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.

Monday, June 6, 2011

Would People Take PrEP Every Day? How Much Would they Pay?

An article by Enrique Rivero discusses the reactions of some people to the concept of pre-exposure prophylaxis (PrEP), the use of HIV antiretroviral medication by HIV negative people to reduce the probability of becoming infected. So far, there has been little written about PrEP that is not industry driven hype.

A study carried out in Peru used consumer marketing techniques to gauge the attitudes of some members of 'high risk' groups there. Apparently cost was a lot more important to them than effectiveness. The amount they would be willing to pay would not be considered much in the minds of the pharmaceutical industry, whose greed is boundless.

But there's also a problem with expectations because people expected PrEP to be 100% effective. In trial conditions, PrEP was only found to be 44% effective, which doesn't bode well for its use outside of trial conditions. People also expressed a preference to use the pill intermittently, a use that has not yet been demonstrated. In the much hyped trial with the 44% effetiveness, participants were supposed to take it every day.

I'm not a big fan of such techniques but they do suggest that the issue of PrEP would be better dealt with through sober research and honest reporting than the infantile hype that we have seen so far.

Also, the lowest cost, which participants preferred, would still be far too high for most Africans in high HIV prevalence countries to afford. PrEP never looked like something intended for people in high prevalence countries but I guess those trying to hawk PrEP still hope that bucket loads of aid money will be spent on it. So they don't want to pitch a competitive price if there is no real need to compete.

The study doesn't show much that couldn't have been worked out beforehand and the methodology will probably cut little ice in the scientific community. Which is a pity, because they seem more interested in marketing PrEP than in genuinely assessing its potential to reduce HIV transmission.

The industry clout behind PrEP seems much too strong to let a few problems like those alluded to in this marketing study have any influence on the process of foisting it on an unsuspecting public. If the study posed any threat at all, it seems unlikely it would have seen the light of day. Or perhaps I'm just too cynical, altogether.


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