There Is a Daily Pill That Prevents HIV. Gay Men Should Take It

Published: January 6, 2014

Last Monday, the New York Times ran an excellent piece exploring the curious controversy over Truvada, a daily pill that provides almost absolute protection against HIV infection. By far the most effective PreEP (that is, pre-exposure prophylaxis), Truvada has virtually no side effects and, if taken daily, it is more than 99 percent effective at preventing HIV—and it’s covered by most insurance companies. Basically, Truvada is a miracle drug. It’s also one of the most unpopular HIV medications ever invented.

Why have only 1,774 people—half of whom are women—filled Truvada prescriptions over the last two years? The fault lies squarely in the gay community itself. As the Times notes, Truvada’s most vehement opponents are AIDS activists. The AIDS Healthcare Foundation actually lobbied the FDA to reject the drug, arguing that gay men would stop using condoms, forget to take one pill, and quickly become infected. The former editor-in-chief of Poz, a publication for HIV-positive people, called PrEP a “profit-driven sex toy for rich Westerners.” Dan Savage, a popular sex advice column and sachem of the gay community, had similar fears, infamously describing Truvada users as “self-identified idiots who can only be saved by a vaccine.” What’s more, the phrase “Truvada whore” is becoming pervasive on some gay social networks.
Behind all these anxieties lie two beliefs, one condescending and incorrect, the other unpleasant but accurate. First, the suggestion made by AIDS advocacy groups—that gay men will stop taking other safe sex precautions once on Truvada—is simply untrue. Several studies have effectively debunked this rather patronizing notion, illustrating that a Truvada prescription leads in no way to “sexual risk compensation” (that is, ditching other safe sex practices). In PrEP’s early days, this concern was understandable. But it’s now been discredited, and those still bandying it about are only furthering a refuted paranoia.
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