HIV Pre-Exposure Prophylaxis

I was interviewed by ABC News about HIV pre-exposure prophylaxis (PrEP).

“The study they were referring to was performed in 2,499 gay men or transgender women who have sex with men. The group of study participants who took preventative antiretroviral drugs every day for an average of 1.2years had a 44% reduced rate of HIV infections compared to the group taking placebo. The ability of the drugs to protect from HIV infection was dependent on treatment compliance: those who reported taking the pills about 50% of the time had about a 50% reduction in risk of HIV infection. Those who reported taking the medication about 90% of the time had a reduction in risk of infection of almost 73%. Some side effects were observed in the group taking the medication, but were mostly limited to nausea and some weight loss. Interestingly, risky sexual behavior was reduced in the participants of the study, possibly due to the provided risk-reduction counseling and condoms”.

With regard to the PrEP Study the greatest impact would be seen among high risk groups like sex workers or MSM who have multiple sexual partners. Of course that would mean convincing this population to take medication daily to avoid contracting HIV as well as promoting condom use. Another group that might benefit are serodiscordant couples or those in which one member is HIV and the HIV positive individual does not wish to transmit the virus to his partner. 

In theory PrEP is a great preventative strategy and I’m sure many will confuse the issue and think that just because they’re on meds that it will prevent them from contracting HIV, then they could forfeit using condoms. But looking at two PEP studies done in Brazil showed that PEP did not result in increased frequency of unprotected sex as a result of the availability of PEP. Based on these studies and the new study on PrEP, I do not think that offering PrEP will increase unprotected sexual encounters.  

On a global scale, PrEP is far more important, particularly since statistics show the number of HIV cases in Africa are climbing. Currently it is estimated that 6 million people are living with HIV in Africa.  

Since the latest vaccine studies have been halted. The best method to contain HIV is prevention. Both PEP and PrEP need to be discussed in more detail in mainstream media. Most people living in the US don’t even know about PEP or PrEP, let alone those living in Sub Saharan Africa. It’s time we stop thinking about the negative repercussions that could come out of a prevention strategy and celebrate this break through. PEP and PrEP have both been shown to reduce transmission of HIV. Isn’t that enough to warrant its use?

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