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What's All the Noise About PrEP For?


As someone who has been on ARVs since 1987, let me tell you they are not something that you want to take for the rest of your life just so you can have bareback sex.

I can see a value in PrEP for certain individuals, like women in discordant couples whose husbands won't use condoms, and sex workers or drug users who binge frequently and continually have to take multiple courses of PEP annually; but to talk about it as a widespread general prevention tool is crazy.

I have peripheral vascular disease, neuropathy, cardio-vascular disease, arthritis; I have had a hip replacement due to a vascular necrosis, seen times when I had to take Imodium daily as a prophylaxis for diarrhea, etc. - all as a result of the side effects of long term ARV use; are there similar side effects from the use of clean needles and condoms? I don't think so!

Who will pay for lifelong use of ARVs as a prophylaxis for HIV? Certainly not insurance companies, who often won't even pay for ARVs for People Living with HIV, without expensive prescription drug specific add-ons. Governments won't pay for ARVs for all of the people living with HIV who live in their own countries, so count governments out. We all know drug companies won't provide them for free or for reasonable prices - so stop dreaming!!

And the comparisons to hep B or HPV vaccines are apples and oranges comparisons; we are not talking about a cheap one time vaccination or once every five years vaccination here, we are talking about thousands of dollars of annual drug expenses for life.

We can talk about Treatment as Prevention - Treating HIV positive individuals so they survive HIV, so their viral load goes undetectable (rendering them less infectious) and so the global viral reservoir of HIV virus is reduced - this I support with all my heart! But all this noise about PrEP??

I think we would be better off using all this air time and hype to promote the AIDS Cure Project - to call for investing in the development of collaborative research for a cure or for effective vaccines or microbicides.

Even if PrEP works, no one is going to be able to afford it; not unless the price is pennies a day; and what healthy person would want to take ARVs for life with the horrible side effects that now exist from ARVs. Dosing the water supply with ARVs is not the answer - a cure is!!


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Comments on Eric Sawyer's blog entry "What's All the Noise About PrEP For?"

Hi Eric! Hear, hear. Thanks for this. I remember commenting to policy folks at PI when the PrEP study got started, as well as at an SF Town Hall held by StopAIDS, that while I understood the "scientific purity" of proving PrEP's actual efficacy, it bothered me that even if it worked, it was not going to be economically feasible. No insurance company is going to pay $700 month for preventive medication--and very few people have that much extra cash just lying around to pay it out-of-pocket. If there's going to be a role for PrEP then designing regimens that people will actually take, and can afford, will be critical.

And yes, how about a cure? AIDS Policy Project is planning two events on both coasts for April 2011, so any citizen-activists who would like to bone up on their cure advocacy skills and attend either event in Philly or Palm Springs, contact APP through our website:

Here, here. This seems like madness to me.

The only way to sharply curb transmissions (since simple things like condoms and clean needles seem to elude governments and users, and we are still sans cure) is to get every positive person on treatment NOW, to suppress everyone's viral loads below infectiousness.

Yet we are told that this too is prohibitively expensive and impossible to deliver. This is yet another "advance" that we will quickly leave behind.

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This page contains a single entry by Eric Sawyer published on November 29, 2010 10:23 AM.

Malawi Gay Men Sentenced to 14 Years was the previous entry in this blog.

Demand AIDS Drug Assistance Program Become an Entitlement like Medicare! is the next entry in this blog.

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