Last week, the Centers for Disease Control and Prevention came out in support of PrEP (pre-exposure prophylaxis) therapy for individuals at high risk of contracting HIV. The FDA first approved the HIV antiviral drug Truvada for PrEP treatment in 2012. While the effectiveness rate for HIV prevention is considered fairly equal to condom usage, the primary target group of gay men have been slow to accept the therapy, just as doctors have been reticent to prescribe it.
PrEP has a complicated positioning within gay culture. On one hand, taking the drug signals a responsible interest in preventing the disease most known in the U.S. for decimating the gay community in the early 1980s. On the other, young gay men don't want to associate with HIV at all. Unlike past generations, HIV doesn't scare them. Millennial-era gay men find discussion of HIV annoying. It's a distant boogeyman that's unfairly stigmatized the gay community. Avoiding it seems an easier route to social equality.
The problem: HIV hasn't gone anywhere. Individuals who contract HIV and adhere to medical treatment no longer have to live in constant fear of death from AIDS. But early death shouldn't be the standard on which behaviors are based. But unfortunately for many, this has become the standard. The HIV infection rate in the U.S. holds steady at about 50,000 new infections reported per year. Couple this with the CDC reporting that the number of gay men engaging in unprotected sex rose 20 percent from 2005 to 2011, and one can presume the infection rate is just going to rise with time.
Enter Truvada. The regimen does not prevent any infections aside from HIV, therefore it cannot effectively replace a condom. But it can help curb the infection rate by providing an option to people who are currently choosing unprotected sex over their own health, along with extra security for individuals with committed sexual partners. It also provides protection for sero-discordant couples who deserve to feel safe in their relationships. People dealing with drug addiction are another high-risk group that would benefit from PrEP therapy.
"Why endorse an unnecessary medication for a disease that we already know how to prevent?" one might ask. Granted, it lines the pockets of drug companies and isn't the best first-response to HIV, given condoms have no side effects. However, a rising HIV rate is a national health problem. Moral outrage, which I often heartily indulge in other areas, isn't going to stop people from having unprotected sex. And no, labelling people "Truvada whores" for making a responsible decision isn't helping anything. While trickle-down economics are a farce, the notion of trickle-down health costs isn't. As the U.S. gets sicker, the economy suffers from both rising health costs and a reduced workforce.
Let's face it: The reason this therapy is even battling criticism is because it stirs up people's feelings about promiscuity, not because it's ineffective. We're still fighting about birth control (also highly effective). The U.S. population generally has a problem with anyone, aside from straight males, embracing their sexuality. That's what the argument about Truvada is really about. There's a certain part of our national psyche that thinks people deserve to get sick, and even die, for making decisions we don't like, especially when those decisions are about sex.
Not everyone holds these attitudes consciously. The New York Times' report on Truvada shows that even our health-care providers seem to suffer from internal biases about sexual behavior. Seventy-four percent of surveyed infectious disease specialists supported Truvada as an effective treatment. The number of doctors who actually prescribed it for this use dropped to a mere 9 percent.
We have to start talking about sexuality outside of our long-held ideas about what constitutes safe sex if we want to protect the generation ahead of us. It's understandable that people are inclined to view sexual health in black-and-white terms. But it's also understandable that young people who didn't live through the trauma of an AIDS epidemic aren't going to be inclined to share in fear of a disease that's become a much more silent foe.
Sexual liberty comes with complicated questions. But this one isn't too complicated. If a preventative drug can reduce the rate of new HIV infections for a group of people we aren't going to reach any other way, why wouldn't we accept it?
I don't plan on taking Truvada. I keep non-latex condoms in my back pocket at all times, often handing them out to people who seem to be in need. If you haven't tried this frank method, do it! You'll get consistently amusing responses.
But the next time someone tells me they "forgot" to use a condom, I'll be mentioning PrEP therapy.