The Best Threads Of 2014: “Why Aren’t Gay Men On The Pill?”

Andrew Sullivan —  Dec 31 2014 @ 6:59pm

Dozens of readers this year added their very personal perspectives to the breakthrough drug Truvada and the baffling resistance to it by many gay activists. Read the whole discussion thread here. Below are a few previously unaired emails to add to the mix:

Most of the coverage of Truvada has been about the idea of “Truvada whores” who take the drug so that they can have indiscriminate sex with any number of people. I wanted to write truvadayou with a different perspective.  I am a HIV-negative guy in a relationship with an HIV guy. I’m 33 and he’s 30. Unfortunately he made some poor decisions in his very early 20s but he’s been very proactive since. He’s remained at an undetectable viral load for 7 years now and his more recent T-cell count was excellent, as it has been for a while. He was very straightforward with me when we started dating and that has helped a lot too.

Recently I began taking Truvada as an additional step to protect me. It’s very very inexpensive through my insurance and after a few months I’ve had no side effects. Not only does it provide physical aid but it also provides a great deal of emotional assistance. It puts me at better ease and it makes him feel better that there is basically zero chance that he could infect me. It also gives us a daily ritual in which we each take our daily medication, using each other to ensure that we are very strict on taking medication every day. Hopefully, as more news comes out, he’ll one day be free of his decade-old bad choices and we’ll live together totally and completely free.

But another reader cautions:

Your ongoing coverage of Truvada as pre-exposure HIV prophylaxis is fascinating and reaches a large number of gay men. This is why it’s important to correct a error that keeps occurring in Dish pieces on PrEP:

the notion that Truvada “reduces your risk of contracting HIV by 99 percent” (for example). PrEP does not reduce the risk by 99%; it reduces the risk by less than half.

As a young physician, I realize that the medical community does a crappy job of explaining statistics related to treatment. For your readers (a generally sophisticated bunch), here’s a breakdown of the numbers:

In the Truvada study in gay men (found here), 1248 men were given a placebo pill and 1251 men got Truvada. In the placebo group, 64 men subsequently got HIV (rate of infection: 64/1248 = 5.1%). In the Truvada group, 36 men subsequently got HIV (rate of infection: 36/1251 = 2.87%).

So what does Truvada do? With general sex practices, risk of HIV is low. Without Truvada, there’s a 95% chance you won’t be infected and a 5% chance you will be infected. With Truvada, there’s a 97% chance you won’t be infected and a 3% chance you will be infected.

Truvada does reduce HIV infection. And that change is about 2% in absolute terms (5% down to 2.87%) and about 44% in relative terms (5% reduced by 44% is 2.87%).

Saying Truvada “reduces your risk by 99%” mistakenly implies an enormous effect of the drug – one that was not shown by the trial.  Rather, it would be true to say that men taking Truvada had a 97% chance of remaining HIV-negative. But even without the drug, the chance of remaining HIV-negative was 95%. Truvada does make a difference, but it’s not a magic bullet.

Thanks for shining a light on this important issue.