Which study was talked about more than any other at the AIDS 2014 Melbourne Conference? No, I’m not making this up, it was titled ‘iPrEx OLE!’, although I am happy to discuss the results over tapas and sangria.
Would you believe 1603 people were offered the chance to take the before pills Truvada, known medically as Pre Exposure Prophylaxis (PrEP). 1225 took up the challenge, the rest declined. After following everyone for 72 weeks (almost a year and half), no one who took Truvada as prescribed (a daily single pill) or for at least 4 times a week, acquired HIV. That’s right if you took Truvada as a before pill at least 4 times a week it was 100% effective. While approximately 13 guys from the 378 who didn’t take part in the study unfortunately acquired HIV, which equates to an annual incidence rate of 2.6%.
The World Health Organisation in July 2014 published new guidelines. The new PrEP recommendation constitutes a change from a conditional recommendation for PrEP use in demonstration projects to a strong recommendation endorsing PrEP as part of a package of prevention services for men who have sex with men.
The US has already approved the before pill (Truvada for PrEP). Recently Michael Lucas, founder/CEO of Lucas Entertainment, one of the largest porn film makers in New York revealed he was in a poz-neg relationship with Tyler Helms. The couple’s HIV prevention strategy of choice is for Michael to take the before pill consistently and Tyler to be successfully treated with HIV medication (a sustained HIV viral load like this is undetectable).
Love and the desire for intimacy is driving the personal pleasure and safety choices of some gay men. For pos-neg couples the additional protection of having their HIV negative partner on the before pill is transformational, facilitating the additional confidence needed for some to enjoy sex without taking perceived unnecessary risks to achieve closeness.
Many poz-neg couples have for years successfully relied only on undetectable viral load too prevent HIV transmission and are happy to continue this path.
When you consider the casual sex context, now guys who are HIV negative have another option on how to take personal responsibility for their sexual health and prevent HIV. Anxiety over condom slip ups will become significantly diminished and perhaps disappear altogether.
The before pill (Truvada, PrEP) has only just begun to radically change the sexual lives of gay men around the world. Liberating them from the fear of acquiring HIV from the unknown, untested, and unable or unwillingly condom users. The before pill to prevent HIV has the potential to protect other at risk populations too.
There will be some who will attempt to politicise, moralise and gate keep the introduction of the before pill to prevent HIV in much the same way as the contraceptive pill to prevent pregnancy was once heavily debated and stigmatised.
In the US this has already occurred, with terms like “Truvada whore” initially used to shame guys and discourage them from using their protection of choice. There may even be a few gay man who through personal experience and losses from HIV find this novel strategy to prevent HIV to confronting and prefer instead the comfort of the status quo and a singular drum beat, consistent condom use for all for all time.
Some, as reported by Peter Staley on his blog at POZ, have even taken to perverse and disgraceful tactic of pretending to have taken Truvada and described online a false failure. However I have complete confidence that effective science and the freedom to choose your own density will triumph over denial, delays and destructive misinformation.
Where to next? Be sure to let your local doctor, nurse, community worker, politician, whomever might assist know, that you have the right to protect yourself from HIV and demand access to the before pills (Truvada for PrEP), a gay sex revolution and the ending of the HIV epidemic is possible, when we turn to empower and respect each other’s informed choices.
Cipriano Martinez
Read more from Cipriano at positiveadvocate.com
