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|Letter to the editor: Don’t dismiss HIV drugs as prevention strategy|
|by Letter to the editor|
|September 30, 2011 00:00|
Data from the iPrEx study of pre-exposure prophylaxis (PrEP) for HIV prevention in gay and bisexual men and transgender women has led to debate about whether and how PrEP should be used.
Unfortunately, some of that debate has been fueled by groundless assertions that men who have sex with men (MSM) will misuse PrEP, spreading drug resistance if PrEP is made available.
A paid ad campaign by the AIDS Healthcare Foundation has contributed to spreading false information both about PrEP and the commitment of gay/bi men to care for themselves and others. We reject those false assertions and call for a factual discussion of pros and cons of PrEP in our community.
HIV positive gay/bi men committed to promoting and accurate information are circulating an expanded version of the following letter to clarify the facts about PrEP and make clear our belief that we are entitled to respect, accurate information and new HIV prevention tools.
We encourage other HIV+ gay/bi men to sign on to the full version of this letter at http://tinyurl.com/pozPrEPletter.
We are openly HIV+ gay and bisexual men dedicated to protecting our partners and reducing the impact of AIDS for all. We agree with the National HIV/AIDS Strategy that HIV+ individuals have a vital role to play in stopping this epidemic. Gay and bi men account for more than half of new HIV infections in the US and need new HIV prevention approaches.
Pre-exposure prophylaxis, PrEP, is a new HIV prevention method in which an uninfected person takes a daily HIV medication to reduce HIV infection risk. Three studies, including one in MSM and transgender women, have shown that this approach has merit.
PrEP raises important questions deserving debate. We are disappointed, however, that an organization that runs HIV clinics, the AIDS Healthcare Foundation, has spent tens of thousands of dollars on ads using simplistic and often misleading arguments to condemn PrEP before the FDA has had a chance to review it.
Here are key facts, many of which are misrepresented by the AHF campaign:
• 2,499 HIV-negative gay/bi, MSM and transgender women on four continents participated in iPrEx. Participants who received daily PrEP with Truvada in addition to condoms and counseling had an average of 44 percent fewer HIV infections than those who received condoms and counseling alone. Protection against HIV infection was much higher (up to 90 percent) among those who took PrEP consistently.
• No HIV infections occurred in men whose blood test indicated that they took Truvada regularly. But taking the medication regularly was a challenge for many
• iPrEx participants reduced risk behaviors and increased condom use.
• Truvada is widely used for HIV treatment because it is generally well tolerated. While research to understand the long-term safety of PrEP continues, rates of side effects were very low in the study.
• Studies to date show no evidence of HIV drug resistance when HIV infection occurs in spite of PrEP use. Resistance can occur, however, when PrEP is taken by someone who has HIV but does not know it.
• The iPrEx study was paid for by the U.S. National Institutes of Health and the Bill & Melinda Gates Foundation, not by any drug company.
PrEP is a major breakthrough in HIV prevention that also raises important questions. These include how to best support regular PrEP use; how to ensure the continued use of condoms; how to target those who will benefit most; and how to pay for PrEP.
The AHF ad campaign claims to have the best interests of gay men at heart, yet says that men who have access to PrEP will throw away condoms, and urges that gay/bi men be denied access to PrEP. The truth is that gay/bi men have led the HIV prevention movement, invented safer sex, promoted condoms, and worked tirelessly to prevent new HIV infections.
We also reject the argument that providing access to PrEP will result in fewer resources for HIV treatment or other HIV prevention methods. HIV prevention reduces healthcare costs and helps preserve resources for treatment. Resources for prevention and treatment both must be increased.
No HIV prevention method is a magic solution. Ensuring combination approaches with multiple options is key to slowing the epidemic. PrEP is a significant advance, however, that deserves a thorough review by the FDA.
Ad campaigns that misinform will not help end this epidemic. We call on everyone to get the facts about PrEP and express opinions based on real information, not prejudice against gay/bi men.
To that end, we call on AHF to end its expensive and misleading ad campaign, and to work with us to promote an informed public discussion of HIV prevention.
Editor’s note: This letter was submitted by a coalition of PrEP advocates, led by Project Inform and the AIDS Vaccine Advocacy Coalition.
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