Truvada, known on the street as “PrEP,” discourages condom use, some experts say.
An American man who had recently tested HIV-positive wrote a December 2015 article in The Atlantic. The piece is exceptional for its honesty, and it is a fine example of the wishful thinking that often imbues pharmaceutical use with power it simply does not have.
The man, who describes himself as gay and says he had been sexually active, relates his experiences with a prescription drug nicknamed “PrEP” (short for Pre-Exposure Prophylaxis), billed as preventive against contracting HIV.
Truvada (its brand name) is one of four “HIV franchise” drugs developed and marketed by a pharma company called Gilead Sciences. Though the author does not mention it, the nicknaming of drugs by Big Pharma marketers is a growing practice—and one whose ethics are suspect at best.
Gilead and others of its ilk well know that the public (including the intelligent public) will swallow the easiest story to digest. A recent example is the purported libido-enhancing pill nicknamed “the female Viagra,” even though Viagra increases blood flow, not libido, in men.
How easy is it for Gilead to say “PrEP for your sexual activity?” The implication being that you have already thoroughly “prepped” with Truvada, so there’s no need for condoms. “Pre-Exposure Prophylaxis,” they call it. Condoms have long been known as “prophylactics.” “Why use prophylactic on top of prophylactic?” a Truvada user might ask.
The author of the article writes of learning of his positive test result: “I didn’t cry. I was more than hurt; I was shocked, and indignant. I’d been taking Truvada, also known as PrEP a daily, two-drug regimen that prevents the transmission of HIV. How did I get HIV while taking Truvada? I wondered. Was it the guy I had sex with in the first few days, when the drug might not have reached optimal potency in my blood? Was I exceptional? Was PrEP not as effective as it had been billed?” It turns out that the test was wrong. He was actually HIV-negative.
“I began to think about Truvada last fall,” he continues, “when a friend of mine mentioned that it was gaining currency as an HIV-prevention drug. This friend knew that I generally only had condomless sex—and that as a result, I rarely had sex at all. As a gay man who has receptive sex—and who lives in Miami and Washington, D.C., the cities with the first- and fifth-highest HIV rates in the U.S.—I knew how high my risk was, and for the most part, I wasn’t willing to chance it.”
A great fact seems lost on the author: Something that has only a 1-in-500 chance of happening has already happened to him—a false-positive HIV test result. Yet, he himself cites early studies that put the failure rate of Truvada between 1-in-13 and 1-in-100. Though he acknowledges that many experts “approach PrEP with trepidation, concerned it might spur a decline in condom use and fuel an increase in other STIs,” he seems to steadfastly adhere to his “no condoms” preference. Yes, the story in The Atlantic has a happy ending—let’s hope it’s also happily ever after.