HIV prevention pill offers 'sense of control' over risk

A promising HIV prevention drug is drawing criticism for potentially undermining condom use and safe-sex practices.

With pre-exposure prophylaxis, or PrEP, people without HIV but at substantial risk of infection can take a pill on a daily basis, the U.S. Centers for Disease Control and Prevention says. It is sold under the brand name Truvada.

The pill contains two medicines that prevent HIV from replicating in the body. When taken consistently, it’s been shown to reduce the risk of HIV infection in people who are at high risk by more than 90 per cent.

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Last month, researchers in France and Montreal began offering the drug to those who had been in the placebo group of a trial because early results of a pilot study were so positive. The same was true in a U.K. trial of 500 HIV negative men who sometimes don’t use condoms.

The findings are good news, but PrEP will require a change of thinking, said Gus Cairns, who co-chaired the steering committee for the U.K. trial.

"I think we in the gay community have so much associated not using a condom with sexual danger and irresponsibility that along comes something that might work better than condoms," Cairns said. "It takes individual gay men a long time to get their heads around this."

Len Tooley, a 33-year-old Toronto man, has been taking Truvada for two years. His uncle died of AIDS 15 years ago. He’s excited about the research findings and relieved he doesn’t have to rely on condoms alone.

"It's absolutely given me a sense of control and a sense of comfort over my risk," Tooley said.

Some believe PrEP will encourage men to stop using condoms, possibly driving up rates of sexually transmitted diseases.

Dr. Linda-Gail Bekker, an HIV researcher with the Desmond Tutu HIV Foundation in South Africa, believes PrEP could also protect women and sex workers.

"I think this concern that PrEP will undermine condom usage and therefore we'll see a resurgence of STIs and unwanted pregnancies is very real. So that begs the need for education. PrEP does this, but it doesn't do this and this," she said.

The Hassle Free Clinic in Toronto offers that kind of education, said counsellor Shawn Fowler. The clinic has become aware of an increase in sex without condoms, he said.

In Canada, PrEP isn’t approved for prevention, but doctors can prescribe it off-label. It costs about $900 a month and isn’t covered by all drug plans.

Today, World AIDS Day, an estimated 35 million people are living with HIV worldwide, the World Health Organization says. About two million people were newly enrolled in antiretroviral treatment last year.