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."