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Steve Gibson on PrEP: Your Questions Answered

December 16, 2010

A groundbreaking new study shows that antiretroviral drugs (ARVs), when taken correctly and offered along with condoms and counseling, could help to prevent HIV infection. Results show that taking the drug Truvada was associated with a 43.8% reduction in HIV infections. The study involved about 2,500 sexually active gay men and transgenders from cities around the world, including San Francisco.

The method is known as PrEP (pre-exposure prohylaxis). It's an experimental approach that involves taking antiretroviral drugs before exposure to the virus.

In the wake of the PrEP study we sat down with Steve Gibson, Director of Magnet, to understand what this study means for San Francisco.

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Visit San Francisco AIDS Foundation's Web site to find out more about their activities, publications and services.
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More News and Research on HIV Medications for HIV Prevention

Reader Comments:

Comment by: Bobby (Cleveland, OH) Sat., Apr. 23, 2011 at 2:57 pm UTC
There's only so much money to go around, and we're wasting it on those who have options but would prefer dangerous bareback sex. Oh, excuse me, "natural sex". Whatever. Neither I nor anyone I know who got this disease ever did anything stupid enough to have benefitted from prep. We made the kind of mistakes that aren't preceded with a handful of pills.

I'm interested in ending this epidemic for EVERYONE, not just those who choose to put themselves in the line of fire. Rational self interest in the face of the misallocation of resources isn't "puritanism", its normal. Frankly, its healthy for us, and for society as a whole.

Its absolutely pathetic that there is so little consciousness amongst those with HIV that we don't even flinch while funds are diverted to preserving the online/bathhouse bareback "neg, ub2 crowd" while vaccine and especially cure funding remain almost nonexistent.

Screaming "puritanism" and "homophobia" sound damning, but they distract from the real issue at hand. Unless we intend to spike the water supply with this crap, this is only going to help those who choose to screw in risky situations without condoms. We're protecting the people who least deserve it. We're protecting those who have plenty of other options on the table over MILLIONS who are consigned to misery and an early grave. Screw that, I deserve a cure more than they deserve to spend the weekend in a sling at some bathhouse having "good, guilt free" sex.

My reaction isn't "puritanism". Its fair, its honest, and its real. Stop trying to slander my reaction into some sort of idiotic "fear of sex" and dont even TRY to pretend that I'm insinuating anyone else should get or deserves this virus. This is about the allocation of resources, public and private, and I'm rightfully angered. I've not heard any realistic scenario where highly expensive, tempermental and time sensitive pharmaceuticals are more easily accesible than condoms.

[This comment has been moderated to remove profanity and personal insults.]
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Comment by: Bobby (Cleveland, OH) Tue., Feb. 1, 2011 at 4:24 pm UTC
I'm so horrified that we're spending our money allowing willful barebackers to cultivate resistant strains of HIV and buy their way out of infection while thousands languish on ADAP waitlists and MILLIONS lack access to drugs at all. This is such a vile use of public money and time, and the fact that we're ensuring that only those with proper medical connections (ie a doc willing to prescribe off label), money to burn (because your insurance company might not cover it) and a willingness to put themselves in harms way for the thrill of bareback sex will benefit, makes it even more disgusting.
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Replies to this comment:
Comment by: John Eisenhans (St. Louis, MO) Thu., Feb. 24, 2011 at 6:54 pm UTC
"Bobby" is early one of those folks who is not the least bit interested in ending the HIV epidemic, but is only interested in ending sex. What we need, as much as a cure for HIV, is a cure for Puritanism, homophobia and sexphobia. Portraying people who have sex (that's what barebacking used to be called) as depraved or irresponsible is absurd - none of us would be here without barebackers. Of course, what they really mean is that their condemnation only applies to those having recreational sex, especially gay sex.

Truvada is only expensive because we allow it to be. In India, the generic version costs less than $100 per year. Why? Because the Indian government decided that the lives of their citizens were more important than drug company profits. They told Gilead to shove their patent and licensed the manufacture of the generic to local companies. We have to force AIDS profiteers to sell at a reasonable price, or lose control of their drug altogether.

Both Bobby and Mr. Gibson misrepresent the facts. There is no evidence that barebacking or using PrEP will create drug-resistant HIV strains. There is evidence that using PrEP as directed can be as effective as using condoms. Both work less well when they remain in the box on the shelf in the medicine cabinet. In fact, given that PrEP can prevent nearly all new HIV infections and ARV therapy can prevent someone who is already infected from transmitting HIV, the possibility exists, at least in theory, that the last new infection could already have occurred. In other words, except for those already infected, the whole epidemic could now be over.

But that would cost jobs and profits, and it would mean that people might go back to having joyfull, fearless, healthy sex. We certainly can't allow that.

[This comment has been moderated to remove profanity and personal insults.]
Comment by: Randy ( Sat., Apr. 30, 2011 at 6:54 pm UTC
"There is no evidence that barebacking or using PrEP will create drug-resistant HIV strains"

Of course there is no "evidence". We've never tried anything like it before with antiretrovirals. We're in uncharted territory, and anytime we're in uncharted territory, we work with previous experience and reasonable projections. What sort of "evidence" are you looking for? Common sense and the laws of natural selection basically tell us that if PrEP comes to replace condoms, drug-resistant strains will proliferate. We've seen nearly identical scenarios played out with antibiotic usage, and the evidence in those cases points to the proliferation of resistant strains. What epidemiological or biological model do you draw upon to conclude that widespread antiretroviral-based prophylaxis will be unique in disabling the laws of evolution and preventing the rise of resistant strains?

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