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to Section One | to Arts & Entertainment
posted Friday, December 13 2013 - Volume 41 Issue 50
Truvada: The once daily pill to prevent HIV that no one is taking
Section One
ALL STORIES
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Truvada: The once daily pill to prevent HIV that no one is taking

by Shaun Knittel - SGN Associate Editor

For over 30 years HIV/AIDS has been with us. That's quite a while. And it's killed a lot of people.

It still kills a lot of people.

At the height of the epidemic in America, HIV meant (to mothers whose sons were brave enough to come out as Gay to them) death. Being Gay to me meant you would get AIDS and die. That's it. It was an absolute. At least that's the way that mothers - and I would imagine a pretty fair share of fathers - thought in the mid-later 1980s and early '90s. There was stigma, employment discrimination, healthcare professionals who let patients die without dignity or last rights. It was Hell for all intents and purposes.

We wished for a cure. But that didn't work. We prayed for a cure ... that didn't work either. Then, along came AIDS, Inc. and we tried to pay for a cure, but at least on the onset anyway, no matter how much money we threw at AIDS, AIDS didn't move. It couldn't be bought out. AIDS doesn't have a price it would seem.

But what if I told you there was a pill that already exists and is safe, effective, and FDA approved that exists that can prevent HIV? What if I told you that most health plans cover its cost? And what if I told you that you could take said pill when you are negative - to stay that way regardless of whom you have sex with? Sounds great doesn't it? Well, there really is a pill that can do all of those things. But you're not taking it, are you? The big question is 'why not?'

TRUVADA
Truvada, a little oval blue pill, taken once daily - not to treat HIV, but to keep men who have sex with men (or other at-risk populations) from getting HIV, was approved last year by the FDA as a prophylactic against HIV. That approval came on the heels of a groundbreaking study in 2010, called iPrEx, that found that HIV-negative Gay men who faithfully adhered to a one-a-day regimen of Truvada reduced their risk of getting HIV by more than 99%.

If it sounds too good to be true; it's not. Truvada exists.

Truvada, or PrEP (pre-exposure prophylaxis), as the regimen is called, can help you remain HIV-negative and lead a sex life with less anxiety. Which is exactly what has Truvada critics up in arms; they are afraid that Gay men will stop using condoms and use the pill as a safety net from using a condom. But all of that is theoretical bullshit. There isn't any way to prove that that would happen. And what if it did? Well, who cares then? If the pill works as good as they say it does.... But let's just be honest here. Gay men who talk about bareback sex are stigmatized. Even though people are doing it, nobody seems to have any knowledge of it, whenever asked. (Did we learn nothing from the past thirty years fighting this thing? Silence kills).

The truth is that PrEP comes with risks. Truvada can cause stomach upset in the first weeks of taking it. The drug, though low on side effects as HIV meds go, has been linked to mild kidney and bone problems in a small percentage of HIV-positive takers. However, Dr. Robert Grant, a professor at the University of California, San Francisco, and head of the iPrEx study, says he saw only mild side effects in his HIV-negative participants. Among the dozen or so men on PrEP with whom I spoke for this story, some of whom had taken PrEP for more than a year, none reported serious side effects.

It's true that if someone takes PrEP spottily, they lower the amount of the drug in their body, exposing themselves to a higher risk of contracting HIV. There is also the possibility of developing resistance to Truvada, thus losing it as an HIV treatment option. Granted, Truvada is just one among many HIV treatment options. Moreover, Grant says that the only people in the iPrEx study who developed Truvada resistance were a few whose HIV infections were not picked up during the initial screening process.

The more you adhere to the recommended daily dosage of PrEP, the closer to 100% protection you get. According to Grant, those in the study whose blood levels indicated they used PrEP four times a week still had a 96% risk reduction. Those with blood levels showing they used PrEP twice a week had 76% risk reduction. Grant says that experts still aren't certain exactly how little, and at what intervals, one can use PrEP to have it still be effective, which is why one pill daily is currently recommended.

There is also validity to fears about barebacking. Even if PrEP protects against HIV, condomless sex still invites other STDs. Some, like syphilis, gonorrhea, and herpes, are fairly easy to treat.

CONDOM GENERATION
I was born in 1980. I remember how AIDS scared everyone shitless. And I remember how little information my parents gave me about AIDS in 1992; I was twelve and my Uncle John had moved back to Las Vegas from (you guessed it) San Francisco. He had this terrible thing called AIDS and I was not allowed to drink out of the same cup as he, be alone with him, and eat food that he had physically touched and more. It freaked me out. That's pretty heavy for a youngster. Especially since I was beginning to feel the same way my uncle felt about other males. I liked them. I wanted to kiss a boy. But I couldn't, because if I did, I would catch 'it' and that wasn't something I was willing to do.

As 1992 became 1993, Uncle Johnnie (as we called him) became ill. He was in and out of the hospital all the time. He would get fevers and never had any energy. He lost a ton of weight and literally wasted away in front of us. Strange sores began to show up all over his body and my grandmother would cry a lot.

John Knittel died soon thereafter, on Christmas day 1994; my grandmother's favorite holiday. We were told that he passed away in his sleep. 'He died peacefully,' they said. 'He didn't feel anything,' they lied. I found out, years later, that he had done what so many men had done back then. He died by suicide. It was too much to face. For him. For us. But mostly, for him.

Either way, he was gone and I remember being really angry about that when the first protease inhibitor got approved by the FDA on December 6, 1995 - less than one year after he died. For the first time in a long time, AIDS looked like it could be beat and my uncle was already gone. Life is cruel sometimes. Nobody knows that better than the AIDS generation.

Protease inhibitors (PIs) are a class of antiviral drugs that are widely used to treat HIV/AIDS and hepatitis caused by hepatitis C virus. Protease inhibitors prevent viral replication by selectively binding to viral proteases (e.g. HIV-1 protease) and blocking proteolytic cleavage of protein precursors that are necessary for the production of infectious viral particles. Given the specificity of the target of these drugs, there is the risk, as in antibiotics, of the development of drug-resistant mutated viruses. To reduce this risk it is common to use several different drugs together that are each aimed at different targets. Nobody can deny that it was the game changer of all time.

Why tell you about Uncle Johnnie? Because I am 33-years-old and I have never known a world where sex couldn't kill me. We are the first generation to ever to be told to use condoms - forever. And guess what? My peers aren't listening. Condoms are not used as widely as some would hope. Studies since the 1980s have consistently shown that Gay men forego condoms up to half the time, depending on the situation, for reasons ranging from 'the heat of the moment' to alcohol and drug use to a plain old dislike of how condoms feel.

With all the 'nice' messaging around HIV/AIDS treatment (instead of real messaging around prevention) younger guys aren't afraid of AIDS - or anything for that matter. It is the millennial world; we are just in it.

Last Wednesday, the CDC published a report noting that barebacking, or unprotected anal sex between men, is on the rise, increasing almost 20 percent between 2005 and 2011. The news prompted a concerned outcry from public-health experts. HIV/AIDS activist veterans seemed dismayed; some even warned of 'a new AIDS epidemic.' (That's odd, seeing as how the old one isn't over.)

Traumatic memories of the 1980s are fading from generational memory. The horror stories and haunting images convinced a generation of Gay men - my generation - to wear condoms. Now, with the odds stacked against infection, the question is no longer 'why risk it?'- it's 'why not risk it.'

It is important to note, also, that many HIV-positive people don't know their status or are in denial about it. That can translate into a high likelihood of infection. Even those on an antiretroviral regimen can easily miss a few doses and become infectious again.

HIV is treatable; but it's also complicated and expensive. In short, HIV is a disease that no rational person would ever wish to have.

'That task is made more urgent by a rather inconvenient truth: Bareback sex feels better for both partners. At some point, almost every Gay man will learn this fact - so why lie about it?' asks Mark Joseph Stern, a contributor for Slate Magazine. 'If we don't give Gay men the promise of the reward, a foreseeable end to the hassles of condoms, they're bound to get frustrated and either slip up or give up. Giving men the goal of a committed relationship - and with it, the perk of unprotected sex - might convert barebacking from a forbidden fruit to a reward worth working toward.'

'This is not to say that monogamous barebacking doesn't carry some risk,' he continues. 'Just as condoms can break, so too can partners cheat or misrepresent their HIV status. But you don't hear these arguments trotted out as a reason for monogamous straight couples to use condoms - and for good reason: They'd be plainly insulting. Any couple in a committed, monogamous, long-term relationship has earned the right to stop using condoms, if they so choose. Let's stop viewing bareback sex as a rash, shameful mistake and acknowledge what it really is: not a deplorable blunder, but a prerequisite of commitment.'

BAREBACK BROTHERHOOD
The adoption of safe sex practices in the age of HIV is a key part of our liberation. Yet in the past five years, HIV infection rates have increased, and barebacking has becoming somewhat 'mainstream' among Gay men.

'For evidence, Gay-centric underwear brand Andrew Christian prominently featured bareback porn star Antonio Biaggi in a recent promotion,' Queerty.com editors posted recently. 'Perhaps exacerbating the trend is the increased popularity of hookup apps like Grindr and sites like Adam4Adam - a recent study found that nearly 50% of men who used hookup apps engaged in barebacking. Then, earlier this year we reported on a Facebook group that glorified unprotected sex. It had over 20,000 followers, but the Facebook powers-that-be subsequently (albeit temporarily) shut 'er down.'

There is a so-called 'Bareback Brotherhood,' operating openly on Twitter. The Brotherhood is an online social community that claims to have over 6,000 members worldwide, and nearly as many Twitter followers, dedicated to the glorification of raw sex.

According to its mission statement, 'The Bareback Brotherhood...stands a beacon [sic]. The Bareback Brotherhood is as [sic] a social group of men around the globe from all walks of life. We agree on one thing - sex between men without barriers is natural and a legitimate choice. As consenting adults, skin-to-skin intimacy should be a choice that is not demonized or marginalized. The Bareback Brotherhood advocates on behalf of raw sex, knowing that many men engage but hide. The Bareback Brotherhood is a group without judgment and with mutual respect for all, no matter sero-status - positive, negative or unknown. Fuck more. Fear less. Regret nothing.'

According to Queerty.com, 'While that last bit makes for a good rallying call, there's nothing particularly noble about bareback sex. It's not some revolution or revelation. Rather, in advocating raw sex, they are in fact advocating unnecessary risk taking, which for some has become a turn on. We don't purport to be the moral compass of the LGBT community, but we're big believers in condoms because your health is just generally something you don't want to fuck with. Contracting HIV is no longer a death sentence, nor should having HIV be a stigma. And it is true that scientists are closing in on a cure.'

According to the Centers for Disease Control and Prevention, men who have sex with men remain the population most heavily affected by HIV infection.

The report says, 'Comparing 2008 to 2010, the number of new HIV infections among MSM increased 12% from 26,700 in 2008 to 29,800 in 2010, with a 22% increase among MSM aged 13-24 from 7,200 in 2008 to 8,800 in 2010. Although MSM represent about 7% of the male population in the United States, in 2010 MSM accounted for 78% of the new HIV infections among males.'

Are groups like the Bareback Brotherhood partly to blame for glamorizing unsafe sexual practices? Is there a lack of awareness as to the risks involved, particularly among young people?

Nope. Research has shown that millennials don't care about getting infected with HIV. There exists complacency over the threat of HIV/AIDS. That same hookup app study found that 47% of respondents who engaged in unprotected sex were knowledgeable about HIV and were afraid of getting infected. Their reasons for not using condoms then? Nearly 85% claimed 'with condoms it does not feel the same' and nearly 74% did it just for kicks.

So, bringing this full circle - we know HIV/AIDS infections among men who have sex with men are on the rise. We know that barebacking has become more mainstream than many people thought. So, why then, isn't Truvada on every shelf in every Gay man's house?

It is difficult to know exactly how many guys in the U.S. are taking PrEP.

Cara Miller, a rep for Gilead, the company that makes Truvada, said she couldn't pinpoint such numbers because the company doesn't know who is being prescribed Truvada in combination with other HIV drugs - which is necessary for treating HIV - and who is getting Truvada alone for PrEP purposes.

PrEP comes along at a moment when it could potentially help reverse a 22% rise in HIV rates in young Gay men in recent years. The CDC recently calculated that, if HIV infections continue to rise at current rates, half of all young Gay men will have HIV by age 50.

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