Eric Sasson wants more attention paid to “PrEP, or Pre-Exposure Prophylaxis, arguably the biggest breakthrough in HIV prevention medication to come out in the last two years.” He’s dead right. HIV-negative men using PrEP are much, much less likely to get infected, and yet there has been no rush to get this news across or to capitalize on it:
Truvada, the first PrEP drug, was approved by the FDA last summer. When taken daily, it can prevent transmission of HIV 99 percent of the time if taken every day. Even if taken only four times a week, its effectiveness remains as high as 96 percent. One would think that a statistic like that would be widely reported and celebrated, and yet there are few people outside of the LGBT community who have even heard of PrEP.
It’s easy to understand why PrEP hasn’t been heavily publicized by certain institutions involved in HIV prevention. Thirty years into the epidemic, the CDC still says oral sex can result in the transmission of HIV, despite enough evidence showing that the risk is “extremely low.” The agencies play it safe, and PrEP opens them to another kind of risk. There is also the issue of adherence: People are not always good at sticking to a daily regimen of pills, and doctors worry that using Truvada on occasion, rather than as directed, might lead to the emergence of drug resistant strains.
But the lack of reporting about PrEP may stem from something else altogether: a lingering controversy about its use within the gay community itself, and how PrEP has contributed to a growing generational divide between old-guard condom true-believers, many of whom survived the epidemic of the ’80s and ’90s, and a new generation of HIV activists for whom condom use is seen as just one tool in a growing arsenal of prevention methods.
As a survivor of the epidemic, I’m with the new guard and not the old. Not least because I have no core objections to gay men having sex with one another. But those who stand guard over public health policy – gay and straight – don’t seem to share my view.