Our HIV crisis: PrEP is not a cure

published on April 1, 2015 by Kyle Tramonte, in Yale Daily News

Take a pill daily and prevent the contraction of HIV 99 percent of the time.

That is the narrative presented to many young men who have sex with men (MSM) by their peers regarding pre-exposure prophylaxis (PrEP). And, as is normally the case with anything framed in such a simple manner, the nuances of treatment fall through the cracks.

It is unwise to herald PrEP as the key to freeing a generation from HIV. It is merely one piece of a larger effort. Not only is PrEP not for everyone, but public health activists face political obstacles similar to those hurled at advocates of birth control. Universal access to PrEP will implicate two overlapping and traditionally disparaged groups: sexually active youth and individuals in non-heterosexual relationships.

A little background: Candidates for PrEP must first fall into a risk group (MSM being the largest of these). Then they generally must check one of a few more boxes, like having contracted an STD or having had unprotected sex in the last six months.

Dr. Andrew Gotlin, chief of Student Health at Yale, summed up precautions surrounding PrEP this way: “It’s certainly not taking vitamin C.”

To ensure maximum efficacy, patients must take the pill daily. (This seems easy enough, but if you are a man, grab a female friend on birth control and ask if she’s ever missed a pill.) Once someone starts treatment, they must meet with their prescribing physician to monitor progress every three months. Patients certainly don’t want to miss these appointments: They are scheduled to ensure that some of the known side effects of antiretroviral treatment (like kidney disease and early-onset osteoporosis) do not set in, or that, in the event that the patient contracts HIV, the virus does not become resistant to the drugs. Toxicity of antiretroviral drugs has fallen dramatically as treatment has advanced, but the risks must be noted.

What’s more, starting treatment presumes a healthcare market that offers patients reasonably priced drugs and access to healthcare providers. Beyond these baseline challenges, achieving effective, widespread usage will require surpassing political hurdles.

The demographic of young MSM, one of the groups with the most alarming increases in HIV incidence, extends from age 13 to 24. This means that many young MSM must request PrEP under their parent’s insurance — with no right to privacy in their medical records. To get treatment that might prevent the contraction of HIV, young men will have to disclose their sexual orientation not only to their physicians but also to their parents, a prospect that is daunting for many well into adulthood, never mind adolescence.

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Our HIV crisis: PrEP is not a cure

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