We may not have flying cars, time travel or robot maids, but we do have an innovation seemingly straight out of a science fiction novel. Tenofovir/emtricitabine, sold under the brand name Truvada, is a pill that could reduce the risk of contracting Human Immunodeficiency Virus (HIV) by 92 percent when taken daily. This is a revolutionary opportunity for individuals at risk of HIV infection to protect themselves.
The statistics surrounding HIV infection are predictably terrifying. According to the Centers for Disease Control and Prevention (CDC), individuals aged 13 to 24 comprised 26 percent of new infections in 2010. Men who have sex with men (MSM) made up 72 percent of youth infections. Between 2008 and 2010, young MSM saw a 22 percent increase in HIV incidence.
In Atlanta, the city some of us call home, a heartrending 12 percent of young African-American MSM in Atlanta contract HIV each year, according to a Rollins School of Public Health report. If we extend this projection into the future, 60 percent of today’s 18-year-old black MSM will be HIV-positive by their 30th birthdays. This is consistent with the finding that about 60 percent of black MSM above the age of 30 are HIV-positive.
Antiretroviral drugs have been used to manage HIV since the Food and Drug Administration (FDA) approved the first, AZT, in 1987 to delay the onset of AIDS in HIV-positive individuals. However, HIV-negative individuals can also use Antiretroviral’s to reduce their risk of infection, a treatment known as pre-exposure prophylaxis (PrEP). Truvada has been used to treat individuals with HIV since 2004, but was approved as PrEP by the FDA in 2012.
Truvada is recommended by the CDC for individuals in particular risk groups. These include: people who sometimes have sex without condoms, people who are in a relationship in which one partner is HIV-positive and the other is not, people who inject drugs, people who are unsure of their partner’s status, people with multiple sexual partners and those who have recently contracted a sexually transmitted infection (STI).
Just as there was significant opposition to the oral contraceptive pill when it was first introduced in the 1960s, not everyone has embraced PrEP with open arms. Larry Kramer, the 79-year-old playwright of The Normal Heart and longtime LGBT rights activist, was quoted in the New York Times saying, “Anybody who voluntarily takes an antiviral every day has got to have rocks in their heads. There’s something to me cowardly about taking Truvada instead of using a condom. You’re taking a drug that is poison to you, and it has lessened your energy to fight, to get involved, to do anything.”
Although Kramer co-founded the Gay Men’s Health Crisis nonprofit and inspired the creation of ACT UP, he is wrong. Even with perfect condom use, there is not a 100 percent guarantee. According to a mathematical modeling study, 51 percent of new HIV infections in Toronto occurred during anal sex with a condom. Condoms break; condoms slip off. MSM at risk need every weapon in their arsenal to fight back against HIV.
Michael Weinstein, president of the AIDS Healthcare Foundation, has a long history of attracting media attention through controversial statements. Weinstein said to the Associated Press: “If something comes along that’s better than condoms, I’m all for it, but Truvada is not that. Let’s be honest: it’s a party drug.”
His inaccurate and paternalistic statement was published in a variety of news outlets. This perpetuates the false paradigm that presents “both sides of the story” when only one has scientific evidence. Weinstein seems to regard Truvada as similar to cocaine, MDMA or amyl nitrate (poppers). If Truvada were taken only during parties, it would be utterly ineffective. Individuals are not taking PrEP for hedonistic pleasure, but rather to protect their health.
A derogatory term has sprung up for PrEP users who opponents fear will stop using condoms: “Truvada whores.” Some PrEP users have taken steps to alleviate the stigma, including creating t-shirts with “#TruvadaWhore” on the front that can easily be found online.
Although Truvada is certainly new and exciting, other methods of preventing HIV are not. Truvada is not meant to be the sole line of protection against HIV. Across all groups, it’s important to ask your partner’s status, to always use a condom (or dental dam), to avoid having sex while intoxicated and to get tested regularly.
A major concern about Truvada is its cost. Its sticker price, about $13,000 a year, may be steep, but it’s covered by most private insurers and by Medicaid. Gilead Sciences, Truvada’s manufacturer, even provides financial assistance to people without health insurance. Side effects are comparatively minor, including nausea, headache and stomach pain and, much more rarely, kidney and liver damage.
PrEP is currently available at the the Infectious Diseases Clinic at Emory University Hospital Midtown. This fall, Student Health Services will offer maintenance visits for PrEP to stable patients with no copay for the provider visit. Students followed-up with at Student Health Services will need to have had a minimum of two visits at the Emory Midtown Infectious Disease Clinic: an initial assessment and one follow-up visit with lab testing to assess compliance and side effects. With easy access, we can all work to reduce the 50,000 new HIV infections each year in the U.S.
— By Hobie Hunter, a College sophomore from Boca Raton, Florida.