A ‘magical’ pill, popularly known as Truvada, emerged in the HIV community a few years ago but is continuing to cause controversy.
This pill (emtricitabine and tenofovir disoproxil fumarate) was approved as an HIV infection risk inhibitor and was intended for people who engage in high risk sexual behavior. Studies have shown it reduces the risk of HIV infection by 90 per cent.
Truvada was approved by the United States’ Food and Drug Administration (FDA) for pre-exposure prophylaxis (PrEP) in July 2012 – the first drug of its kind. But its use as an HIV prevention tool has attracted a mixed reaction from different people, including HIV advocates around the world. In the Truvada controversy, some people argue that condoms are still the only effective biomedical prevention strategy and that PrEP should be discarded.
Some healthcare activists are concerned about PrEP on the basis that is not clear what side effects its long-term use might cause. Since this medication is for uninfected people, others say PrEP is ineffective because most people are bad at remembering to take pills. Another argument is that adherence will be poor because taking the pill is not a matter of life and death for people who are not infected, compared to those already living with HIV. Another well-used – and in my view rather pathetic – argument against PrEP is that it will encourage bare-backing (unprotected sex).
Condoms are not enough
There is no denying that condoms are the most effective strategy for HIV prevention. They have been around for decades and have prevented numerous HIV infections. But condoms alone are not enough: the number of new HIV infections is still too high – 2.3 million in 2012 (UNAIDS).
The problem is that a lot of people still don’t use condoms. People just love bare-backing – we don’t need a bunch of studies to prove the obvious. That is why we could use another tool. The world needs more prevention tools to fight the virus. Let’s not forget that condoms do break.
Also, according to an article published in The Body, studies reveal that the incorrect use of male condoms is surprisingly common and that condoms are only 70-80 per cent effective compared to Truvada’s 90-99 per cent efficacy rate.
PrEP will not change sexual behaviour
So where does all this resistance to PrEP come from? Am I missing something here? The truth is PrEP is not 100 per cent but neither are condoms. In fact, nothing is. To believe that PrEP will alter people’s sexual behavior and will encourage bare-backing isn’t just ridiculous, it is unfortunate. A study published in December 2013 proved this notion to be wrong. I know PrEP does not prevent the transmission of other sexually transmitted diseases like gonorrhea and hepatitis, or unwanted pregnancies, but as an HIV-prevention tool it should not be dismissed.
Truvada has been used in HIV antiretroviral regimens for some years now and it hasn’t shown any serious side effects on its own. It is also not unusual for some individuals to have different reactions to any type of medication. Different people react differently to different drugs. Even with condoms, some people complain about the lubricants giving them rash – but that doesn’t happen to everyone and we cannot renounce condoms based on that fact.
The argument presented about the ineffectiveness of PrEP due to non-adherence is absurd and makes little sense. Of course PrEP will not work if you don’t take it. As a matter of fact, no medication is effective if you don’t remember to take it and condoms don’t work if you don’t use them. Now it all comes down to education on prevention.
Combined approach to prevention
HIV is a nasty virus and AIDS can be fatal. Although globally the number of new HIV infections is decreasing, in certain areas and population groups the virus is still on the rise. For example, after many years of a declining HIV rate in Uganda findings from the last Uganda AIDS Indicator Survey showed rates had started to increase again. HIV has significantly impacted all parts of the world and, if we are to stop it, we need to use all the tools at our disposal.
It is clear that there is no one-size-fits-all when it comes to HIV prevention strategies, so why not use a combined approach to win the battle? This should include voluntary medical male circumcision, condoms, treatment as prevention and PrEP. All these methods should be accompanied by education on prevention.
Let’s give people the option to use the methods that works best for them. Whether that is taking a daily pill, using a condom, or both, this approach will help prevent more new infections than simply using one method alone.
Read about HIV and the post 2015 development agenda
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