Fully PrEPPed
AROUND 50 people — mostly gay men — gathered at the upstairs bar of the Colombian Hotel in Sydney’s Oxford St. They were there with a panel of experts discussing PrEP. Proceedings began with the basics.
PrEP stands for pre-exposure prophylaxis (“prophylaxis” means to prevent or control the spread of an infection or disease). It is recommended for people who are HIV-negative and who are at substantial risk of HIV infection. PrEP involves taking a single pill — Truvada — every day to protect against HIV.
Then came the science. Truvada is a dual combination pill used to treat HIV. It contains tenofovir and emtricitabine which block important pathways that HIV uses to initiate infection. The presence of these medicines in the bloodstream stops HIV from taking hold and spreading in the body.
If taken daily, trials have found Truvada to be upwards of 92 per cent effective in protecting against HIV. Indeed, in one analysis, the drug was shown to reduce the risk of HIV transmission by 99 per cent. As an HIV-prevention method, PrEP, we learned, is as effective as condoms.
But, said the speaker — and it was a big but — in order for PrEP to significantly reduce the risk of HIV, strict adherence is required. Truvada is not a party pill to be taken before a night out, or the morning after. PrEP is only effective in protecting against HIV if taken every day — regardless of whether you have sex or not.
From the science, the panel moved on to address PrEP’s social implications.
Since Truvada’s release for PrEP use in the US in 2012 it has polarised the gay community. Some see it as an additional method (alongside condoms) of protecting against HIV — especially if the condom breaks or, for whatever reason, there is an episode of condomless sex. There are others who fear PrEP will provide an opportunity for risky sexual behaviour that will in turn lead to an explosion of other STIs such as gonorrhea and syphilis.
The American experience shows that far fewer gay men have embraced PrEP as experts had anticipated. There are many reasons for this: confusion, lack of education and the stigmatisation of PrEP users by other gay men (the term “Truvada whore” has long been bandied about on social media networks).
A Q&A followed the panel discussion and it was clear from the questions asked that there are many concerns:
“What are the side effects?” Short-term effects include headaches and stomach aches, weight loss, nausea and diarrhoea. Kidney health may be compromised; decreases in bone density may also be noted.
“What does taking PrEP involve?” At first you will be counselled and tested for HIV, hepatitis B, kidney function and STIs. If all is okay, and you’re thought to fit the “at risk” criteria, you will be prescribed PrEP. You will need to take the medication strictly as prescribed (orally, once a day). Once on PrEP, you will need to be tested regularly for HIV (at least every three months); you’ll need to be regularly tested for STIs; and your kidney health will need to be regularly assessed.
“How long does Truvada take to become effective?” No-one knows for sure, but five to seven days seems to be the conservative consensus.
“Where can I get it?” Truvada is currently only licensed in Australia as a component of existing HIV treatments. It is not licensed here for use as PrEP. However, a number of trials are underway. One — the PRELUDE Study — is designed to look into how clinics can provide PrEP in NSW. It will study whether people will find it agreeable to take PrEP every day, why they take it, what it’s like to take it, and whether it changes how the participants have sex.
“Isn’t there a chance PrEP will discourage condom use?” Studies conducted in the US have not found any evidence to suggest participants had deserted condoms en masse and engaged in risky behaviour. What PrEP was found to lead to was decreased stress, fear and guilt around HIV.
No doubt, in the months ahead, the questions will keep on coming. But at least a community dialogue has begun.
This article first appeared in Positive Living.
Christopher Kelly is the editor of Positive Living, which is published by the National Association of People With HIV Australia (NAPWHA)
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web the simplest thing tto be aware of. I say to you, I ccertainly get irked while people consider worrids that
they plainly don’t know about. You managed tto hit the nail
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eftfect , people could take a signal. Will probably be back to get more.
Thanks
Teach people to have respect for their bodies
Ken – My understanding is that the drug company Gilead in the US has a scheme in place under which you could get the amount you need to contribute reduced or covered. I would suggest you look into that.
I have been taking PrEP since before the Melbourne trial started; am now taking part in the trial and have experienced minimal side effects .
By taking PrEP I have made a concious decision to eliminate the risk of HIV from my life. That has been a wonderfully emporwering experience.
Cannabis is prevention
Alcohol is encouragement
( of the virus )
Anyone know when trials will start. Melbourne has already began
As Cameron said, those attending the forum would have learnt that the side effects are minimal, are only ever experienced by a tiny proportion, and are entirely reversible. They would have also learnt that using PrEP involves 3-monthly sexual health screening, which is far more frequent than most people have now, so it would likely decrease the presence of STIs.
The reason why this offers a real opportunity to reduce HIV infections beyond what we have now, is that PrEP has the capacity to protect people from HIV at least as much as condoms, possibly more. The level of protection it offers for those who take PrEP as prescribed, is estimated to be as much as 99% and could possibly be 100%. However, there has never been a documented case of someone who was taking PrEP daily and then got infected. It has never happened, making it difficult to get any more precise than ‘at least 92% protection’, which is the same as occurs with condoms.
Condoms alone have never prevented HIV spreading through our community, not even at the height of the epidemic when the consequences of getting infected really were a matter of life and death. Of course, without them our community would have been even more devastated than it was, but condoms have never been the complete solution. Just assuming that the answer lies in getting everyone to use condoms all the time, is ignoring both history and current reality. And, it ignores what it is to be human.
PrEP provides protection even when individuals can’t be ‘perfect’, as much as they might try. And no one, anywhere has been suggesting that people should simply stop using condoms and take PrEP instead. Just that for those who don’t always use condoms, for whatever reason, PrEP would be a good added protection. Of course, there are some people, a minority, who never, ever do anything that might be a risk, and using something like PrEP would be completely redundant for them. Though my guess is that plenty of guys who suffer the occasional ‘slip-up’ probably believed they would never be the kind of person that could do something that puts them at risk of HIV infection. Certainly, that’s true of plenty of the guys who get infected. PrEP could help and that can only be a good thing.
Indeed, the most likely side effect of PrEP is relief from anxiety.
It was great to see the issues around PrEP dealt with with in such as comprehensive, comprehensible, straightforward and unbiased manner.
The issues raised in these comments were in fact dealt with at the forum.
Condoms were named as remaining the primary method of preventing HIV transmission, side effects of Truvada and the risks of developing resistance were dealt with as was the available evidence on the relationship between the uptake of PrEP and the use of condoms by those who choose to take PrEP.
The likelihood of other STI increasing in prevalence was also discussed. It was noted that the fact that PrEP also requires 3 monthly screenings for all STI’s would probably work towards curtailing an increase in other STI’s. Further given the population expected to uptake PrEP it could lead to a decrease in STI levels among gay men.
This is a great option for those who for whatever reason tend to not use condoms!! Better than the risk of catching HIV
USE A CONDOM
Fuck off, Michael.
Sigh. All kinds of stupid in that one. Condoms are still only 70% effective. Learn 2 Science Michael before you start falling into that slut shaming cycle that happened in the US over this. Poor thing.
Michael, we are not all as disciplined as some!! We all make mistakes, some more often than others!! Yes, I’m guilty!! Does that mean I deserve to get hiv? Or if there is another option, should I be not allowed that option??
lol
If we can give people a greater chance of not contracting HIV, why is this not already widely available? PrEP and PEP. Also, it’s not just a ‘gay’ thing, there are people who are heterosexual who happen to have partners who are positive. We suggest condom and the pill to prevent pregnancy, we need to be able to suggest condom and a bill to help prevent HIV. It’s really a no-brainer.
I understand potential side-effects, but that’s for a doctor and their patient to discuss and decide. If we went solely on possible side-effects nobody would even take a Panadol.
prep is already being overused and will start losing its effectiveness like most antibiotics now. people need to stop looking to fix lazy, careless behaviour and wear a condom.
Your arrogance is frightening.
Mine or Michael Steven?
Here in the USA, those I run into taking the drug, want to only bareback, they believe they are invincible!
Also nothing is mentioned about the price of the drug, it is not cheap, after my insurance I would still have to pay $100 a month x the rest of my life………
Must be the drug companies pushing this on us!
The sooner it’s available the better!! I’ll feel safer!!
apart from putting this crap in your body which isn’t good for you and just make $$ for big pharma, all this does is promote condomless sex and a further spread of STI’s which are rampant. We need to promote education and using a condom which seems to be lost on many – ill further add if these pills are only 91% effective then condoms should be used!
Reducing the infant circumcision rate as close as possible to 0% will increase the likelihood of condom campaigns working, but not for about 16-17 years. Until then, PrEP is probably worthwhile for those who will probably bareback anyway.
Correct Peter!!
Valid point: doesn’t stop STI transmission, rates for which are already at all-time highs in Sydney for the big three (gonn, syph, chlamidya). And that 91% effectiveness would almost certainly drop when factoring in infection piggy-backing, as HIV is prone to hitching a free ride with other STI’s.
Hi Peter, what link are you making between circumcision and condom use? It’s an interesting idea that I haven’t heard before.
its absolute rubbish another excuse
I assume the link is that un-cut have less of a reduction in sensitivity, while using a condom, than cut.
Fair call.
Haimish Milne he might be referring to this http://www.who.int/hiv/topics/malecircumcision/en/
I don’t think so Geoff^. That article ‘advocates’ circumcision as a prevention measure.
Peter is saying that ‘reducing’ circumcision rate will ‘increase’ condom use.
This debate is similar to when women were given the pill. If you don’t want to take it Michael, nobody is saying you must. It’s about the individual having the ability to make choices that most suit themselves. It’s about giving the individual every means by which to take responsibility for themselves… not having to take someone’s word for it.
The sooner the better