Got PrEP?

What would you do if there were a pill that could prevent HIV infection? Would you throw your rubbers out the window? Would you feel safer?

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Maybe it was a condom that broke — Daniel doesn’t like to talk about the details. “It was just a stupid accident, and not even something usually considered too risky.” But it’s how he went from loving a man with HIV, to living with HIV himself.

But what if taking a pill a day could have reduced his risk of infection? “We had years of practice playing safe, so that might have seemed like overkill,” says Daniel. “But looking back now, I think it would have been nice to have that option.”

Long-term serodiscordant couples — where one partner is HIV-negative, the other positive — are just one of the potential candidates for a new HIV prevention technology under development called pre-exposure prophylaxis, or PrEP.

The theory behind PrEP is that some of the same drugs that people with HIV use to manage their infection may also be capable of preventing the virus from taking hold in someone’s body in the first place. A study published on Jan 15 showed that PrEP prevented HIV transmission in mice. And human safety trials are underway, including one involving 4,000 gay men in Lima, Peru.

“We are still years away from knowing whether PrEP will be a safe and effective option for people,” says Jim Pickett, who heads advocacy efforts at the AIDS Foundation of Chicago and calls himself “an ardent supporter of new prevention technologies.” But he’s optimistic about PrEP because the results are encouraging so far.

There are precedents for this sort of HIV prevention effort. HIV drugs such as nevirapine given to pregnant women have been shown to have a high success rate in preventing transmission of the virus to their children.

And studies have suggested it can be safe for positive men and negative women to try and conceive naturally — if the woman uses PrEP, the man is on HIV meds and their intercourse is timed for a period when he is least likely to be infectious.

PrEP would provide added protection for those who use condoms already, but “it could be especially important for people who don’t use latex,” says Pickett. “A lot of women and men around the world don’t have a say over when or how they have sex. This would give them an option that they can control.”

Robert Grant, the researcher coordinating the Peru study says, “HIV prevention tools are used less if they alter the way people have sex.” This exposes a truth many people find uncomfortable: after two decades of safer sex education, many people reject condoms.

Even a cursory glance at the amateur videos on XTube suggests just how widespread unprotected anal sex is. We ignore this — or simply judge it — at our peril, Pickett suggests. “We get mad if people can’t or don’t use latex — but it’s a reality. Many people just don’t want to use condoms, and won’t.”

There are many unanswered questions about PrEP. In addition to whether it will work, there are questions of cost, availability, and the long-term implications of taking the drugs. Still, says Pickett, “there may be a significant group of people — gay and straight — who would rather take PrEP than use condoms.”

Not that we should all throw our latex sheaths out the window. “Condoms will likely always be the best option — they are effective 98 percent of the time, when used consistently and correctly,” he adds. And condoms offer valuable protection against some other STDs some of the time as well.

“Some people claim that with new prevention technology, safe sex will go out the window for everyone — but the same kinds of false arguments are made about comprehensive sex education, or needle exchanges. Those things work, and we don’t have an epidemic of nine-year-olds having sex or non-drug users suddenly taking up the needle.

“If you use condoms, great. People who use them will likely continue to. But we still need to come up with alternatives,” adds Pickett. “We know that people alter their sexual behaviour in different contexts — inside or outside of a relationship, tricking, with long-term fuckbuddies. So we need different ways of protecting ourselves in all these situations.”

Even if it proves to be effective and safe, taking a pill a day might not make sense for all men who have sex with men, especially those who consider their personal situation low-risk. But it might make sense in some cases.

“We were both committed to me staying negative, but something just went wrong one time,” says Daniel of his long-term relationship and the incident that lead to his HIV infection. “This could have never happened, or it could have happened 10 years down the road. It might have felt weird to take HIV drugs when I was negative, but if that had been an option, maybe I wouldn’t be talking to you today.”

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If you are HIV-negative, could you picture a circumstance in which you would take anti-HIV meds to try and stay that way? Share your thoughts.

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