Every morning, I pretty much start my day in the same way: I read through some morning headlines and I take my pills, including some for high blood pressure, others for blood sugar, and one for preventing HIV -- I use Truvada (tenofovir/FTC) as HIV pre-exposure prophylaxis (PrEP).
Today, those actions coincided. I awoke to news that, for the second time in two weeks, a European study of PrEP in gay men is ending the placebo arm and offering PrEP to all participants. This time, the study was IPERGAY out of France. PrEP works. C'est vrai.
Why are these studies altering their course? It's simple: PrEP works. C'est vrai.
As of now, PrEP is licensed in the United States -- the only country where it is available outside of clinical trials -- as a daily dose of Truvada. But IPERGAY looked at it differently. While I will likely continue to choose to make my Truvada a daily habit, this study may lead to another option for PrEP use: syncing it up with when sex happens. In IPERGAY, participants were asked to take two pills (some people got a placebo) no less than two and no more than 24 hours before anticipated sex; another single pill every 24 hours during the period in which sexual activity was taking place; and then a final pill 24 hours after that. Although we have to wait till early next year to get more details, IPERGAY researchers announced today there was a "very significant reduction" in the risk of HIV infection in those on Truvada, and that the reduction was "much higher than the one observed in the iPrEx trial" where men and transgender women were asked to take PrEP daily.
Real talk: This is a great thing. And I say that as someone who thinks that this dosing regimen would not work for me at all. I like that PrEP is an option that is wholly separate from sexual activity -- or any other activity that may carry the risk of HIV transmission. I think that PrEP's strength is that it allows people to practice HIV prevention as part of a holistic health regimen that includes other daily pills.
As someone living with type 2 diabetes, I take my pills every morning and say, "OK, I'm keeping my blood sugar in check, I'm lowering my high blood pressure, and I'm staying HIV negative." And that affirms me. I don't know if I could adhere to an anticipatory regimen. There will be prevention options that are not for everyone -- and I say, "Bring them on." When it comes to HIV prevention, I may not be a user of your option, but I will defend to the death your right to use it. Too often, people calcify around whatever prevention option has worked best for them -- or has been forced upon them.
The cry of "Why can't they just use a condom?" often has an unspoken follow-up clause: "Like I always have!" If we can put aside the idea of championing a particular option and instead come together for the concept of prevention options for all, we'll be all the better for it.
An anticipatory PrEP regimen may sound more difficult to me than a fixed regimen, but if it helps others stay HIV negative and enjoy a fully-realized sex life, then who am I to deny them their choice? I do see a lot of benefits, and for those concerned about side effects or toxicity (arguments I understand, but will happily combat), this may be a way to take PrEP while still having less of the drug in your system.
What's most intriguing to me about the IPERGAY study is that it literally brings PrEP back into the realm of sex. So much of the current language about PrEP revolves around the idea of its routineness -- take it every day with your coffee, whether you're experiencing a sexual dry spell or you're in the middle of a Bacchanalia. IPERGAY, on the other hand, asked participants to take it a few hours before an anticipated sex act -- and that's pretty sexy.
Like a great horror movie, prevention research can often be scary and exciting all at once. We don't know what's ahead, or what lies behind the next door -- but, the possibility of "what's new" gets our synapses firing and our neurotransmitters revved up. But we may be scared to trust something new. We don't want to wake up later to find out that what we thought was a treat turned out to be a trick, especially when the stakes are so high.
The work of HIV prevention is not done until all seven billion of us earthlings have an HIV prevention method that works for each of us -- regardless of how we have sex, in what orifice, and with whatever person or people we consent to have sex with. I would hope that one day we will become as accustomed to brand-new HIV prevention options as we are to brand-new iPhones -- and, hopefully, these new options won't bend in our skinny jeans.
The full IPERGAY results won't be available until early 2015 -- so we'll keep our eyes peeled and our ears open. In the meantime, I'll keep waking up to the news, and to my Truvada.
Mathew Rodriguez is the community editor for TheBody.com and TheBodyPRO.com.
Follow Mathew on Twitter: @mathewrodriguez.