Janet Weinberg is the chief operating officer of the Gay Men's Health Crisis.
We stand at the cusp of achieving an AIDS-free generation. The adoption of the National HIV/AIDS Strategy, combined with advances in scientific research, has reinvigorated our fight against the spread of HIV. New tools and treatments, especially ones that will decrease transmission rates in highly affected groups, are critical.
Recently, the Food and Drug Administration approved the use of Truvada, a medication originally used in anti-retroviral therapy to treat people infected with HIV, for use as pre-exposure prophylaxis or PrEP. This is a positive development, and one that can save lives. Yet with any tool to combat HIV, no one tool will serve all people.
What is pre-exposure prophylaxis? It is a prescribed medical procedure taken prior to exposure to a disease-causing agent (in this case HIV) in order to prevent the individual from contracting the virus. It is prevention rather than treatment. An example of PrEP is when people take medication to prevent contracting malaria. The FDA, seeing the success of Truvada in containing HIV among HIV-positive people, and after extensive tests, now has approved the use of Truvada as PrEP targeting high-risk HIV-negative people to decrease their likelihood of contracting HIV. Truvada will not eliminate all incidences of HIV transmission but will reduce infection rates, and that makes it an effective and welcome tool.
To combat HIV, a disease connected to complex issues such as homophobia, poverty, and stigma, we need a broad range of approaches. No single approach works for every group or person. Truvada as PrEP will decrease HIV transmission rates in four key groups that are at high risk of contracting HIV: men who have sex with men, sero-discordant couples (where one person is HIV-positive and the partner is HIV-negative), sex workers, and heterosexual women. The highest rates of HIV transmission continue to be among men who have sex with men. Recent studies document that use of Truvada as PrEP, with proper adherence in taking the pill daily, can greatly reduce HIV transmission within this group.
It is important to note that Truvada will not eliminate the need for condom use nor will it decrease the need for public education campaigns about safer sex. Sexually active adults must continue to be educated on negotiating and practicing safer sex, which includes using condoms and being tested for HIV regularly. The FDA approval of Truvada mandated that people be tested and documented as HIV-negative before the pill can be prescribed for use as PrEP, and explicitly states that Truvada must be used in conjunction with condoms.
Truvada is not a substitute for safer sex or a "green light" to abandon other prevention tools—many of which have even greater impact. Fears that Truvada will lead to an increase in unprotected sex are unfounded, as use of Truvada will be tightly regulated and require ongoing supervision by medical professionals. The cost of Truvada (over $13,000 annually) means it will not be widely used and will definitely not replace condoms. However, it will provide communities with high concentrations of HIV a new way to decrease new infections.
Gay Men's Health Crisis, along with other leading AIDS service organizations and the World Health Organization, agree. Truvada will be a helpful new tool and is one of the first steps in a new front of the biomedical war against HIV transmission.