Elizabeth Pisani reacts to the news. She notes that the test subjects weren’t very good at taking pills:
[Taking the pill is] a smaller protective effect than using a condom all the time, of course. The thing is, we know that people aren’t good at using condoms all the time. And what these study results show us is that people aren’t very good at taking a pill every day, either, though they are keen to tell researchers that they do. One of the most striking things about the results was the mismatch between self-reported pill taking and measured levels of active drugs in people´s bodies.
Her second fear:
10 people who tested negative at the start of the study were actually in the very early stages of HIV infection. Both of the 2 who happened to be assigned to the Truvada group developed resistant forms of the virus, suggesting that giving these drugs in the early stages of infection when the virus is replicating very rapidly may fertilise resistant strains.
Her bigger point on the politics of the breakthrough:
Worries about resistance aside, the news seems pretty good. So why do I say it’s a political nightmare? Because antiretroviral drugs are expensive; a lot of people who need them to prolong their lives can’t get them. Now we’re talking about giving them to gay guys so that they can go out and screw around as much as they like without having to think about using the cheaper and potentially more effective (but generally more bothersome) option of condoms. I’ve been a bit sniffy about this myself in the past, though I did spend about 15 years taking a pill every day so that I could have as much sex as I liked without contracting that long-term, life-changing sexually transmitted condition called pregnancy. But in many countries it is still very hard to give out condoms because it is seen to promote promiscuity.
If we could figure out a way to improve adherance, putting ARVs on the public tab will probably save money overall. It’s certainly something we should be trying out in all sorts of different ways. That includes the possibility of “disco dosing” — taking pills only on the days when one has a pretty good idea that one’s going to end up barebacking. But as condoms have taught us, the fact that things work technically doesn’t necessarily mean they work in real life, let alone in politics. Even if we can find a better way to deliver pre exposure prophylaxis (implants? it’s what I do instead of pills these days against that other STD, and I love it) I think it is going to be a hard sell in many countries.