Safer Sex: Now in Pill Form

November 8, 2012
Category: Wellness

We've talked about this a few times this year, but I'm continually amazed at how much more open we are about discussing what it means to date and have sex in an HIV+ world. It's been an ongoing conversation, but what's beginning to change is the way in which we're talking about it. The stigma of having HIV, both within our own community and the world at large, is shrinking by the day. Due in part to the candor from both sides that we've seen in the media and the ever changing face of HIV medications. Big Daddy Carl, has written an incredibly thorough article over at the Huffington Post about pre-exposure prophylaxis, or PrEP, which, when taken daily by an HIV- person, can reduce the risk of transmission to that of using a condom.

There are many things to consider when you look at the merits of something like PrEP, which Carl outlines explicitly, but it begs the question of why this information isn't more readily available to the public. Let's face it, there will always be risk when it comes to gay sex, but would something preventative like taking a pill everyday make you feel safer? Or as a community that has been indoctrinated with the importance of condom use, are condoms the one and only protection against HIV? In an ideal world we'd all be using condoms and taking PrEP, but as you'll read there are obstacles preventing that from happening at this point in time.

I urge you all to read this article and let us know your thoughts. We've already heard from some people that fear many will abandon condoms altogether leading to the spread of other STDs. Does that concern outweigh the potential benefits from preventing HIV infection for people who can't or won't use condoms?

We encourage you to do your due diligence and research this topic beyond this article so that you can make an informed choice about what works best for you. At the end of the day, we want to open this dialogue up and get the conversation going so we can all live and love and safely as possible.

UPDATE: Carl will be speaking about this article at 3:30pm EST TODAY on HuffPost LIVE.

Tags: Safe Sex, HIV, Condoms, AIDS, Carl Sandler, Huffington Post, Pills
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Post written by RobHeartsDH (View Author Profile)
About this author: Rob lives in Manhattan with his black pug Riley. When he’s not thinking about daddies, he enjoys writing, eating burritos, watching copious amounts of television, and thinking about his next meal.
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Comments

Part of the reason why this information isn't available to the public is that insurance companies often don't want to put out dollars for prevention. They want you to get sick so you'll need to take their drugs for the rest of your life. When I was first diagnosed as a Type 2 diabetic, my doctor recommended that I take a half-day class at a local hospital about how to manage the disease. The class cost about $1,100. Aetna was not interested. Their attitude was that if they had to, they would spend $50,000 on amputating my leg, but they wouldn't spend $1,000 to prevent the need to amputate. Let's face it, a chronic illness means more money for the drug companies than a cure. I wouldn't be at all surprised if there were cures for diabetes, cancer and other such diseases sitting in the vaults of various drug companies, cures that will never see the light of day because treating forever is more profitable than curing.

Thank you for writing here what I have always thought. Why should they cure anything? Treatment is so much more profitable. It's sickening.

I totally agree with you..!!! They are making billions of dollars!!! No incentive to let there be a cure...

While I agree that the idea seems to be to keep people sick and dependent upon the drugs they hold the keys to, $1100 for a half-day course is worthy of ridicule. There are several on-line sources and support groups that have such information readily available for free. The class was a scam and Aetna was right to refuse it.

Consider how much more readily available common antibiotics are in poor countries (over the counter). And the pharmacist or doctor prescribes what provides cure. Why? No money in keeping poor people sick, so they cure them.

On to the subject: No clue how much it costs for this pill, and an ounce of prevention and all of that, but... we COULD just try getting a bit more responsible with our sexuality, too.

A daily drug to prevent (maybe) HIV while condoms prevent 100% and do not have side effects? I'm sorry, drug companies and insurance companies are evil for sure, but I won't quit the condom for a daily drug. More reasonable to make condoms totally free to everybody. Believe it or not in western countries people that cannot afford to buy condoms do exist.

if you read FDA report you would see that with proper medication adherence this is more effective for reducing risk of transmission. Insurance companies I have issues with. They may not want to cover this as it is expensive. I can tell you that in the next year when the tools of the underwriting world crunch the numbers they will see that this PrEP treatment would save them money compared to having to cover treatment costs of someone who is positive like me. The Atripla I take to stay alive and reduce my viral load is an awesome thing. I wouldn't villify the drug companies that make these meds. They charge a lot as they put them money into researching new meds. They definitely aren't making a lot on it. I bought stock in the company that makes my Atripla. It wasn't too make money as much as to support them in their research. They aren't making a lot of money, honestly the stock is worth what I paid for it six years ago.

Condoms are great but people don't always use them properly or regularly, 96% effective according to the studies. This PrEP treatment is an awesome way to reduce transmission risk among partners and in high risk demographics. As someone who is positive I thrilled to know there is a new way to keep those I love safe. We may not choose it as an option but the more options the better. The goal for these prophylactic treatment is that it reduces potential transmission between people, and therefore future infections. This is the basis for vaccinations and the concept called "herd immunity." With such research we increase the possibility of ending the transmission of this disease. That seems like a distant possibility but it is how we have managed to almost wipe out other communicable diseases like Polio and Small Pox.

I can tell you the side effects of my Atripla are minor compared to my seroconversion and b symptoms before I went on medications. Encourage insurance companies to cover this but don't villify the people that make the meds that keep me alive.

I agree with you that condoms need to be available to everyone. Even in rural Wisconsin I can find free condoms easily at the nearby AIDS Resource Center. This PrEP treatment is just one more option and breakthrough to reduce transmission. I hope that it becomes available to everyone interested in using it.

Andy

Well written !!

Now I've heard everything. Why would anyone want to be on medication when they don't need to be? Sure, condoms aren't perfect but I'd rather use a condom than be on medication for the rest of my life when I don't need to be. And just for the record, I've never had a condom break on me. Maybe people need to look at the expiration dates on the package. Can we all just take some responsibility for our own health and stop looking for a way to endorse risky behavior?

I use the Trojen Magnum condoms and I have to admit, I have had them break. I would say at least 15 of them over the course of maybe 10 years.
You can tell right away thought when they break and I just pull out right away. I put a little lube on my dick first and then of course on the outside but they have still broken. But so far, after 17 years being out, still negative.

The reality is that condoms do break, I have had three break in my lifetime. It is an added precaution for those that do partake in risky behavior. In no way are they endorsing risky behavior when there is no ads or promoting going on...lets face it, most people didn't know this product exists...I didn't until recently and how long has it been out/available?

This therapy has only been recommended for prostitutes, or perhaps those who have partners with hiv. Medications are dangerous and costly. I have been permanently affected by medications I took years ago. The best prevention and the only real one remains not being exposed. Why don't you promote female condoms as an alternate? Why are they so much more expensive?

Thought it was viagra, maybe they should revisit the color?

Thought it was viagra, maybe they should revisit the colour?

Thanks for this enlightening article, Rob. Really worth knowing.

Wow, what an amazing article. I had heard of Post exposure prophylaxis, but never pre-exposure. This could help thousands and thousands of people and could possibly put an end to HIV if implemented properly. This could also help healthcare workers who are exposed by accidental needle sticks. This needs to be pushed further, hopefully with the healthcare reform act the profitiability of healthcare will lessen and initiatives to improve quality of life will take it's place. I would love to help get this information out there if there's anything I could do, please let me know.

I had a discussion with my doctor about this several weeks ago. The cost of the prescription would not be covered by my medical insurance (they do not cover any PrEP protocols) and it would be an out of pocket expense of $800.00+ per month. A $10K yearly expense puts this method of HIV prevention out of reach for nearly all of humanity until pharmaceutical companies make this a viable option.

So here we are in 2012: a thirty year old disease is still a major profit industry. The meds still have freaky side effects including lipodystrophy, swollen parotid glands, and ridiculously vivid and exhausting dreams. Why would anyone even think it's easy ro take HIV meds? It doesn't matter that I think doctors are like car mechanics: opportunists who navigate the human body for any so called sign of a condition needing "treatment", ( for their own profits or that of a colleague?) I manage to stay on top of it, despite my skepticism and jaded eye upon those who financially feast on the HIV positive.

Wow! I had heard about this type of prevention, but hadn't seen any information about it. I checked, and my prescription plan covers this treatment. It is VERY expensive without coverage. I'll be visiting with my doctor next week about getting a prescription! Thanks for posting this! This is a blessing! I also don't understand why insurance companies don't work with the manufacturer to make this more widely known and less costly. I'm in a high risk situation (partner is poz) and the insurance company knows this. You would think that they would be suggesting it to avoid the costs of treating me for HIV. I may be quite uniformed, but I have little compassion for the profit motive here when we're talking about the social and medical health of millions. What's the dang deal?

Informative.

Pharm companies are only concerned about how to make as much money as possible while trying to look like they have humanitarian interests. Sad but true.

THIS WAS NEWS FOR ME..AND I WILL CONTINUE CONDOM USE EVEN IF I DO QUALIFY FOR INSURANCE COVERAGE OF THIS MED...AND I WILL ASK MY DOCTOR ABOUT IT..ANY HELP IS WELCOME IN THIS AREA..THANKS FOR THE VALUABLE AND NEW (TO ME) INFO

I, like others, have heard of and read about Truvada. I contacted my doctor who referred me to the pharmacist (HMO). He did an investigation for me on Truvada's availability and my insurance/Medicare coverage. Truvada is, indeed, available to me and covered to a point. It would be affordable for a period of months until I reached the (Bush) Medicare drug coverage "donut hole" and, then, would be prohibitively expensive. Two of my FB's are HIV+. I am, and continue to be, HIV-. Like my HMO, I am always looking for ways to prevent diseases rather than contract them and, then, deal with them and the added complications and added expenses.
So, my conclusion was that, because of the expense of Truvada, it is not a viable option for me.
PocktDad

Regarding the first comments here about diabetes and insurance companies -- in China in the old days, it was customary to keep your doctor on a regular retainer BUT HE ONLY GOT PAID IF YOU STAYED HEALTHY. If you got sick, he wouldn't get paid! The incentive was to keep you well. It's an interesting alternative model.
This pill is probably better than nothing, but the question to ask before relying on it totally is: Are you prepared to bet your life on it, quite literally?

Although the article is excellent and well-researched, I can't agree about the amount of protection Truvada can give. I wrote a similar article for The Body a little while ago based on different research and it takes the view that issuing Truvada as PrEP is not well thought -out at all because, people just don't follow the rules and behave the way they are supposed to when dealing with drugs like these.
For a slightly different view, if you're interested, please read here:
http://www.thebody.com/content/69314/truvada-troubles-ahead.html

Even the condom mfrs admit they are NOT absolutely safe. There is safer sex but the only safe sex is Abstinence or absolute monogamy with someone you trust implicitly. Anything else you are only fooling yourself. The PrEP, though they aren't certain, may prevent well known and useful meds from doing their job by changing the environment the HIVirus works in. Til they know for certain I will abstain, very safe sex (nothing intrusive) or only with someone I know and trust.

There's been some debate recently in the UK about providing Truvada on the NHS for high risk individuals as pre exposure phrophylaxis. It's already available for free as post exposure prophylaxis and combination therapy.

I think that people who engage in high risk activity are just as likely to forget to take the drug as they are to forget to put a condom on, and no-one ever mentions how sick these drugs can make people. I forget the exact the statistic, but a certain amount of people don't complete the whole course of pep because of the side effects, so I don't see how prep will be any different.

Absolute monogamy with someone you trust implicitly.

Trust does not necessarily equal safety and disease free.

Advice from a friend who is HIV+ says always to use a condom even years into a relationship because so many people lie.

It is one thing to find out your trust has been mislaid it is another thing to find out you are HIV+ because of it.

A tad late to the conversation here, but as someone who participated in the third and final phase of the PREP trials, there are other things to consider, aside from insurance companies motives, and cost. I experienced chronic fatigue while taking the drug. It came on so slowly that I didn't even make the connection between it and how tired I was at the end of the day. And my blood work came back looking like I had anemia after about 6 months on it. The doctor overseeing me suggested I go off the drug for a while, (everyone connected with the study was amazingly professional, and put our welfare first and foremost at all times) and within three days I felt like I was 25 again. A couple of months later, my blood work results were back to where they had been. I've met other guys who were in the study (our identities were kept secret, so you only found out by accident) and said they didn't experience what I did. Or they experienced it to a lesser degree. Both of them were younger than me. Which leads me to think age probably plays a role in your ability to handle the effects of the drug. Not scientific, I know...

The take away; if you're in a relationship with someone who is positive, it may be worth it to you. But as a pill you take just in case you slip, or a condom breaks, eh, prolly not so much.