ABC News Examines Pre-Exposure Prophylaxis for HIV Prevention

ABC News on Tuesday examined concerns among some health officials and HIV/AIDS advocates that pre-exposure prophylaxis -- which currently is undergoing trials worldwide -- could lead to a decrease in safer-sex practices. According to ABC News, PrEP "seems promising," because "HIV drugs taken within days after exposure to the virus have been shown to reduce the risk of infection by 80%." ABC News reports on the debate over whether approval of such pills could lead some high-risk groups -- such as men who have sex with men -- to forgo condom use and "instead rely on a drug regimen that doesn't provide full protection against the disease."

According to Albert Liu, director of HIV prevention intervention studies at the San Francisco Department of Public Health, there have been "reports that people may be using PrEP out in the community before it was in trial." To investigate this possibility, Liu and colleagues conducted studies in three cities in California involving 1,800 MSM. Of the men questioned, 16% reported having heard of antiretroviral use to prevent HIV transmission and 1% admitted trying PrEP on their own. In addition, a similar study of more than 227 men in Boston found that one person reported using PrEP drugs instead of a condom. However, despite the low reported rates of PrEP use outside clinical trials, some advocates worry that the number of people substituting such drugs for condoms could increase if FDA approves a PrEP regimen. Sean Strub, founder of POZ Magazine, said that the "problem" with PrEP drugs is the idea that they could act as a "disinhibitor" and thus discourage people from practicing safer sex. According to Liu, the "important thing to realize is that [PrEP is] not just an evening-before pill that people pop." Strub added that members of the community could become involved in encouraging safer sex to prevent HIV transmission.

Dana Van Goder, executive director of Project Inform, said PrEP drugs could be "costly," ranging from $500 to $900 monthly. However, prices for the drugs could decrease if the medications became more widely available, Van Goder said. According to ABC News, Liu currently is leading a trial of the drug Truvada among 3,000 men in the U.S., South America, Asia and Africa. Liu said the daily pill could have side effects such as kidney or liver damage, adding that the study participants need routine HIV testing and follow-up services. "These are men who are at risk for HIV," Liu said, adding that "since we don't know whether [PrEP] works, we want to keep them on the best prevention" (Cox, ABC News, 1/20).

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