Don't fear progress in HIV prevention

Published: March 18, 2011

The paid advertisement in this issue of GA Voice correctly reminds us that “there is no magic pill” to prevent HIV infection. Unfortunately, the ad is part of a campaign to convince the FDA not to review, and Gilead Sciences not to submit, data to support approval of Truvada for HIV prevention. (Truvada is now available by prescription to treat HIV.)

It is based on fear and speculation at a time when we need reason and research to guide us through scientific and policy issues raised by this new HIV prevention tool.

In spite of 30 years of fighting HIV, there will be an estimated 2.7 million new HIV infections globally in 2011, with 56,000 of these in the US, a number that has remained stable across a decade. Gay and bisexual men, especially men of color, will bear a disproportionate burden of these infections, as will women of color.

But 2010 breathed new life into HIV prevention. The CAPRISA 004 study in 889 HIV-uninfected African women was the first to show that vaginal tenofovir gel (a microbicide) used before and after sex, and given with risk-reduction counseling and condoms, could decrease HIV infections in women by 39 percent.

Months later, the iPrEx study of “pre-exposure prophylaxis” (PrEP) in 2,499 HIV-uninfected gay and bisexual men and transgender women showed that daily Truvada decreased HIV infections by 44 percent overall. All study volunteers received condoms, STD screening and treatment, and risk reduction counseling.

However, drug levels showed that those who became infected were not taking drug, while up to 95 percent of persons with high drug levels were protected against HIV. Drug resistance was not associated with taking Truvada. Side effects of treatment were generally mild and infrequent.

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