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Word on the Street: PrEP Use by Gay and Bisexual Men

October 16, 2012

Love and Relationships, PrEP Use By Gay and Bisexual Men

Although the U.S. Food and Drug Administration has approved the HIV medication Truvada for use as pre-exposure prophylaxis (PrEP) to help prevent HIV infections in certain cases, the issue of PrEP leaves the HIV/AIDS community divided. While some hail the drug's arrival as another effective tool towards HIV prevention, others raise concerns as to whether the downsides outweigh the upsides. Moreover, some from the gay community fear that a rise in use of PrEP could lead to less condom usage and more risky behavior.

We asked a diverse group of attendees at this year's International AIDS Conference, "What are your views on the use of PrEP by gay and bisexual men?"

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Butch McKay

Butch McKay

Executive Director, AIDS Oasis; Fort Walton Beach, Fla.

I support PrEP. I think that it's very important. I think that it's going to be an individual choice. I mean, some people I know are against the concept, but I think if somebody wants to try that and, in conjunction with their doctor, that they make that decision together, that it's right for them, and they have the resources with which to make that happen, I think that's a great thing. It's another tool in the arsenal, and it's important. And, I think, it's an individual choice, though.

Craig Washington

Craig Washington

Atlanta, Ga.

I think that PrEP is a new, additional "tool," as they say. It's yet another mode of prevention that we could add as part of a multi-pronged approach for prevention, particularly with gay men. Since we've learned over the years that a method, or an approach, that is excessively condom-centered is not working. There are people, for any number of reasons, from actual, informed choice to certain constraints that people live under, including anything from sex work to not being necessarily able to negotiate condom use with partners, to just, you know, not finding condoms pleasurable, and, again, in an informed way, in a way that exercises sexual agency, who are choosing not to use condoms.

I think that, again, PrEP offers somewhat of a back-up. And, it's not an either/or. I think that's the point to make, is that we have to move away from this very binary notion of prevention, and give people options and give people a menu. And, at the same time, so, PrEP is not meant to be used as a replacement for any particular strategy. It's meant to back up those strategies, or those other tools.

David Morris

David Morris, M.D.

Atlanta, Ga.

Well, first of all, I'm very happy that it's here. That it's available. I think it has the potential to transcend and change the game, and I'm grateful about that. I think that the other part of the view is, if we don't get the cost of the treatment down, it doesn't make any difference that it's available. So, bringing cost down is going to be a huge issue involved with it.

Dawn Averitt Bridge

Dawn Averitt Bridge

Founder, Well Project

Well, I think that PrEP is an incredibly exciting new advancement. I think we have great data in gay and bisexual men. Unfortunately, we don't have a lot of information about how best to use PrEP in women, and I think that that's a very important, and an essential, area for further research. We've really got to know, not only how do we use it, but how often should we use it? How should it be prescribed? And, who should be managing it? And that's true for gay and bisexual men, as well. There's a whole lot of implementation questions that I think are really important. But, as a women's advocate, and an HIV-positive woman, I am definitely very concerned that we don't have as much information as I'd like to have on how best to use PrEP and where it's most applicable.

Kathie Hiers

Kathie Hiers

CEO, AIDS Alabama

Well, you know, I think that PrEP and all of the other biomedical interventions are fabulous. You know, in my opinion, it gives us one more tool in the toolbox. And, while I'm very excited about the science, I also am very grounded in the reality that, in places like Alabama, we don't even have enough funding to buy medications for people living with HIV disease. We have a waiting list for the AIDS Drug Assistance Program. So, I want everyone to have access to whatever means they can reach to prevent HIV infections, so I don't want to come off that "I'm opposed to PrEP." I'm not. I think, for people who know they're in a high risk situation, it's a wonderful tool. But, I do want our government to prioritize people living with HIV, as well, so that we don't have waiting lists.

Dr. Lee Anisman

Dr. Lee Anisman

Atlanta, Ga.

Actually, I'm very happy that PrEP is here, because I think it's all about choices. And, I think that having a choice is a wonderful thing. I think that, for those people that are very committed, and those people who are going to be adherent to taking Truvada once a day, this is a great thing. It's going to reduce infections by somewhere between forty and fifty percent in gay men. And, I think, the other thing is, the FDA has approved this, and, thus, by approving it, most, if not all, insurance companies that cover fully-insured patients will have to cover this under their insurance policies. My other feeling is my opposite feeling of, what I don't want to see, is I don't want to see people rely on PrEP and be very complacent about safer sexual behavior and I don't want to see us go back to where we were in the eighties, the early eighties.

Rob Newells

Rob Newells

Oakland, Calif.

I think it's good to have options for HIV-negative people to stay negative. I've been hearing a lot of community concern about whether or not it's affordable and practical when there are so many people that need treatment that don't have access to it already: Is it appropriate to treat negative people when positive people still need treatment? So there are some questions about it.

There are also questions about toxicity of the drugs. I was on Truvada and had to come off because it was affecting my kidneys. So I wonder, long-term, how safe it really is for people that don't "need" it.

Zidane

Zidane

The Caribbean

I think if persons in my area know that they can get something like that, they will go around having unprotected sex just the same, thinking "Oh, I'm immune against HIV and AIDS, so everything is all right." And there are other sexually transmitted infections (STIs) other than HIV. So they can pick up other infections, as well. When they come with PrEP, it's only pushing a negative person to say, "You know what? I have something I can run with to remain negative." Then now they'll be more risky; they'll take more risks with their life.

Natasha Travis, M.D.

Natasha Travis, M.D.

HIVMA Minority Clinical Fellow, Atlanta, Ga.

I'm very excited for any opportunities for different types of prevention methods. I'm a big fan of science, and any science we can use clinically in the future to help us, I'm so for that, at this point. When I heard about PrEP at the International AIDS Conference, I was very excited to hear that this was something well-supported, and something that potentially could make a big difference if we could give it a shot.




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