The internet went haywire last week when the news broke that someone taking the antiretroviral drug Truvada as pre-exposure prophylaxis (PrEP) to prevent HIV infection had contracted a "drug-resistant" strain of HIV.
Buzzfeed and Gawker even weighed in, in addition to HIV-focused online outlets like TheBody.com, POZ, and Betablog.
This News Changes Almost Nothing We Already Know About PrEP
Despite the barrage of panic-inducing headlines, the reality of someone taking PrEP becoming HIV-positive, despite adhering to the PrEP regimen consistently, is not surprising to anyone who understands the science around Truvada to begin with. PrEP was always said to be "99% effective," not fullproof, and it was only a matter of time, as more people began to take PrEP, before a case like this cropped up. Doctors and researchers have never claimed PrEP works 100% of the time, any more than condoms work 100% of the time, or than any medication for anything works 100% of the time. But 99% effective is still 99% effective. This is the first case of infection we are hearing about out of the over 40,000 people in the United States currently taking Truvada as PrEP.
Why This Man Became HIV-Positive Despite Taking PrEP and What It Means
In terms of the strand of HIV this man contracted being "drug-resistant," let's take a minute to understand what that means. Truvada, which right now is the only PrEP regimen approved in the U.S., is made up of two antiretroviral medications: tenofovir and emtricitabine. It is extremely rare for a strain of HIV to be resistant to both of these drugs. (Estimates suggest that fewer than 1% of HIV-positive people carry this particular HIV strain.)
The fact that this man contracted a rare strain resistant to the drugs in Truvada also doesn't mean that he is unable to be treated. Many viable options for HIV medication exist and are widely available, and it has been reported that not only has the man in this case found a combination that works for him, but that his viral load is currently undetectable.
The Real Problems Remain: Stigma, Homophobia, Ignorance and Miseducation
What has been most notable about this case is the frenzy of click-bait/scare-tactic news on mainstream internet outlets. This burst of "news" has confirmed once again that we still live in a world in which much of the mainstream reporting on HIV/AIDS and indeed on sexual health in general is HIV-phobic, sex-negative, and homophobic. The contrast between the fact- and science-based reporting in HIV-focused outlets and the pieces appearing in more commercial, mainstream outlets illustrates the work we still have to do when it comes to stigma and misinformation.
For example, POZ posted an interview with the man, who is anonymously identified as "Joe" for the article, that was informative, clarifying, and ultimately uplifting and hopeful. The POZ interview celebrates the way PrEP is another tool to add to HIV prevention, one that also offers a possibility of sexual liberation, and notes how "Joe" is continuing to live a full life. The reporting in Gawker on the other hand takes details about the man's sexual activity out of context, bringing them to the forefront of the conversation for its gossip-obsessed audience. That kind of framing provokes more homophobia and more stigma and misinformation about HIV prevention and treatment -- and one need venture no further than the Gawker article comments section to see that ignorance in full force.
The important point that tends to get lost in the flurry of new articles about a case like this is that many nuanced, essential discussions are being had about PrEP -- ones that go beyond the usual anti-PrEP propaganda and misinformation campaigns put out by places like the AIDS Healthcare Foundation -- and more of those dialogues need to continue to happen. Those kinds of exchanges touch upon the challenges associated with utilizing PrEP as HIV prevention, including the role and interests of Big Pharma, and ultimately,how we can better serve the needs of communities most at-risk for new infection (hint: PrEP alone was never the answer!).
The bottom line is that all of us have the right to make informed, consensual decisions about our bodies and sexuality and to be free of scrutiny from the media, the state, and pharmaceutical companies. When we talk about our AIDS-FREE campaign here at Housing Works, this is exactly the kind of freedom that we need to invoke. Driving down rates of HIV infection is crucial, but it is not enough to focus solely on that biomedical goal. We must also actively cultivate a world free from the stigma, homophobia, racism, and poverty that prevent us from experiencing our full humanity -- with all of its risks and pleasures.