10 things you need to know about the pill to prevent HIV

[Steven_Draker]

10 things you need to know about the pill to prevent HIV

 

 

It's been called, simultaneously, a medicine to "end the HIV epidemic" and a "party drug:" Pre-exposure prophylaxis, or PrEP for short, refers to a daily antiviral treatment that prevents HIV.

 

That's right: People who don't have the virus can take a pill a day to save themselves from getting infected.

 

Haven't heard about PrEP? You're probably not alone. The drug-maker, Gilead, doesn't advertise Truvada (its brand name) for prevention, and the Centers for Disease Control and Prevention only endorsed it this past May—two years after it hit the market.

 

Going forward, however, you'll be hearing a lot more. On Friday, the World Health Organization backed the antiviral, recommending all HIV-negative men who have sex with men consider taking it as part of a strategy to reduce the global incidence of the disease. But there's a lot more to the story. Here's what you need to know:

 

 

1) Public health officials are NOT recommending this pill for "all gay men," despite what the headlines say

 

The pill is "for people who do not have HIV but who are at substantial risk of getting it," according to CDC guidance. "At substantial risk" means you regularly have unprotected sex with partners of unknown HIV status. This can include men who have sex with men, heterosexual men and women, injection drug users, sex workers, and people in couples with an HIV-positive partner. In other words, not simply "all gay men."

 

The latest headlines about Truvada were so misleading that the WHO had to issue a clarification noting that they support PrEP "as an additional choice"—again, not for all men who have sex with men.

 

 

"WE KNOW FROM SURVEILLANCE THAT CONDOM USE IS NOT AS HIGH AS IS NECESSARY TO CONTROL THE EPIDEMIC"

 

 

2) Truvada is not a condom replacement

 

Public-health officials are not endorsing Truvada as an alternative to other forms of protection. "We are suggesting that for people who are already not using condoms, we have another option to help protect them from HIV infection," says the CDC's Dawn Smith, biomedical interventions implementation officer. "It's part of being practical and realistic." So the hope is that those who get prescriptions are folks who just aren't using anything to protect themselves. "We know from our surveillance systems that condom use is not as high as is necessary to control the epidemic," Smith added.

 

 

3) We don't yet know exactly how the drug will be used in real life

 

Still, this public-health message hasn't stopped some activists and AIDS campaigners from worrying aloud that the pill will undermine traditional advocacy messages about condoms—especially at a time when HIV infections are on the rise among gay men. And the truth is, we don't yet know what kind of impact PrEP will have on people's behavior.

 

To find out, there are now "demonstration trials" being run around the world. These will look at how Truvada works outside of clinical trials, the impact of non-daily use of the drug, and whether the antiviral encourages more risky sexual behavior or leads to an increase in other sexually-transmitted infections.

 

 

4) We do know Truvada only works effectively when taken every day

 

A three-year clinical trial of PrEP in HIV-negative men who have sex with men found that users got much more protection when they took the drug every day. Participants who took the drug less than half the time had a 50 percent reduction in HIV acquisition; daily users cut their risk by more than 90 percent. These results have been supported by other studies in a range of populations—from injection-drug users to heterosexual men and women. The trouble is, most people don't take their medications as their doctors prescribe.

 

 

DRUG-RESISTANT STRAINS OF HIV HAVE EMERGED WHEN PEOPLE WITH ACUTE, UNDETECTED INFECTION WERE GIVEN TRUVADA

 

 

5) Truvada can cause drug-resistant HIV infection

 

Drug-resistant strains of HIV have emerged when people with acute, undetected infection were given PrEP. This means they were positive when they started the medicine, but levels of the virus in their blood were hardly detectable because their infections were so new. They hadn't made enough antibodies to show up in a test and so they were prescribed the drug anyway.

 

There's some question about how serious this risk is for individuals and public health. For now, doctors are asked to confirm the HIV status of patients and to do follow-up and re-testing throughout treatment.

 

When asked how much of a concern drug resistance is, Smith of the CDC said, "We don't know yet. That's one of the things we'll learn as the first few demonstration projects begin telling us."

 

 

6) Besides that, it's pretty safe

 

Though Truvada for the prevention of HIV was only licensed by the Food and Drug Administration in 2012, it was first authorized in 2004 to treat HIV positive patients. That's right: the same drug used for these two purposes. Since it has been on the market as a treatment for over a decade—with very minimal side effects and harms—doctors are pretty confident in its safety profile for preventative use. There seem to be few side-effects with Truvada for prevention, the most common one being nausea.

 

 

PEOPLE HAVE BEEN SLINGING THE TERM 'TRUVADA WH0RE' AROUND, AND THE HEAD OF THE AIDS HEALTHCARE FOUNDATION CALLED THE PILL A 'PARTY DRUG'

 

 

7) "Truvada wh0res" are a thing

 

Because of the questions about whether PrEP will cause people to have risky sex and ditch condoms, there's some related stigma in the gay community. People have even been slinging the term "Truvada wh0re" around, and the head of the AIDS Healthcare Foundation called Truvada a "party drug." In response, one PrEP activist created a #TruvadaWh0re t-shirt campaign to reclaim the word.

 

Many have pointed out that this divide parallels the early days of the birth control pill and suggestions that the medication would encourage promiscuity.

 

 

8) Uptake has been slow—but that's not the full story

 

According to data from the drugmaker Gilead, by March 2013 there were approximately 1,774 people in the US taking the drug. But it's important to put this number in context. First of all, these findings were not published and peer-reviewed; they were presented at a scientific conference last year. When studied, we'll have a better picture of the PrEP landscape and it may look quite different. Secondly, Truvada has only been on the US market for prevention since 2012, a year after these numbers were gathered. It often takes decades for innovations to penetrate a market, especially in the conservative field of medicine.

 

 

9) The drug is expensive

 

Without insurance, Truvada can cost up to $14,000 a year, according to the CDC. But for most people, it is covered in their insurance programs and there's only a co-pay. There are also medication assistance programs across the US for the uninsured that will cover the entire cost of the medication.

 

 

10) HIV remains a socioeconomic crisis in America and around the world

 

Globally, men who have sex with men, prisoners, injection-drug users, and sex workers are still the groups most affected by HIV. The picture is similar in America, where the number of HIV infections has stagnated for about a decade. Here, men who have sex with men and African Americans are most affected by the virus.

 

http://tempmedia.tumblr.com/preview.6p5aoxLXVW03VPY5/7616d5d296dc3372aefc35d9300eac8a_500.png

 

 

When it comes to race, the same is true for youth.

 

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If PrEP is going to have a chance at nudging down the HIV rate, the sub-groups most impacted by HIV will need to have better access to the health system: to get tested, see their doctors, and learn about this option; to have regular health care with proper monitoring and follow up. Unless Truvada is a miracle drug, it's not clear how a pill will do that.

 

 

source: http://www.vox.com/2014/7/14/5896887/explainer-about-the-pill-to-prevent-hiv-aids-Truvada?utm_medium=social&utm_source=facebook&utm_name=share-button&utm_campaign=vox&utm_content=article-share-bottom

[LookingAround]

Do you take truvada? I know many escorts who are neg and do. Simply number of sex partners is also a significant risk factor for HIV infection.

[Steven_Draker]

Do you take truvada? I know many escorts who are neg and do.

 

Did you read the article?

 

The pill is "for people who do not have HIV but who are at substantial risk of getting it," according to CDC guidance. "At substantial risk" means you regularly have unprotected sex with partners of unknown HIV status.

 

To answer your question: I'm not on Truvada.

 

I have been using condoms and condoms remain a very reliable protection against HIV and other STIs.

 

I can personally vouch for that.

 

Simply number of sex partners is also a significant risk factor for HIV infection.

 

Number of Partners Doesn't Explain Gay HIV Rate

By Steven Reinberg (HealthDay Reporter)

 

THURSDAY, Sept. 13 (HealthDay News) -- The HIV epidemic among gay men can't be explained by their number of sexual partners, U.S. researchers report.

 

More than half the new HIV infections diagnosed in the United States in 2005 were among gay men, a team at the University of Washington, Seattle, noted. In addition, as many as one in five gay men living in cities may be HIV-positive.

 

But the sexual behaviors of gay and heterosexual men in the United States may not be as different as most people think, the researchers said.

 

In fact, two surveys found that most gay men have a similar rate of sex with unprotected partners compared to straight men or women.

 

"Just because gay men continue to have much higher levels of HIV, we can't jump to the conclusion that that means that they are promiscuous or that prevention messages aren't working," said lead researcher Steven Goodreau, an assistant professor of anthropology.

 

In the study, Goodreau and a colleague, Dr. Matthew R. Golden, analyzed data from two large population-based surveys. Using those figures, they estimated how many sex partners gay men and straight men and women have, and what number of gay men have either insertive or receptive anal sex, or both.

 

The report is published in the Sept. 12 online edition of Sexually Transmitted Infections.

 

"We found that even if gay men behave the same way heterosexuals do -- in terms of sexual partner numbers -- gay men would still have a huge HIV epidemic," Goodreau said.

 

Conversely, "even if heterosexual men behaved the way gay men do, they would not have a huge HIV epidemic," he added.

 

In fact, for straight men and women to experience an epidemic of HIV infection as widespread as that of gay men, they would have to have an average of almost five unprotected sexual partners every year -- almost three times the rate of the average gay male, Goodreau and Golden found.

 

So, why the higher HIV risk for gay men? "A couple of different things could give gay men an overall higher risk for HIV than heterosexuals," Goodreau said.

 

One reason HIV remains epidemic among gay men is that anal sex is much more conducive to the transmission of HIV transmission than is vaginal sex, the researcher said.

 

"That puts gay men at much higher risk overall," he said.

 

In addition, HIV transmission is more easily transmitted through the penis than via the vagina or the anus, Goodreau said. Heterosexuals tend to maintain the same role (insertive vs. receptive), while gay men can switch roles -- making the transmission of HIV more likely, he noted.

 

So, for gay men and straight men who have the same number of partners and have unprotected sex, gay men are more likely to transmit and receive HIV, Goodreau said. "That's why you can get huge epidemics among gay men and virtually none among heterosexual men," he said.

 

To end the HIV epidemic, gay men would need to have significantly lower rates of unprotected sex than those seen among the straight men, Goodreau believes.

 

One expert believes the study does have its flaws, however.

 

"The information here is mostly based on people's reports of their own behavior," said Philip Alcabes, an associate professor at the School of Health Sciences of Hunter College/City University of New York. "When trying to make use of information on self-reported sexual behavior, we have to remember that it isn't clear that anybody tells the truth," he said.

 

source: http://abcnews.go.com/Health/Healthday/story?id=4508672&page=1

 

 

In other words, what matters is the type of activity (protected or unprotected) you're engaging in over the number of partners !

[SteveEscort]

I am not on it either and I've been working for 14 years and I am 100% hiv negative

 

I have an HIV test every 4 weeks

[Steven_Draker]

Do you take truvada?

 

The pill is "for people who do not have HIV but who are at substantial risk of getting it," according to CDC guidance. "At substantial risk" means you regularly have unprotected sex with partners of unknown HIV status.

 

To answer your question: I'm not on Truvada.

 

I have been using condoms and condoms remain a very reliable protection against HIV and other STIs.

 

I can personally vouch for that.

 

Why put another chemical in your body that you don't need and 'stress' your liver unnecessarily?

 

IF I was engaging in bareback sex, I would make sure to talk to my doctor about Truvada.

[LookingAround]

Steven you are doing a disservice to the men here by discouraging use of truvada. Leave your morals behind. You also should know that NUMBER of sexual partners epidemiologically represents an independent risk factor for HIV infection. Do you disapprove of the HIV negative escorts here (I know of three who are very well reviewed here) who as far as I know who always play safe but take truvada?

 

Leave your moralizing elsewhere

[Steven_Draker]

Steven you are doing a disservice to the men here by discouraging use of truvada.

 

Oh, puleeze, don't put words in my mouth.

 

I STRONGLY ENCOURAGE YOU TO TALK TO YOUR DOCTOR ABOUT TRUVADA AND CONSIDER IT SERIOUSLY IF YOU ENGAGE INTO UNPROTECTED SEX.

 

Please check all my contributions in this Forum about HIV prevention before pointing out fingers and jumping to conclusions.