Dear Dr. Ren,
There’s a buzz in the clubs that there’s a pill I can take that will prevent me from getting HIV. This means no more condoms. Can this be true? If so, why hasn’t there been some big announcement? If not, is there something coming soon that is creating this gossip? Please tell me there’s good news.
Sick of Condoms
Dear Sick of Condoms,
The drug you have been hearing about is called Tenofovir (Viread), an antiretroviral drug that may help prevent HIV infection, or a number of other closely related pharmaceuticals. It is a highly controversial and thus far unproven means of protection known as pre-exposure prophylaxis, or PrEP.
These drugs belong to a new class of drugs called Nucleotide Reverse Transcriptase Inhibitors (NtRTI). They look promising in suppressing both the HIV and the hepatitis B virus.
Tenofovir and other PrEP drugs are not new. They’ve been available in the US for several years, sometimes dispensed in clubs in “party packs” including crystal meth and Viagra, a combo known as “MTV”.
PrEP is another application of post-exposure drugs given to people possibly exposed to HIV —such as health care workers, rape victims, or those who’ve experienced condom failures —and by the medications that HIV-positive pregnant and nursing women routinely take to prevent mother-child transmission.
A host of studies are now underway to determine if it actually works.
But before you applaud, this story is more complex than it may appear.
Tenofovir has a list of unpleasant —and socially embarrassing —side effects, including diarrhea, nausea, vomiting, dizziness and flatulence. Yes, when you’re not pooping in the loo, you’ll be farting. More serious side effects include such severe liver problems that some are actually fatal.
Access is another issue. Here in Canada, all HIV drugs are overseen and dispensed by the Centre of Excellence or one of their satellite agencies. ‘Regular’ GPs cannot prescribe them. Though covered by MSP, many are not fully approved by Health Canada as they are still experimental. Trusting in Tenofovir is a big risk to be taking with such a deadly disease!
And even if you could score some Tenofovir from an authentic HIV-positive person willing to sell life-saving drugs for food money, you’d be denying him his needed meds so you can take an unproven drug that may or may not prevent HIV transmission, all so you don’t have to slip on a condom —hardly a pride-inspiring behaviour.
And there’s more: even if PrEP is proven safe and effective, we still have many questions to be answered. How long prior to sex must you take this drug to prevent infection and how long does that protection last? Does the drug’s effectiveness decrease over time?
If a sex partner’s viral load is very high, can it render PrEP ineffective? Might the drugs interfere with the immune system’s response to HIV, making you more susceptible to infection when you discontinue the medication?
And if people on PrEP do seroconvert, might they be resistant to their already-established antiretroviral drugs?
What about drug interactions? All of these are serious considerations and require medical management.
On the other hand, if effective, Tenofovir and its cousins could change the face of HIV/AIDS. Gay men would benefit, as would other at-risk groups: sex workers, IV drug users, and women, particularly in developing countries, whose partners resist safe sex practices.
Less altruistically, you would be less likely to contract HIV from unprotected sex, and might therefore choose not to use condoms.
However, you would still be vulnerable to other STIs like syphilis (which places you more at risk to HIV infection and is becoming more difficult to cure), gonorrhea, Chlamydia, HPV, herpes, hepatitis C, and now TB.
We already know that condoms are effective. There is a difference between something that might be effective and something that actually is. We just don’t have sufficient information yet about Tenofovir or PrEP to warrant a change in our sexual behaviour. To do so would be foolhardy.
No one will argue that the gay community has borne the lion’s share of responsibility regarding condoms and safer sex. Fair? No.
Nevertheless, with a cure nowhere in sight, microbicides still in the testing stages, and hope for a vaccine fading, PrEP is certainly cause for cautious optimism, but until odds of efficacy are much improved and access and affordability no longer a problem, it is unwise to count on this magic bullet to protect you.
Condoms may not add to your sensitivity or be convenient, but the gay community learned to eroticise latex a quarter of a century ago. We have not yet moved beyond the need to do so.
An entire generation has grown up knowing no other manner of sexual expression. It is premature to replace responsible condom use with an unproven pill, convenient though it may be.
Tenofovir and other PrEP medications show promise for a future that boasts chemical, as well as barrier, protection against the HIV virus. The wait is not over yet, though.
In the meantime, it is still raining danger out there. Remember your mother’s wise words and wear your rubbers when you go out.