Sunday, 13 May 2012

HIV pill can stop new infections

HIV prevention got a boost from the FDA this week when an advisory panel recommended that doctors be allowed to prescribe an anti-retroviral medicine to prevent the initial infection. A study that came out last year showed that Truvada was partially effective in stopping new infections if taken regularly, which was quite a revelation given that the drug was developed to prevent viral replication in people who already have HIV.

The NY Times article outlining the Truvada story was pretty accurate, but it’s amazing after all these decades that its editors still fling around the discredited terminology and concepts of the epidemic’s early years. The front-page story spoke of the drug’s utility for ‘high risk people, like prostitutes’ while just a few lines before, reporter Denise Grady had written of ‘people at high risk of infection, like gay men who have multiple sex partners’.

It’s understandable that the Times wouldn’t call women in the sex trade ‘sex workers’ as many of them like to call themselves. But how about something a little more neutral, like ‘women in the sex trade’? And BTW, Miss Grady, behaviors, not people, are ‘high risk’, just as you seem to have grasped when describing gay men. But gay men, even the randier ones, are legal now, and their relationships are endorsed by the state—‘prostitutes’ are still high-risk ho’s.

The Truvada decision is a bit of a no-brainer given that people in sero-discordant relationships (one partner HIV-positive, the other not) are likely to want the option of medicinal pre-exposure prophylaxis (‘PreP’, for short) to use along with the other precautions available to reduce their worries during a lifetime of intimacy. Given the costs, it’s not a strategy that will make sense for many people, but it will work for some. Nonetheless, a vocal minority raised all kinds of cain about the supposed disinhibiting effect of making Truvada available because, they argued, people will be less committed to condom use.

Hello? Condoms are not being left on the nightstand now? There is a vast amount of unprotected sex taking place and always has been, even among the most vulnerable population groups. With 50 thousand new infections per year in the U.S., nearly half of them minority gay men, anything that works is a welcome addition to the toolkit. Biomedical solutions like PreP are no magic bullet because any method, just like condoms themselves, only works if you use it correctly. But it’s another tiny step.

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