Take a pill once a day and you essentially reduce your risk of con- tracting HIV by almost 99 percent— sounds like this would be an easy idea to back by activists and physicians who want to stop the 50,000 new HIV infections each year just in the U.S.
But the story of Truvada, the blue pill manufactured by Gilead Sciences, is just not that simple.
Renowned HIV/AIDS activist Michael Weinstein of the AIDS Healthcare Foundation has called Truvada a “party drug” while Larry Kramer, whose play ‘The Normal Heart’ was just adapted for TV by HBO, says people who want to pop a pill once a day instead of use condoms must have “rocks in their heads.”
Last month, however, the Centers for Disease Control and Prevention released guidelines for providers on the use of PrEP, or pre-exposure prophylaxis, that includes Truvada as an HIV prevention tool along with other safer-sex practices, including condom use.
“While a vaccine or cure may one day end the HIV epidemic, PrEP is a powerful tool that has the potential to alter the course of the U.S. HIV epidemic today,” said Jonathan Mermin, director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, in a statement.
“These guidelines represent an important step toward fully realizing the promise of PrEP. We should add to this momentum, working to ensure that PrEP is used by the right people, in the right way, in the right circumstances.”
The notion that gay men on Truvada will begin participating in risky behaviors—or be- come “Truvada whores”—hasn’t played out in research, said Dale Maddox, a clinical research nurse at Emory University School of Medicine AIDS Clinical Trials Unit.
When people are on PrEP they see their doctors more often, they are getting constant care and they are clearly reducing their risk of contracting HIV, she explained.
The scare tactics that condoms are the only safe way for gay men to have sex can be compared to the controversy when the birth control pill was approved in the 1960s, Maddox said. Moralists decried “the pill” as a gateway to untamed promiscuity by single women, and judgment was harsh.
But none of the apocalyptic predictions of society’s downfall made back then came to be. Today, moralists cannot denounce Truvada, a proven effective tool to stop the spread of HIV/AIDS, because it only hurts all of society, Maddox added.
“This is non-judgmental. This is a harm reduction technique,” she said. “It gives control to the user.”
DRUG HISTORY Truvada has been marketed by Gilead Sciences since 2004 as a drug to help in the treatment of those who are HIV positive. In 2012, the FDA approved Truvada as the first drug shown to reduce HIV infection rates—a major milestone in the fight to end the 30- year HIV epidemic.
The FDA approval two years ago came after the groundbreaking 2010 study, known as iPrEx, which showed that when people—gay and bisexual men, heterosexual men and women and transgender women—took Truvada daily and consistently, they reduced their risk of contracting HIV by 99 percent.
Yet no one has been shouting the news from the rooftops in Georgia, which ranks sixth in the nation for new HIV infections, according to the CDC.
At a recent town hall meeting hosted by Team Friendly Atlanta, an organization working to reduce HIV stigma, panelists discussed the need to educate the public about Truvada and dispel misinformation as well as stigma surrounding the drug.
Craig Washington Longtime Atlanta HIV/AIDS activist and Prevention Program Manager at AID Atlanta
On the rates of HIV infections among young black gay men: “The results the InvolveMENt Study are jarring. For some of us who are veterans [in HIV/AIDS activism], this is not surprising. We know that young black gay men need an array of tools to protect themselves [including PrEP]. They have a right to that and we have to educate them. How we can use history as a segue to people’s current realities. It’s certainly true for young black gay men, that they are interested in having these conversations—but as it relates to their realities.”
On PrEP and Truvada: “This is also about a human right. There is a lot of talk of HIV fatigue and what that suggests is we need to have conversations differently. Whether it’s through Twitter chats, film, music, and social media. I’m happy the CDC demonstrated that level of leadership [in issuing guidelines for Truvada]. We may discover a more effective PrEP than Truvada but it holds its place as first verifiable HIV prevention drug. This is a historical benchmark in our work of HIV prevention.”
On sex and pleasure: “Regardless of what people do they have a right to an effective tool to protect themselves. We need to consider pleasure itself. It’s only gay men, queer men, upon who we impose this sentence with condoms, that sex is synonymous with condoms. We should promote the use of condoms but not to the point of holding them hostage. People who don’t like using condoms still have a right to reduce their risk and PrEP can be a tool and I think we need to own it. There is clearly a need for education and increased advocacy, particularly the LGBTQ community to make sure our community is informed this is another tool in the box.”
Jeff Graham Executive director of Georgia Equality
On HIV among gay men: “I think we need to put pressure, frankly, back on LGBT organizations to reclaim HIV. For 20 years we have been very intentional about pointing out HIV did not equal gay. There were really good, solid, important reasons we did that. But then what got lost is that we began to believe HIV didn’t have anything to do with the LGBT community and politics.”
Dylan West Member of Team Friendly Atlanta who has been on Truvada for nearly two years
On Truvada stigma: “I am very public about my use of PrEP. When I was on the [mobile] apps all my profiles blatantly said it. One thing I did notice on multiple occasions when it was mentioned I was on PrEP the conversation switched from I practice safe sex to, ‘We don’t need condoms.’ And I’m, ‘No, that’s not how it works.’ And they say, ‘But I’m on PrEP, too. We don’t need to practice safer sex. It’s not a big deal.’ And that’s just not how it works. There has been a large amount of stigma as far as the non-LGBT community and every now and then there’s that, ‘Oh, so you have HIV’ or ‘you’ve been exposed to HIV’ and I have to explain difference between PrEP and PEP (post-exposure prophylaxis, taking anti-HIV drugs as soon as possible after being exposed to HIV).”
Dr. Colleen Kelley Emory School of Medicine
On PrEP: “I think for me it’s incredibly simple. There is an effective prevention method and people should be able to use it. Period. We have heard the hope and promise of PrEP. It’s going to evolve and there are things coming down the pipeline. We have to be ready to pounce when those things are ready for us.”
From AZT to Truvada
From the promise of a vaccine 30 years ago to drug cocktails, the road to an HIV free world is dotted with many milestones and missteps.
April 23, 1984 Margaret Heckler, Secretary of the U.S. Department of Health and Human Services expresses hope that an AIDS vaccine will be produced within two years.
March 19, 1987 The U.S. Food and Drug Administration approves the first antiretroviral drug, zidovudine, more commonly known as AZT. Congress approves $30 million in funding to states for AZT.
1992 Combination drug therapies for HIV begin being introduced. These cocktails prove to be more effective than AZT alone in slowing the development of drug resistance.
June 1995 The FDA approves the first protease inhibitor, Saquinavir (SQV). This ushers in an era of highly active antiretroviral therapy, or HAART.
1997 HAART becomes the new standard of HIV care. Due to the use of HAART, AIDS-related deaths in the US decline by 47 percent compared with the previous year.
Sept. 26, 1997 The FDA approves Combivir, which combines two antiretroviral drugs in one tablet, making it easier for people living with HIV to take their medications.
2004 The FDA approves Truvada, a fixed-dose combination of two antiretroviral drugs used to treat HIV.
Oct. 6, 2009 The FDA, in association with the PEPFAR program, approves the 100th antiretroviral drug.
2010 The National Institutes of Health announce the results of the iPrEx study, showing that a daily dose of HIV drugs reduces the risk of HIV infection among HIV-negative men who have sex with men by 44%, supporting the concept of pre-exposure prophylaxis, or PrEP.
July 2011 Scientists announce that two studies have confirmed that people taking daily antiretroviral drugs experience infection rates more than 60 percent lower than those on a placebo.
July 16, 2012 The FDA approves Truvada for prophylactic use to fight the possibility of HIV infection.
May 14, 2014 The Centers for Disease Control and Prevention publicly recommend physicians consider Truvada to prevent infection for high-risk, HIV-negative patients.