A new study suggesting HIV-negative gay men could avoid becoming HIV-positive by popping a single daily pill is being hailed as a breakthrough, but HIV/AIDS workers say those who are already HIV-positive must have priority access to drug therapies.
The study, published in the New England Journal of Medicine on Nov 23, suggests that the use of two antiretroviral medications (commonly used to treat HIV-positive people) lowered the risk of infection in HIV-negative study participants by 43.8 percent.
AIDS Committee of Toronto spokesperson Andrew Brett calls the news promising but says it’s not a vaccine, and condoms are still much more effective.
“It demonstrates that pre-exposure prophylaxis (PrEP) is something that could be effective in the future, that there’s more research that needs to be done, and it’s a good sign that there are other technologies out there beyond condoms,” he says. “The reality is we need more prevention options.”
Ron Rosenes, treasurer for the Canadian Treatment Action Council, says the study raises more questions than it answers.
“What does this do to our safe-sex messages?” he asks. “There’s no magic pill here. There’s no guarantee. It’s still only partially effective. Who are they going to give it to? Gay boys who party on the weekend? People with mental health issues? People with addiction issues? And who is going to pay for it? It raises tremendous ethical concerns.”
Brett warns that widspread PrEP use could lead to a drug-resistant strain of HIV, so frequent testing of those on it would still be needed. In the study, participants were tested monthly, a frequency that is unrealistic for most people, says Brett.
“Viruses can become drug resistant if they don’t have the proper medication treating them,” he says. “PrEP is assuming you are HIV-negative. It’s not providing enough of the treatment to treat HIV. So if you are HIV-positive, but undiagnosed and taking PrEP, you could actually cause a drug-resistant strain of the virus.”
Rosenes says some people are already “experimenting” with PrEP.
“I worry there are people taking the drugs, which they should be taking themselves, and selling them on the black market,” he says. “It’s a real concern.”
More than 27 percent of HIV-positive Canadians do not know their status and haven’t been tested, Rosenes says.
“And infection rates are back at levels we haven’t seen since the early 1980s,” he adds. “The number of Canadians who are HIV-positive and do not know their status is indicative of the number of people who may be putting other people at risk.”
Alex McClelland of AIDS Action Now, says the study could deflect the message that condoms are still the best preventative method, and far less expensive.
“I’m always concerned about quick, biomedical fixes,” he says. “HIV highlights various complex social issues that we need to deal with. Everyone would like a magic pill to stop HIV.”
McClelland says there is a significant cost difference between PrEP and a $10 box of condoms.
“It’s not always fun to use condoms, and I don’t think people talk about that enough, but they work really well,” he says. “These pills are very expensive. I do think it would deflect attention from very simple interventions that have been around for a long time.”