On PrEP, and TaSP, and the imminent end of HIV/AIDS
The Thursday before last, I was interviewed as a subject in an ongoing research project, led by the University of Toronto’s Peter A. Newman and Carleton University’s Adrian Guta, examining the PrEP front in the ongoing fight against HIV/AIDS.
The PrEP choice project: Exploring PrEP users, non-users, and provider perspectives
Are you a man who has sex with other men, living in Toronto, and over the age of 18? We would like to talk to you if you:
1. You are currently using Pre-Exposure Prophylaxis (PrEP) and would like to share your experience and you are not currently enrolled in a clinical trial about PrEP.
2. You know about PrEP but you have decided it is not right for you at this time and you would like to share your experience.
As I explained in my enjoyable sixty-minute interview, I fall in the second category. My reasons for not taking PrEP have nothing to do with skepticism on my part about the science, or about taking medication. Rather, it relates directly to matters of cost: My drug plan at work does not cover PrEP, Truvada not yet having been approved by Health Canada as a drug that very effectively prevents HIV transmission, and I don’t know how I could get the funds to do so. I have very recently heard that some people have been able to access the Trillium Drug Plan, and this is definitely something I’ll be looking into in the New Year. For the time being, I feel as if I’m sitting in an uncomfortable place, looking at a medical revolution occurring outside Ontario–in the United States, in Québec, and most recently in France–and wondering how I’ll last.
It isn’t that I think I’m at especially high risk: I know what I do and who I do things with, I know what the actual risks are, and I think that if, one day, I ended up testing positive for HIV, I’d have legitimate reason to be surprised. The protocols of safer sex with condoms are protocols I have not had any problems following in my personal life. Were I to get PrEP, I don’t think that my sexual practices would change substantially–I certainly would not, as described in the 2005 Los Angeles Times article where I first heard of what might be called proto-PrEP, embark on crystal meth-fueled lost weekends. That sort of sexual behaviour is frankly uninteresting to me, much more of a problem than a source of relief.
In part, it’s a matter of my liking a belt-and-suspenders approach. Condoms work very well, used consistently. PrEP also works very well, used consistently. Why not combine the two to absolutely minimize HIV transmission? Truvada does have costs, financial and perhaps otherwise, but as noted by many even the costs of lifelong Truvada treatment are substantially less than the costs of lifelong HIV treatment. What’s wrong with a simple pill that can ward off a disease that is still life-changing? Or, rather, what’s not right with it? Not taking the drugs can be an issue, but that’s always the case with any medical regimen.
It also relates to deeper shifts in the nature of the epidemic. It’s starting to become a relative non-issue in ways I scarcely imagined when I first came out. At the same time that the PrEP revolution is ongoing, preventing HIV infections among HIV-negative people, the latest anti-retroviral treatments are not only keeping the HIV-positive in good health, they are radically reducing the chances of further infection. One thing widely reported in the media with varying levels of incredulity after Charlie Sheen’s self-outing as HIV-positive, in Vox and Gawker and MacLean’s and New York Magazine, is that Sheen has undetectable levels of the virus in his system and cannot infect people. This was not just Sheen talking: This is the actual science. Multiple research projects, including the ongoing PARTNER study, have so far concluded that the chances someone HIV-undetectable could transmit HIV on to someone HIV-negative are trivial. The PARTNER study has not yet found a single instance of such a transmission happening, not with tens of thousands of sex acts in hundreds of couples in two years. TaSP, treatment as prevention, also works. The approach of systematic testing and universal treatment of HIV, pioneered in Canada in British Columbia by Dr. Julio Montaner, can break the back of the epidemic. Saving people’s lives also slows down the epidemic.
Take the existence of PrEP, to start. Throw in alongside PrEP TaSP, equally effective in preventing infections. Throw in alongside these two the existence of condoms, a technology that is also quite effective. I do not think that I am wrong to say that, in my particular First World environment, HIV/AIDS is starting to become a trivial threat. It makes my head spin as I think this, so contrary it is to what I learned and what I practiced, but fearing HIV is something that might be falling out of style. This is wonderful, but this is a shock with profound ramifications for me and others. Once, when I read psychotherapist Walt Odets’ In the Shadow of the Epidemic, I was struck by an exchange in which a gay speaker explained to a straight counterpart that, in the context of HIV/AIDS, every instance of sex, every moment of intimacy, was overshadowed by the possibility that something might go wrong, that someone might become infected with a lethal agent or (even worse) infect someone they loved with said. Not living under this fear would be such a relief, I can scarcely imagine what it would be like.
We need many things, here in Ontario at the end of 2015, here on this world, even. PrEP is one of them.
Originally published at abitmoredetail.wordpress.com on December 22, 2015.
