"The Obscure Federal Policy Change That Could Transform The Way We Fight AIDS"
On Wednesday, federal health officials released new guidelines related to HIV treatment that, for the first time, officially endorse the use of a daily pill as a preventative measure against contracting the virus. The subtle shift in policy signals a move toward a different approach to addressing the AIDS epidemic, which has claimed more than 630,000 lives over the past several decades.
The pill, known as Truvada, was officially approved by the FDA in 2012 after a landmark study found the medication is more than 90 percent effective at preventing HIV infections among individuals who take the drug as prescribed. That method of protecting people against contracting the virus is technically called “pre-exposure prophylaxis,” or PrEP.
Over the past couple of years, public health advocates have been hopeful about Truvada, along with the the other medications that have been developed to prevent the transmission of HIV from mother to child, eventually shifting the course of the epidemic. Some people are cautiously optimistic that Truvada could be the “new condom,” especially since studies have consistently shown that gay men in the U.S. — along with most men around the world — aren’t always using condoms.
But norms are slow to change. Even though the vast majority of infectious disease specialists in North America support PrEP, a recent survey found that just nine percent of them have actually recommended it to their patients. In human terms, that means among the 500,000 people in the U.S. who become newly infected with HIV every year, fewer than 10,000 of them are prescribed Truvada as a prevention strategy.
Now, the CDC hopes that the new guidelines will encourage more doctors to prescribe PrEP treatment — which is almost always already covered by insurers — to the rest of those 500,000 at-risk individuals. That could include someone who’s in a sexual relationship with an HIV-positive person, someone who uses intravenous drugs, or men who regularly have sex with men without using a condom.
In short, the CDC is hoping to save lives. “On average, it takes a decade for a scientific breakthrough to be adopted,” Dr. Jonathan Mermin, director of the CDC’s national center for sexually transmitted diseases, explained to the New York Times. “We hope we can shorten that time frame and increase people’s survival.”
Many public health advocates are celebrating the news, and welcoming the federal announcement as an important step in legitimizing Truvada as an HIV prevention tool.
“These guidelines are a terrific and significant step forward in normalizing oral PrEP as a key component of high-impact HIV prevention in the United States,” Mitchell Warren, the executive director of AVAC: Global Advocacy for HIV Prevention, told ThinkProgress. “PrEP can have significant personal and public health impact, and it is so great to see this amplified by CDC!”
This isn’t the first step forward CDC has recently taken in this area. In February, the federal health agency officially switched to using “condomless sex” instead of “unprotected sex” to refer to sex without a condom — a shift that reflects the reality that some gay men who aren’t using condoms are taking Truvada, so they’re not actually completely unprotected against the virus. The change was the result of pressure from advocacy groups trying to encourage more acceptance for PrEP.
“As discussions about HIV prevention strategies evolve, the terminology needs to evolve as well,” a CDC spokesperson acknowledged at the time.
But PrEP isn’t without its controversies in the public health community. Michael Weinstein, the president of the AIDS Healthcare Foundation, has emerged as Truvada’s biggest skeptic. He’s called it a “party drug” and critiqued the government for endorsing it, saying that move will “give gay men more excuses not to use condoms.” Unlike barrier methods such as condoms, Truvada doesn’t protect against other sexually transmitted infections, and Weinstein thinks that’s a public health disaster waiting to happen. Some members of the gay community have taken that stance, too.
Not many other HIV prevention groups have aligned themselves with Weinstein. They argue that the benefits of taking Truvada outweigh the potential risk of dissuading Americans from using condoms, and point to one large clinical trial that didn’t actually find any link between Truvada and increased risky sexual behavior. On Thursday afternoon, a group of 68 leading HIV/AIDS and health organizations signed onto an open letter in support of the CDC’s new guidelines.
“No intervention is for everyone, but these guidelines will help providers, policy makers, advocates, and potential users to cut through the noise in the system to make true, evidence-based decisions,” Warren noted.