PREP: A NEW PILL IN THE FIGHT AGAINST HIV

Condoms, condoms, condoms, has been the safe sex message for gay men since the AIDS epidemic in the 1980s. However, this message isn’t working.

By Patrick Cash

New HIV diagnosis rates were at record rates for gay men in recent years, and it’s estimated that many young homosexual men living with the virus do not know they are infected. ‘We need a reality check on how prevalent unsafe sex is and the fact that no amount of condom advocacy will turn the tide and secure 100% condom use,’ says Yusef Azad, Director of Policy and Campaigns at the National AIDS Trust.

But now there is a new development and one that it seems few people in the UK have heard of. It comes in the form of a daily pill and could significantly reduce the risk of acquiring HIV, even if you are having condomless sex. Its name, currently, is PrEP. This means those men who used the pill at least 90% daily, had a 73% reduction in their risk of acquiring HIV.

PrEP stands for Pre-Exposure Prophylaxis, and is not to be confused with PEP which is taken after you have had a risky sexual encounter with somebody (see the box out for essential differences between the two treatment courses). It is taken as one blue pill named Truvuda and, when imbibed daily, it has proved highly effective in US trial studies at protecting the body against HIV infection.

In an iPrEx study in the US, ‘Truvuda reduced HIV acquisition risk by 73% amongst those who had a 90% adherence as measured by counts of unused pills,’ says Mitzy Gafos, an HIV Prevention Social Scientist.

Obviously 73% is not 100% and PrEP is a drug that reduces your risk of contracting HIV, it does not eliminate that risk. ‘In terms of opposition the main concern has been around reductions in condom use that may arise, coupled with moral arguments around encouraging or rewarding irresponsibility in some way,’ says Yusef. Indeed, some publications are misguidedly reporting upon PrEP as a drug for the incitement of barebacking; a very wrong concept of the treatment.

“We need another prevention option to put in the hands of HIV negative men at significant risk”

Yusef explains that with HIV rates rising as they are, all avenues of prevention must be explored: ‘We need another prevention option to put in the hands of HIV negative men at significant risk. It is not designed to replace condoms but to add to condom use, which with the best will in the world is not for most men consistent, nor free from slips, breaks and accidents.’ What PrEP could potentially be is a breakthrough in additional safety to complement condoms for those men who make mistakes, either through drink or drugs or simply foolish flings with an ex. Most of us have been there.

Yet before excitement mounts about the possible advantages of this advancement in HIV prevention treatment, the pills need to go through an extensive clinical trial before they are deemed beneficial to British public health, and released for general medical use.

However, if you are worried about your risk-taking during sex and are regularly finding yourself ending up in unsafe sex situations, then you could take part in the PROUD study right now. For details of recruitment, follow the link at the bottom of this page.

‘It is vitally important that we find out more about PrEP to see whether it can be used here to reduce HIV transmission amongst gay men,’ Yusef explains. ‘Gay men who are having sex without a condom are being recruited to the trial and one half of those in the trial will start immediately on PrEP and a package of safer sex support, the other half will have the safer sex support but only start PrEP after twelve months – the whole trial stage will last twenty-four months. Men are encouraged to volunteer for the trial if they meet the criteria.’

PrEP could be a significant battle won in the war waging against new HIV infections, but, as with all prevention treatments, the first step comes with ourselves. Beginning the PrEP course is not a license to throw your condoms out the window and, to ensure protection against HIV, this pill must be taken every day without fail.

It can’t be forgotten about for a three-day bender at the weekend, and then triple dropped on Monday to make up for it. But if this PROUD study does return good results, then let’s work together as a community to use condoms and innovations like PrEP to our advantage, so that we can stop the spread of a virus that has been disproportionately affecting our section of society for far too long.


• PREP VS PEP

In a recent meeting at the Medical Research Council discussing PrEP, one of the major issues raised was the possibility for confusion between PrEP and the more widely known PEP (Post Exposure Prophylaxis).
PEP is a course of intensive anti-retroviral drugs taken after you have had sex with someone who might have HIV, designed to stop the virus from burying its way into your cells. It has an 80% success rate and involves five pills you must take each day over the course of four weeks. PrEP, as described above, is a prevention measure like condoms.

• To find out more about PrEP and the PROUD study that is currently recruiting go to: www.proud.mrc.ac.uk

 

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