Pre-Exposure Prophylaxis or PrEP

Pre-exposure prophylaxis (PrEP) involves putting HIV negative people on antiretroviral drugs (ARV) with the aim of protecting them from HIV infection. This blog looks at some of the pros and cons of PrEP.

Saturday, June 25, 2011

Interest in PrEP Wanes with Accurate Information about Effectiveness

The Aids Healthcare Foundation is one of the few very influential institutions questioning the wisdom of rushing into widespread use of PrEP before we really know how well it will work, what challenges it may present and whether it is the best option for some, or even any, risk group.

Their survey is worth a look but a couple of the findings in particular caught my eye. Aside from the fact that most people think they are not at risk, even thought they are sexually active and engaging in anal sex, only 42% say they always use condoms. Saying they 'sometimes' (34%) use condoms is rather vague and may not differ from those who 'rarely' (9%) use them. And 15% say they never use them.

These figures for condom use contrast strongly with answers to the question about using condoms if taking PrEP as well. 83% say they would continue to use condoms if they knew that PrEP was only 90% effective. And only 63% said they would be 'very likely' to remember to take PrEP every day.

The need for regular health visits and other measures only reduce the percentage willing to take PrEP a bit but sharing costs puts a lot of people off. $720 a year results in 59% of people saying they wouldn't choose PrEP. The result is not much different when the cost sharing goes down to $400 per year.

But resistance and side effects are taken very seriously by these health conscious people, many of whom only sometimes use condoms when engaging in anal sex. A small risk of kidney damage or bone loss over a long period of time taking the drugs results in 66% saying they would not take it.

And for the possibility of resistance to certain antiretroviral drugs if the user becomes infected with HIV, which may be far more likely than the side effects mentioned, a whopping 71% say they would not take PrEP. Perhaps they are aware of the implications of resistance, one of which is that the cost of their treatment will rocket.

It's good that the Aids Healthcare Foundation are interested in probing the issue of PrEP, rather than joining in the wholly unwarranted jubilation. Perhaps HIV drug users and potential users are aware that resistance, which is so incredibly valuable to the drug industry, is a potential disaster for them.


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