Opinion: Why Aren’t More People on PrEP?

Last November I was invited to attend L.A. County’s Commission on HIV’s annual meeting where they outlined their plans to get to “zero,” as in zero new HIV infections by 2020. I was impressed with the plan, but shocked at the numbers of PrEP users. For those unfamiliar, PrEP stands for ‘Pre-Exposure Prophylaxis’ and it consists of a single pill (Truvada) taken once daily to prevent HIV infections. It’s estimated that less than 100,000 people are utilizing PrEP nationwide, which is equal to less than 4% of Grindr’s users in the USA. These numbers highlight that a large majority of the gay community are not on PrEP. This lead me to wonder, why aren’t more people on PrEP?

The CDC estimates that there will be 265,330 new HIV infections between 2015 and 2020, if current testing, treatment and PrEP trends remain the same. However, if PrEP use was increased then that could mean that roughly another 48,221 of those infections could be eliminated.

On its own, PrEP is up to 99% effective in preventing HIV when used as prescribed. For the first time, the gay community has a viable path to eliminating the disease with the adoption of PrEP as a standard sex practice.

I was inspired by the newfound knowledge and frustrated by the lack of adoption by the gay community. How can the numbers not be higher for a drug that became approved by the FDA for prevention in 2013 and has endorsed by the Centers for Disease Control since May of 2014.

I started to investigate and discovered there is a lack of knowledge and misinformation amongst my peers and the general public. Some have criticized PrEP, most notably AIDS Healthcare Foundation President Michael Weinstein, who called Truvada “a party drug.” Weinstein claims that it encourages irresponsible sexual practices and leads to decreased condom use.

The reality is many people don’t use condoms, or don’t use them 100% of the time – so PrEP is less about safe sex, in my opinion, and more about responsible sex. You can’t make people wear condoms who don’t want to use them.

Weinstein’s comments illustrate what some have coined as “PrEP Shaming”. It is the equivalent of “slut shaming.” Choosing to protect your body from any risk of contracting HIV is not a bad thing.

Furthermore, providing access to PrEP to sexually active gay men doesn’t translate to more sex. Just as providing birth control to women doesn’t mean they will have more sex. Some people choose to use condoms and others don’t. Just because I have airbags in my car, doesn’t mean I don’t want to wear a seatbelt. People will have sex regardless of their preferred practices.

The reality is that condoms break, one’s judgement may be impaired, or the heat of the moment takes over. These are variables that can alter the outcome of a sexual encounter. Isn’t it better to know that there is a back-up plan to protect against the exposure of HIV? My point of view is there is no proven downside to taking PrEP if it means fewer HIV infections.

The gay community has an opportunity and a responsibility to support the use of PrEP, which has the potential to end new HIV infections. PrEP is in its infancy, but the community has to educate one another and eliminate moral judgements if the end result means less people being affected by a disease that is PREVENTABLE.

Opinions aside, here is what I found to be the biggest misconceptions and concerns that may explain why more people are not of PrEP:

“PrEP (Truvada) hasn’t been studied enough.”

False. There have been numerous studies on PrEP, most recently with nearly 1,000 people receiving Truvada for HIV prevention at Kaiser Permanente Northern California. There were no new infections and side effects were rare.

Truvada has been around for over a decade, originally approved by the U.S. Food and Drug Administration (FDA) as a treatment for HIV Infection in August of 2004, and later in July 2012 for HIV prevention.

“Taking PrEP has side effects.”

True. Some people in clinical studies of PrEP had early side effects such as nausea, loss of appetite, upset stomach or mild headaches, but these were mild and usually went away in the first month. No serious side effects have been observed.

“It’s too expensive.”

False. PrEP is covered by most health insurance plans, and there are co-pay coupons available from Gilead, the drug maker, to eliminate any out of pocket costs. There is also Gilead Advancing Access for those without health insurance or who don’t qualify for Medicaid programs. There are even programs that cover the cost of PrEP for undocumented individuals living in the country.

“It doesn’t protect from STDs.”

True. PrEP only prevents the spread of HIV.