PrEP is absolutely critical in a three-pronged public health strategy for containing and eliminating the circulation of HIV.
The US CDC and the NIH strongly urge policy makers to view PrEP as a cost-effective, cost-saving measure that should not be seen as a luxury in public health budgets.
TASP isn’t just ART or HAART, antiretroviral treatment to suppress HIV once a person is already infected with HIV.
TASP includes both Pre-Exposure Prophylaxis (PrEP) and Post-Exposure Prophylaxis (PEP).
PrEP is a daily course of treatment that can be taken by people who are at high risk of exposure to HIV. Data is increasingly showing us that PrEP is very close to 100% effective at preventing infection.
PEP is a 28-day course of the same medication, and can prevent infection after exposure. It has to be started within 72 hours of exposure, but the sooner the better.
The arguments against PrEP are typically that it either isn’t actually needed because condoms work well enough, or that it encourages irresponsible behavior while presenting a risk of the emergence of drug-resistant strains of HIV.
In my opinion, neither argument holds up to scrutiny.
Condoms do work perfectly well, of course. But that’s not the point.
We’re trying to stop the circulation of HIV. Young gay men are still most at risk of being exposed to HIV due to population prevalence rates.
Young men sometimes don’t act responsibly. That’s life. That’s human nature. The US CDC would love to see everyone at risk for HIV infection on PrEP tomorrow.
The epidemic would be stopped dead in its tracks, and for a fraction of the cost of living with current rates of infection and then treating people for life after they become infected.
I’m not on PrEP. I don’t consider myself to be at risk. But I sure would have been at 25.
I think any gay man who doubts his ability to use condoms properly every time he has sex should be on PrEP.
The drug resistance issue doesn’t trouble epidemiologists and virologists who study this issue. Yes, there are hypothetical concerns. In the main, though, the risk is seen to be very, very low — too low to outweigh the benefits of strangling viral circulation.
Some populations in particular, including young gay men who are black or Hispanic, already face elevated risk. Stigma, homophobia, the downlow culture, and reduced access to routine medical care have resulted in higher rates of new infection among those populations compared to other gay male populations.
PrEP should be especially important for these young men. Higher viral prevalence means any mistakes they make are even more fraught.
In many parts of the US, PrEP is now available at no cost or at reduced cost for those who can’t afford it.
When I talk to gay men about safer sex, I almost always ask them to consider if PrEP is right for them.
I think for many of us, the answer is absolutely yes.
