The drug may be making people take fewer sexual risks.
Approved by the U.S. Food and Drug Administration in July 2012, Truvada is the first drug the agency drug green-lit to protect uninfected people who may be having sex with people who are infected. The pill contains two anti-retroviral medicines, tenofovir and emtricitabine, that keep the virus from establishing a permanent infection if it enters your body, the Centers for Disease Control and Prevention (CDC) explains. (The CDC estimates taking the medication consistently can reduce the rate of HIV infection by 92 percent.)
Critics, including leaders in the gay community, have called the pill a “party drug” that encourages men to have anal sex without condoms. In theory, “PrEP,” short for “pre-exposure prophylaxis,” could make people think they’ve covered their bases so they can go wild.
Proponents of Truvada point out that after many years of public health campaigns promoting condoms, many men still go bare. Research with Truvada also suggests that it tends to make people a bit more cautious than they were before.
Don’t believe it? Imagine that you tend to have unsafe sex. You’re probably pretending that HIV doesn’t exist or that you don’t care about your life or have any control over your fate.
Now you are taking a pill every day. In that moment, you recognize the danger of HIV. You remember that you don’t want to get sick. You choose to be hopeful that you can avoid it. You’ve changed your thinking in a way that could make you more cautious.
The most recent study focused on a high-risk group: gay or bisexual men who had high rates of other sexually transmitted infections. The participants did get chlamydia, gonorrhea, and syphilis during the study, but not HIV. The pill emerged as highly effective, especially given that the researchers don’t know for sure how often participants took it.
PrEP is recommended for people at high risk of HIV infection, which includes gay or bisexual men who have anal sex without a condom, intravenous drug users who share equipment, and heterosexual men and women who don’t regularly use condoms during sex with high-risk partners.
An estimated half million Americans could be good candidates for Truvada, and a few years ago, public health officials thought that gay men would descend in hordes on clinics to get their prescription. The rush never came, probably in part because the manufacturer didn’t actively market the drug for HIV prevention. From 2012 through mid 2014, fewer than 3,500 people had started PrEP. Some may fear the cost unnecessarily. Without insurance, the drug costs about $1,300 per month, plus other expenses, but the manufacturer offers assistance to the uninsured or people with large copays, and most insurers cover part of the cost.
October 23, 2015
Christopher Nystuen, MD, MBA