you'll use condoms and not using them. And that's often the choice people make."
I know I'm not a public health expert, but I can't understand why we're not discussing, in a serious way, getting the most at-risk in our community on this medication immediately. With new and preventable HIV infections happening every hour, is the silence about PrEP among the safe-sex establishment not criminal?
One more statistic: US News reports that if HIV infections among gay men continue to rise at current rates, more than half of college-aged gay men will have HIV by the age of 50. We desperately need a new approach to battling new infections.
To be sure, taking Truvada is not like taking a vitamin. This is serious medication, and unless people take it every day, the protection it offers is greatly reduced. And like all medications, it carries risks and potential side effects—some of which are potentially quite serious. But none of the friends I know who are taking Truvada PrEP have experienced anything abnormal.
And here's as another good thing about Truvada PrEP: You can stop taking it! You can use it at times when you're most sexually active, and stop taking it when you're not having sex. If the side effects are a problem for you, you can simply go off of it.
But if you are HIV positive, that's simply not an option. As of now, you're on it for life. And if you're positive, you have to take another pill, which often causes diarrhea and other unpleasantness. I know this because I've slipped up before, and went on post-exposure prophylactic treatment, which includes all three medications.
There are a few other downsides to the PrEP strategy. If your insurance doesn't cover it, Truvada costs around a thousand dollars per month. But Gilead, the maker of Truvada, is offering assistance (free pills) to qualifying individuals who can't afford it.
You also must get an HIV test before starting Truvada, and between any "breaks" in using it. And, yes, you should continue to use condoms even while taking Truvada to avoid getting other STD's.
I'm now 41 years old, and have been sexually active for at least 23 years. I've lived through the horrific period when AIDS was untreatable. It's a memory that will never go away. But since this disease is no longer a death sentence, our daily fear of it has diminished, and we have become more likely to slip up. That's why the possibility PrEP offers our community is one we need to be talking about. Now.
MICHAEL LUCAS is the creator of Lucas Entertainment, one of the largest studios producing all-male erotica. He lives in New York City. This article is the opinion of the writer.