A Resisted Pill to Prevent H.I.V.

Published: December 30, 2013

 SAN FRANCISCO — Over a cup of tea at a downtown Starbucks, Michael Rubio recalled how four friends became H.I.V. positive through unprotected sex, all within a year. The news shocked Mr. Rubio, a 28-year-old gay man, into trying a controversial new form of H.I.V. prevention: a daily pill that studies show is highly effective in protecting people from infection. 

 
“With my inner circle so affected in the last year, it was a no-brainer to consider this for my life right now,” said Mr. Rubio, a front-office coordinator at the Positive Resource Center, a social service agency for people with H.I.V. 
 
The very existence of that option represents a startling turn in the too-long history of the AIDS epidemic. Many health experts hoped that the medication — Truvada, a combination of two antiviral drugs that has been used to treat H.I.V. since 2004 — would be exuberantly embraced by H.I.V.-negative gay men. Instead, Truvada has been slow to catch on as an H.I.V. preventive in the 18 months since the strategy’s approval by the Food and Drug Administration. In some quarters, the idea that healthy gay men should take a medication to prevent infection — an approach called pre-exposure prophylaxis, or PrEP — has met with hostility or indifference. 
 
“It’s gotten tons of attention at H.I.V. meetings as a new tool for prevention, and I consider it an important option for the right person,” said Dr. Lisa Capaldini, a primary care doctor here who treats many gay men. “And yet there’s been very little interest among my patients. There’s a fascinating disconnect.” 
 
For 30 years, public health officials have aggressively promoted condom use during every sexual encounter as the only effective method, apart from abstinence, for preventing H.I.V. transmission. Still, 50,000 new infections are occurring annually in the United States; sexual transmission between men accounts for more than half of them, and a disproportionate number among African-Americans and other minorities. 
 
Many experts hailed Truvada as an opportunity to reduce new infections among high-risk groups like young gay men, people in relationships with H.I.V.-positive partners, and prostitutes. The F.D.A. called for prescriptions to be accompanied by counseling, frequent H.I.V. testing, and continued promotion of safer sex, although research suggests that daily use of the pill alone confers close to full protection. 
 
For many gay men, and for some public health officials, the new option has brought both hope and confusion. 
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