A Pill to Stop HIV: Here's What You Need to Know

Thursday, June 26, 2014

Update: The World Health Organization now recommends that all sexually active gay men take Truvada, following guidelines the U.S. federal government issued in May.


For years, people with HIV have had access to drugs that allow them to live a full life. Now, the CDC has issued new guidelines for Truvada, an anti-retroviral drug with a novel use: the promise of blocking HIV infection to begin with.

How it works: Truvada is regularly given to HIV-positive patients, but can now be prescribed for Pre-Exposure Prophylaxis or PrEP. By taking Truvada every day a patient can drastically reduce the chance that unprotected sex will result in an HIV infection. The medication works by blocking the replication of HIV that enters the body. Taken daily, the CDC says the drug may have an efficacy rate of up to 92%.

Who can take it: Dr. Demetre Daskalakis of Mt. Sinai Hospital is a leading advocate of Truvada who said the drug is appropriate for people who move in and out or certain risk windows where they're likely to engage in unsafe sex. But, he said "from my experience, just guessing, over 50% of men who have sex with men will likely qualify for [PrEP] using the CDC guidelines.” He said he prescribes Truvada as a second barrier against HIV when condoms fail. "This is how you end an epidemic," he added.

It has side effects: A transgender woman named Lilly, who didn't want to share her real name citing privacy concerns, has been taking Truvada for a few months. She described her initial side effects starkly: "I had night sweats. I had pains. I had these like pins and needles in my groin. I wasn't able to sleep...for a whole week, and after that week I was fine.” More severe side effects like liver and kidney damage, and bone loss are possible but rare, according to Drugmaker Gilead.

It's a commitment: Much like the birth control pill, the CDC stresses that you have to take Truvada every day for it to be effective. Dr. Daskalakis said: “People don’t take their meds all the time and adherence is a really hard thing to convince people to do, especially when they’re feeling well." Lily confessed that she sometimes forgets to take her pill, but works hard to make it a routine. Researchers are currently examining the effectiveness of intermittent Truvada dosing.

It has detractors: Michael Weinstein of the AIDS Healthcare Foundation has come out swinging against Truvada, citing a potential decline in condom use and rise in STDs: “In a few years we will have more transmission of syphilis among gay men in the United States than we have of HIV."

Opinions about it are pretty strong: At a bathhouse in Chelsea, patrons like Chris, who declined to give his last name, said: “I think any drug that you take, you should take when you’re really sick. Just to prevent the virus to enter makes you probably more prone to more unsafe sex, which personally, for my taste, I wouldn’t like.” Others mentioned a stigma attached to Truvada users, who may be perceived as promiscuous. Omar Follocano said: "That’s bullsh** because why is it ok to use prophylaxis for malaria and not HIV?” Omar also said he had many friends who he thought should be on the drug.

Could it change how we have sex?: Gay rights activist Avram Finkelstein said that while he thinks Truvada should be handed out in subway stations, the drug creates new gray areas, as it did for him in a recent sexual encounter: "He believed it would be totally o.k. with him to take the condom off and not tell me because he was on Truvada... Maybe he was, maybe he wasn't. Maybe I wasn't put at risk, but why should he get to make a decision about my sexual health?"

Will men stop using condoms?: Dr. Sarit Galoub, principal investigator of a National Institutes of Health study about Truvada use, called the drug "revolutionary." She said: "it separates the act of HIV prevention from the act of sex itself." And while she mentioned some people are signing up through her New York City-based program to take Truvada so they can have unprotected sex, she cautioned that the overall effect on condom use remains unclear: "We’re going to see what happens to peoples' use of condoms over time. We have not seen reports of huge changes, and if people were using condoms 100% of the time already, we wouldn’t have an epidemic."


Julianne Welby


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Comments [9]

Rory Bernstein from Brooklyn, NY

Excellent story, Steven. It's amazing that this drug has been developed. I hope it becomes available in developing countries.

Jun. 27 2014 07:06 AM
James from NYC

It's already being misused in the NYC hook up culture. I've personally spoken to people who are HIV positive, on PrEP, and having condom free sex. It's only a matter of time before resistance renders this approach useless. Meanwhile HIV negative people are going condom free on Truvada because they erroneously believe they're safe to do so.

Jun. 26 2014 08:58 PM
Dissenting View from Outside the Herd

Neither in the article nor in the comments have I found a single mention of a FAR more effective means of preventing HIV that has no side effects and doesn't cost anything (and should be rather obvious): Avoiding anal penetration.

The statistics are clear: Said act is the one factor, more than any other, that accounts for HIV rates among homosexually-active males that are as high as FOURTY-FOUR TIMES those of the general population (CDC). In contrast to a pharmaceutical, simply respecting basic anatomy and physiology enough to not attempt to enter what is clearly an exit-only orifice carries no risks, has no side effects and doesn't cost a penny. Plus, it is not only the threat of HIV that is drastically reduced when anal penetration is avoided but also the risks of a whole host of other serious and even deadly infections that are also disproportionately spread via this inherently unhygienic act.
(But such a simple behavioral choice doesn't generate revenue for anyone, does it?)

This is all appreciated and pointed-out by a number of dissident voices within the homosexual community, such as Bill Weintraub ( * ), who coined the term "Frot" for the phallus-on-phallus act that he advocates as the natural, safe, dignified and egalitarian form of male homosexual intercourse. Rob McGee also touts Frot on his blog at * (It is difficult to imagine anyone being more emphatically and unapologetically PRO-homoerotic than Weintraub or McGee.)
(*Graphic content)

Here is an excerpt from McGee's blog that is highly apropos here:
_______Begin Quoted Text_______
In 1985, which is to say just a few years before C. Everett Koop's AIDS letter, the Dutch government launched a two-pronged AIDS prevention campaign aimed at gay/bi men. The message was very simple:

(1) If you are a man who has sex with other men, the surest way to avoid AIDS is to abstain completely from anal intercourse.

(2) If you are unwilling to abstain from anal sex, you must use a condom every time.
"By the early '90s, the language of the Dutch campaign had been changed -- totally dropping the "don't have anal sex at all" suggestion. (Which was, let's remember, MERELY a suggestion, as the libertarian Netherlands had abolished its anti-sodomy laws as of 1813 .) In place of the two-pronged approach, the revised language put all the AIDS-prevention eggs into just one basket. That basket being, of course, "Use a condom every time you have anal sex." Which in no time at all got truncated to "Use a condom every time" -- thus subtly reinforcing the highly dubious notions that breaking-and-entry through the backdoor is not only "vanilla," but also the Default Mode of male/male sex."
_______End Quoted Text________
Full-text at:

Jun. 26 2014 06:33 PM
Staci from San Francisco

I understand some of the uproar in response to this being handed out in NYC; however, targeting audiences (regardless of sexual orientation) in the Carribean, African countries and other places where death from AIDS and HIV are pandemic and there is less emphasis/access/cultural value on condoms than America, would be extremely valuable. Think bigger than NYC; frankly, I agree that handing out the drug on subways seems ridiculous (if someone gave you some birth control pills on a subway, would you then purchase a months worth?) but if these drugs were mass produced and made widely available as part of typical health check-ups in countries where HIV is highly prevalent and hampering the productivity of society, imagine the impact!

Jun. 26 2014 01:18 PM
Graham Mayer from new york

Men, who tend to be terrible with keeping schedules with medicine, are supposed to take a pill once-a-day to prevent a disease they don't have?? Does anyone at Gilead know the habits of men????

Jun. 26 2014 11:26 AM
Tyco Manheim from NYC

OF COURSE, people will stop using condoms; that's the WHOLE POINT of Truvada. The studies are equivocal now because they use patients who are hyper-aware of getting HIV (like those who are HIV negative but with HIV positive partners). The minute this drugs starts being using in a wider population, condom use will go down.

I'm glad there's another weapon in the anti-HIV armamentarium, but let's be realistic about the consequences.

Jun. 26 2014 11:23 AM
Tom Herman from New York City

This sounds like a recipe for disaster. Even if the studies are correct, which they well may not be given the tendency of drug companies to ignore studies which do not fulfill their expectations, the article says it's 92% effective. 92%? Would you use a condom that was 92% effective? Eight percent of the time it doesn't work! So if one has sex 200 times a year without a condom, one will have 16 opportunities to contract HIV. I realize the drug is intended to be a backup to condoms, but you know that many people will use it as replacement for condoms. And you also know that, since they are not actually ill, many people will not be consistent in their taking of it. Do not underestimate the power of denial when it comes to fulfilling one's immediate passions.

Jun. 26 2014 11:18 AM

Why do you bother with health "jounalism" on this station. This is no more than an extended advertisement. Did you actually bother reading the documentation you linked to???? We are talking about a very limited number of short-term studies. The only studies that showed any real efficacy were those with the smallest numbers, on men who were COUNSELED on safe-sex practices before drug administration. These unsurprisingly had the highest rates of adherence unsurprisingly and these were the only ones with participants from the US. They also unsurprisingly showed a significant change in lifestyle habits. Most of the studies however took place in Africa and Thailand, yes Africa and Thailand. Those of us who keep informed on such things, know just how trustworthy the work of pharmaceutical company researchers are in these regions. Two of these studies were cut short, without adequate explanation. The studies concerning females showed an appalling lack of adherence to the protocol, and to think that that would not be reflected in both men and women in this country is remarkably naive. Those women that did participate showed no significant efficacy. Of much greater concern and obviously linked to the lack of adherence (not cited anywhere in this piece) is that there is already a drug-resistant form of the virus which would make this a criminal waste of money because obviously this drug will become redundant in the very near future. But they can exploit the fears of the vulnerable for their own short-term profit as usual. I ceased to trust the CDC or the FDA many years ago. I have to live with the guilt of legally administering drugs, approved by these bodies, that have done far more harm than good over the years. If you wish to pay to be a guinea pig, by all means buy this drug. But don't complain when you have to seek justice, and you find the tort laws in this country have been totally eviscerated and you have no redress (watch the documentary, "Hot Coffee". WNYC should yet again be tagged as corporate drug peddlers.

Jun. 26 2014 10:00 AM
Suzanne Gill

Recently there was a small reference to Truvada vaginal gel (effective in preventing transmission of HIV) within a Truvada "pill for Men" article. This important finding deserves a full story!

Jun. 26 2014 08:59 AM

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