Before Transmission
By Kyle Harris
Physician Mark Thrun sees the end of the AIDS epidemic as a viable possibility and the potent blue pill may be the answer we were looking for.
PrEP (pre-exposure prophylaxis) goes by the brand name Truvada and is the backbone of the HIV-transmission preventative. According to CDC test studies, “the risk of getting HIV infection was much lower — up to 92 percent lower — for those who took the medicines consistently than for those who didn’t take the medicines.”
Truvada is not only effective in treating HIV, but if taken regularly and daily, it’s as effective as condoms in preventing the spread of the virus, Thrun says.
Most insurance companies cover PrEP. If you’re uninsured, Gilead Sciences, the biopharmaceutical corporation that makes Truvada, has a program to help people access the drug for low to no cost.
Even though PrEP prevents a fatal disease and is affordable, only 27 percent of men who sleep with men know about it, Thrun says. Among heterosexuals, that number is even lower.
In his job as the director of HIV/STD Prevention and Control at Denver Public Health, Thrun oversees the organization’s STD clinic. While he has spent decades trying to persuade people to use condoms, patients often don’t. Up to 75 percent of gay men forgo rubbers during anal sex; heterosexual men rarely wear them.
Most HIV doctors have heard of PreP, Thrun says, but not all prescribe it. This does not surprise him. Many of his colleagues base their recommendations for HIV prevention on myth rather than science.
Some physicians suggest to patients that all sex is equally risky. Take oral sex, for example. While evidence shows the rate of HIV transmission via oral is next to zero, doctors regularly tell patients to use condoms for blowjobs to prevent transmission.
Some doctors suggest that transmission is a certainty if patients have unprotected sex with HIV-positive people. Thrun says if an HIV-positive person has an undetectable viral load, there is virtually no risk of transmitting the virus while having sex without a condom. But do most doctors acknowledge this? No. The necessity of rubbers has an almost religious power over the medical community.
When it comes to Truvada, HIV docs are catching on, he says. The more experience the medical community has with PrEP, the more agreeable physicians are to prescribe it. Regarding general practitioners, “Most doctors are not PreP educated.”
Denver Health has had little money to inform the public and medical community about Truvada. In lieu of a mass marketing campaign, patients have to educate their communities and doctors, Thrun says.
A majority of primary care physicians never ask their patients about their sexual orientation, their gender identity, number of sexual partners, and safer-sex practices.
Patients have to advocate for themselves to get a prescription.
PrEP users may also need to educate their prospective hookups about the drug, Thrun says. While Truvada is pervasive in the gay communities of San Francisco and New York, gay men in Denver and other smaller cities are still catching on.
PrEP may be shifting the practical conversations people need to have before a hookup. “If I’m HIV positive and have a zero viral load, do I have to disclose?” Thrun asks. “If I’m negative and taking PreP, can I have unsafe sex? Science suggests that’s the case.”
But science does not always shape public perception.
“There are a lot of people in the gay community who don’t believe PrEP is safe,” Thrun says. After 30 years of condoms as king, many find it hard to believe they’re no longer the only way to halt HIV transmission. “Providers and the community don’t quite trust it — it’s not been around a long time. There is a knowledge gap, a trust gap.
“All that many people have ever known are condoms. The [PreP] stigma is rooted in mistrust. We have to get beyond that and trust science and feel comfortable. People fear things they don’t know much about.”
Though an incredibly promising drug, PrEP does not stop the transmission of other STDs. Like his colleagues at the CDC, Thrun still recommends using condoms. Combining rubbers and PrEP is safer than either method alone.
When it comes to side effects, “There can be lots of nausea at first and gastrointestinal side effects. People with conditions that impact the kidneys like diabetes or hypertension need to be careful on PrEP. There can also be headaches early on.” But overall, “the side effect profile is low,” Thrun says.
People promoting the notion that Truvada users are “slutty” or “sexually irresponsible” bother Thrun.
“Why would you peer pressure people for protecting themselves against a fatal disease? That’s goofy,” he says.
While there have been fears that Truvada usage would lead to higher rates of careless sex, Thrun says this is not the case. Taking PrEP is not much different from avoiding pregnancy via the pill.
Thrun hopes that in the future, high school students will learn about PrEP in sex-ed classes and that the drug will be widely recognized as a smart, safe option in the prevention of HIV. In combination with better treatment of the virus, the use of PrEP has the power to greatly diminish the number of new infections.
“We’re talking about ending AIDS by the year 2050,” he says. “We’ll never get rid of it completely, but we’ll have a handle on it.”
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