For as long as HIV and AIDS have been around, condoms have been the only protection against it for the sexually active. Finally, there is a second choice: in 2012, the FDA approved a drug called Truvada, a combination of two antiretroviral medications that are used in HIV treatment, to prevent infection in HIV-negative people in high-risk groups.
Taking a drug commonly used to treat a disease to potentially keep from being infected with it is not new; the medical term for such treatment is pre-exposure prophylaxis (PrEP). Like hormonal birth control (HBC) pills, Truvada must be taken daily for maximum effectiveness; unlike HBC, however, it is a highly potent drug, with even more potentially serious side effects.
Still, as gay activist and pornography director Michael Lucas said, “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.”
Lucas just came out as being HIV-negative and on Truvada; he says the decision to go on it was not lightly made, nor was the decision to go public about it. However, he was convinced after the researcher who led the multi-nation study on using PrEP against HIV, Dr. Robert Grant of UCSF, said at an AIDS conference that no one whose drug levels indicated that they had been taking Truvada daily became infected with HIV in the course of the study—if they regularly used condoms or not.
Such a finding is huge, since all the people in the study were at extremely high risk for HIV infection due to having an HIV-positive partner, or having multiple partners.
In the article for Out, Lucas makes it a point to say, “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.” His own would be included if someone else had written the article, as he is well-known for advocating safe sex practices. He continues, “Am I telling people to pop a pill and go have bareback sex? I’m not.”
Lucas did ask Dr. Grant if, considering the results of the study, being on PrEP is better than using condoms. The response was, “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.”
The idea of being able to simply take a pill every day and be protected (if to an uncertain extent) from HIV infection is almost a miracle, after decades of the virus’ impact on the LGBT community and beyond. But, Truvada is genuinely not something to be taken lightly; as with any drug, it has a long list of potentially very serious risks and side effects. The official website states:
The most serious possible side effects of TRUVADA (emtricitabine/tenofovir disoproxil fumarate) are:
-Lactic acidosis (a buildup of acid in the blood), which is a serious, sometimes fatal, medical emergency. Symptoms of lactic acidosis include weakness, unusual muscle pain, trouble breathing, nausea, vomiting, a fast or irregular heartbeat, and/or feeling cold, dizzy or lightheaded.
-Serious liver problems (hepatotoxicity), with liver enlargement (hepatomegaly), and fat in the liver (steatosis). Symptoms of liver problems include your skin or the whites of your eyes turning yellow (jaundice), dark colored urine, light colored stools, lack of appetite, nausea, and/or pain in your lower stomach area.
-You may be more likely to get lactic acidosis or serious liver problems if you are female, very overweight (obese), or have been taking TRUVADA or similar medicines for a long time. In some cases, these serious conditions have led to death. Call your healthcare provider right away if you have any symptoms of these conditions.
And that’s just the beginning of the list.
On the flip side, Lucas says that he has multiple friends taking it, and none have experienced anything “abnormal.” He adds, “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.”
Predictably, Truvada is expensive; unless your insurance covers it, the drug costs about a thousand dollars per month. At present, its parent company, Gilead, has a medication assistance program for those who qualify, but if demand is too high, it will only become harder and harder to get into (and that’s IF it lasts). Truvada also does not protect against other STDs.
Considering the risks, side effects, cost, and other issues, condoms still seem like the best choice for preventing HIV infection; unfortunately, safer sex practices are too rarely used. As Dr. Grant noted, not using condoms is “often the choice people make.”
Whether through ignorance, apathy, or recklessness, condom use amongst those who engage in high-risk sexual activities, especially men who have sex with men, is considerably lower than it should be; according to AIDS Map, 58% of gay men admitted they hadn’t used a condom the last time they engaged in anal sex.
The fact that HIV/AIDS is now treatable has ironically enough also hurt the fight against it; Lucas says, “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.”
At present, condoms are still technically more effective, being a preventative measure against nearly all STDs as well as pregnancy, with fewer drawbacks and a much lower cost, but they don’t work if they’re not being used. Nearly thirty years after the AIDS epidemic began, infection rates are still unacceptably high across the world; obviously, current approaches aren’t working.
So it’s time for a new one.