Truvada, the HIV prevention pill approved by the FDA in 2012, passed another test this week.
Kaiser researchers reported that there were no new HIV infections among 650 men who took the medication also known as pre-exposure prophylaxis (PrEP) over a three-year period.
The men were sexually active and some did not use condoms for protection.
That’s despite CDC and FDA guidelines that say Truvada should be used along with condoms.
With that in mind, Healthline asked five experts in the field earlier this year, “Does PrEP encourage risky behavior?”
The answers may not be what you expect.
When a pill to prevent pregnancy came on the market in the 1970s, women who took it were called promiscuous. So are many gay men taking Truvada today — even by other gay men.
Yet with more than 50,000 annual new HIV infections each year, there’s little disagreement that a new prevention tool is needed.
Damon Jacobs, 44, New York City counselor, PrEP consumer, and advocate
Damon Jacobs is a New York City counselor taking PrEP. He also runs the largest social media page in the world about PrEP on Facebook, called: PrEP Facts: Rethinking HIV Prevention & Sex.
Jacobs likes to say PrEP stands for Proactive, Responsible, Empowered, and Pleasure. He is one of the first people on PrEP to publicly admit he uses it so he can have sex without a condom.
Jacobs said people who are at high risk for contracting HIV need to focus on the medical science behind the prevention pill, as well as other risks, so they can make informed decisions.
He points out that many people on PrEP still use condoms every single time. Some use them with PrEP only when meeting someone whose sexual history they may know nothing about.
He noted one study showed that, between 1998 and 2001, 84 percent of men who have sex with men did not use condoms. He said it’s far riskier sex if the partners are not taking PrEP.
“PrEP by far in my experience is the most proactive, responsible, and empowered way to maximize pleasure and stay HIV-negative,” Jacobs said.
Dr. Robert Grant, director of the Gladstone-UCSF Laboratory of Clinical Virology
Dr. Robert Grant believes that by going to a doctor to obtain PrEP, people are taking control of their sexual health.
That sort of empowerment allows people to think about what they want out of sex. They can establish boundaries based on informed decisions and medical science.
Conscientious decisions are safer than those made at the spur of the moment, he said.
“So far, PrEP does not encourage risky behavior, PrEP makes behavior safer by directly protecting people against the acquisition of HIV and encouraging people to be more mindful of their sexual goals and practices,” Grant said.
Jim Pickett, director of prevention advocacy and gay men’s health at AIDS Foundation of Chicago
Pickett said taking PrEP encourages safer, more proactive, and more responsible behavior.
Most people don’t use condoms consistently and correctly. They’ve been using them inconsistently, incorrectly, or not at all since well before anyone heard of PrEP, Pickett said.
In the United States, Pickett said, there are approximately 50,000 new HIV infections every year, and on the planet there are around 2 million new HIV infections.
None are from “immaculate infection,” instead most are from not using condoms, he said.
Taking a pill every day, seeing one’s doctor four times a year, getting HIV tested and STD screened quarterly. These things are disciplined, safer behaviors, the opposite of risky.
“Does wearing a bike helmet encourage you to pedal on the expressway?” Pickett asked.
Dr. Antonio Urbina, senior faculty medicine, infectious diseases, Mount Sinai Health System, New York City
Many of the same conversations whispered about women who chose the pill when it came on the market are being had about people who choose PrEP today, Urbina said.
Would women become more promiscuous? With time, that type of anxiety, stigma, and judgment declined.
The same thing will happen with PrEP, Urbina believes.
It’s an effective prevention tool that can keep people from becoming HIV-positive, which is life altering. There are people that before PrEP had inconsistent condom use and after PrEP are doing the same thing. There are people who used condoms more consistently before PrEP and continue that same behavior, he said.
“I do think that PrEP is a game changer, very much like the birth control pill was,” Urbina said. “With anything that’s revolutionary and changing the game, it’s going to be met with resistance, ignorance, and prejudice, but that just means it’s something worthwhile.”
Michael Weinstein, president, AIDS Healthcare Foundation, Los Angeles
The most recent data on PrEP released by Gilead Sciences, the maker of Truvada, shows that 5,272 prescriptions were written in the third quarter of 2014.
While this data does not encompass all pharmacies, it’s still a small number, Weinstein said.
Despite the fact that there has been an intensive campaign to promote PrEP, it has not caught fire. Every indication is that patients are not asking for it and doctors are not recommending it, Weinstein said.
In a questionnaire published by the Academy of HIV Medicine in April 2015, of 363 HIV providers — who were all knowledgeable about HIV medications — 95 percent indicated they were concerned about adherence to the daily regimen and to follow-up appointments.
“Almost three years after FDA approval, serious questions remain about the effectiveness of Truvada for PrEP among health professionals and affected communities,” Weinstein said.