To PrEP or Not to PrEP, That Is The Question

Published: May 20, 2014

It seems to me that it’s only fitting that on the eve of the Black AIDS Institute’s 15th anniversary, the CDC has released guidelines for the implementation of pre-exposure prophylaxis for HIV, or PrEP.

PrEP and treatment as prevention are the scientific breakthroughs of this era. PrEP, while not for everyone (and probably not for anyone all of the time), is a critical addition to the anti-HIV/AIDS toolbox.

Let’s break it down: It takes two people to transmit HIV; it takes only one person to stop the transmission. Treatment as prevention addresses one side of the equation. We know if people living with HIV achieve viral suppression, it’s almost impossible for them to transmit the virus. PrEP addresses the other side of the equation. When properly administered, PrEP makes it almost impossible to acquire HIV, even if you are exposed to it. The math is simple: you stop transmission, you stop acquisition and you break the back of the epidemic. If our goal is to end the AIDS epidemic, then we need as many tools in the toolbox as possible.

Certainly there are critics of PrEP, and quite frankly that’s a good thing; critique is vital. One of the critics’ concerns is that if people start using PrEP, they will stop using condoms. That might be. But if we are brutally honest, among many people who are most at risk for HIV, we have already lost the condom battle. It doesn’t mean that we should stop the fight. It doesn’t mean we should pull back from a message of PrEP and condoms. In fact, it doesn’t have to be either PrEP or condoms. It does mean that having more options that work for more people moves the needle forward.

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