A cure for HIV/AIDS has become the medical holy grail, as elusive as it is sought after. In lieu of such a miracle drug, a commandment has been all but carved into stone over the past quarter of a century: Always wear a condom. But doctors, researchers and a growing population of high-risk individuals know something you might not: Development of a medication that could prevent the contraction of the HIV virus in the case of direct exposure is well under way, and some doctors are already prescribing it to their patients.
Yes, you read correctly – a pill that some say effectively prevents HIV/AIDS transmission is no longer the stuff of myth. However, while the potential this development has to impact the world’s health is staggering, if you ask me, it has seriously dangerous implications, the most alarming of which is the real possibility that people will break the golden rule of sex and stop using
condoms altogether.
You may have heard that HIV/AIDS infection is on the rise again. While data is unclear on whether overall infection rates are increasing, some demographics show very distinct spikes. Gay men in particular have seen HIV diagnoses steadily increasing: Since 2001, HIV prevalence in the under-30 gay crowd has shown a 33 percent increase, according to a 2008 article in “GQ” entitled “We All Forgot the Condom.” The New York Times has called its city’s climbing rates “an alarming comeback” for the epidemic. What happened during the last 10 years to cause such a seemingly avoidable lapse in sexual health? Ask a number of gay men about their recent sexual activity or just surf a couple of popular porn sites on the Internet and you’ll understand: No one uses condoms anymore.
OK, maybe not no one. Still, it doesn’t take much research to discover that attitudes toward the rubber aren’t what they used to be. A good idea? Sure. A necessity? Maybe. Used every time?
Not likely.
Enter PrEP. The treatment, whose name stands for “pre-exposure prophylaxis,” is “an experimental HIV-prevention strategy that would use anti-retrovirals to protect HIV-negative people from HIV infection,” according to the AIDS Vaccine Advocacy Coalition. Officially called tenofovir and marketed under the brand name Viread, the drug is currently given to people who are HIV-positive to help suppress the infection, but is being touted as effective when taken while still HIV-negative, as a sort of “preventative sexual-health regimen.”
Some believe this could be a revolution in combating the HIV epidemic and surely its potential is exciting, to say the least. HIV-positive gay pundit Andrew Sullivan seems to agree, calling the drug “a way for HIV-negative men to do something which is not simply defensive in nature, and make decisions about their health in a moment outside the inevitable irrationality of a sexual encounter.”
On his blog, Sullivan suggests putting all HIV-negative men on a simple anti-retroviral regimen as prevention, rather than treatment. Some doctors are already prescribing PrEP to patients who wish to reduce the risk of engaging in risky sexual behavior (i.e. not wearing a condom). But, wait, isn’t it still risky?
I acknowledge that the drug could be valuable – invaluable, even – to quelling the spread of the global AIDS epidemic. According to Avert, an international AIDS charity based in the U.K., PrEP could be an effective way to “protect women (and men) who are victims of sexual violence or coercion, or who are afraid to insist that their partners use condoms,” such as sex workers or people who live in countries where rape is an all-too-common reality. Worldwide, the most common form of HIV transmission is through unprotected vaginal sex with an infected partner, according to Avert; thus, millions of people could benefit from taking a pill a day as a way of reducing their risk of contracting HIV.
But to promote and distribute the drug in the United States, not only before conclusive research on its effectiveness and side effects, but as a reliable way of not contracting HIV, is flat-out irresponsible.
When I first heard of PrEP, my overriding reaction was one of disbelief, but not toward the idea of finding an effective AIDS prevention method. I couldn’t believe some people were suggesting taking a drug that is still undergoing research and is not proven to work, according to the AIDS Vaccine Advocacy Coalition, as an alternative to using condoms. I know people who have HIV/AIDS and to even suggest that condom use could become unnecessary seems offensively negligent.
The drug will inevitably lead to populations of people who think they can simply pop a pill before having sex and be safe. The U.S. Centers for Disease Control and Prevention recently surveyed men at four gay-pride events and found that 7 percent of those interviewed had tried taking tenofovir. In some places, men are even taking the drug in “party packs,” meaning alongside methamphetamine and Viagra (dubbed MTV – cute, huh?) in anticipation of reckless sexual behavior.
Now, I realize arguing against the drug may seem a bit like supporting abstinence-only sex education: The reality is some people are going to have unsafe sex, so why not just try to reduce their risk as much as possible? But isn’t that a bit of a cop out? I’m not satisfied with the idea that it’s just as likely and unavoidable that mature, educated adults will have unsafe sex as is the fact that young people are going to have sex, period. Facilitating healthy and informed decisions about people’s sex lives should be the number-one method of HIV/AIDS prevention, not a miracle pill that has yet to prove itself miraculous.
There is also the question of how one goes about testing such a drug. You can’t expose someone to HIV after giving them an experimental medication to see if they contract the disease or not. You can’t expose someone to HIV, period. Research is currently being conducted on populations that are already at high risk of contracting HIV, to see if taking PrEP regularly for an extended period of time reduces infection rates among these populations.
But considering the problems and ethical concerns of such testing, it seems that research will continue to be inconclusive, at best. And, if all that isn’t enough, the AIDS virus has been found to be highly adaptable, and if a generation of sexually active individuals start taking the drug, the virus could eventually develop a resistance and simply become stronger.
After all of this, I wholeheartedly support further investigation about the viability of PrEP and other such medications. The concept of a drug that could help eradicate the AIDS epidemic deserves the highest priority in terms of research and funding. But safe and reliable testing methods and significantly more consideration should be given before doctors and drug companies start giving it out as the birth control for gay men.
“Scientifically, it makes sense. Sociologically, it doesn’t,” said leading AIDS specialist Douglas Ward, M.D.
Education, responsibility and reinforcement of time-tested methods must remain our first lines of defense, rather than experimental methods that could open up a dangerous can of worms. Personally, I’ll stick to the age-old commandment: No glove, no love.
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Prepping for a miracle?
Daily Emerald
January 15, 2009
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