Truvada, the Miracle HIV Drug Few People Take, Suffers Another Setback
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Since the Centers for Disease Control and Prevention started collecting data on HIV-related deaths just over 30 years ago, more than half a million of those people have died from AIDS.[contextly_sidebar id=\"lO0syDiO3AlElegX7fRdQulfH7k681UG\"]\u003c/p>\n\u003cp class=\"danger-zone\">And yet, today, the struggle against HIV may be undergoing a sea change.\u003c/p>\n\u003cp class=\"danger-zone\">U.S. health officials and HIV experts are beginning to talk about a future \u003ca href=\"https://www.statnews.com/2018/03/29/cdc-director-hiv-remarks/\" target=\"_blank\" rel=\"noopener\">in which transmission in the United States could be halted\u003c/a>. And that future, they say, could come not within a generation, but in the span of just a few years.\u003c/p>\n\u003cp class=\"\">“We have the science to solve the AIDS epidemic,” Dr. Robert Redfield, the director of the CDC, himself a longtime HIV researcher and clinician, told STAT in a recent interview. “We’ve invested in it. Let’s put it into action.‘’\u003c/p>\n\u003cp class=\"\">Other leaders in the HIV field have been musing about the idea, buoyed by the astonishing impact effective HIV medications have wrought, both on the lives of people infected with or at risk of contracting the virus, and on the trajectory of the epidemic.\u003c/p>\n\u003cp class=\"\">“It’s certainly doable in the United States,” said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and a researcher whose study focused on HIV from the earliest days of the AIDS epidemic.\u003c/p>\n\u003cp>Fauci and other health experts are quick to point out that the goal of stopping transmission entirely is largely theoretical. There will always be some new cases, and the barriers to providing treatment to existing cases remain significant. There are still just under 40,000 people in the U.S. each year contracting HIV. As Fauci put it: “We live in a real world, we don’t live in a theoretical world.”\u003c/p>\n\u003cp>But “if we implement all the tools that we have and if we can theoretically, conceptually, get everybody who’s HIV infected on antiretroviral drug so that they will not transmit the infection to anyone else, theoretically you could end the epidemic tomorrow by doing that,” he added.[contextly_sidebar id=\"wauS1YFripUOWbpsTIa7lXm8j8pGcJjw\"]\u003c/p>\n\u003cp>In the absence of a highly effective vaccine — and likely, even, in the presence of one — consigning the global HIV/AIDS epidemic to the history books would be impossible. And at the moment, that’s moot: Despite decades of research on HIV vaccines, the holy grail of HIV control remains an unmet goal.\u003c/p>\n\u003cp>Still, even without a vaccine, experts believe transmission could be largely stopped in this country — a goal that until the past few years would have been unthinkable.\u003c/p>\n\u003cp>In March, Redfield told CDC staff that he believed HIV transmission in the United States \u003ca href=\"https://www.statnews.com/2018/03/29/cdc-director-hiv-remarks/\" target=\"_blank\" rel=\"noopener\">could be halted over the next three to seven years\u003c/a>.\u003c/p>\n\u003cp>The foundation of the dream is the realization that, if taken correctly, today’s potent antiretroviral drugs will drive down the amount of virus in an HIV-infected person’s system to undetectable levels. People who reach that state, known as viral suppression, are not contagious — even, it seems, if they have unprotected sex.\u003c/p>\n\u003cp>Accumulated data from several studies show that in nearly 80,000 condomless sex acts between pairs of men who had discordant HIV status — one was negative, the other was positive, but virally suppressed — not a single new infection occurred.\u003c/p>\n\u003cp>In the HIV world, that finding has given rise to a slogan: U = U, or undetectable equals untransmissible. To maximize the benefits of viral suppression, though, people must know their HIV status and start treatment if they are infected. Currently the CDC estimates that 15 percent of infected Americans are unaware they are HIV positive.\u003c/p>\n\u003cp>“People with HIV infection need to be diagnosed, getting care, stay in care, get on antiretrovirals, and get their viral load down to undetectable,” Redfield said.\u003c/p>\n\u003cp>Pairing the power of viral suppression with another tool further increases the chances of stopping spread of the virus. That other tool is \u003ca href=\"https://www.statnews.com/2018/07/24/digital-pill-prep-truvada/\">PrEP\u003c/a>, pre-exposure prophylaxis — antiretroviral drugs used to prevent infection in people who are at high risk of contracting the virus.\u003c/p>\n\u003cp>Taken correctly, PrEP reduces the risk of contracting HIV from an infected partner by 95 percent. If the infected partner is virally suppressed, the risk is lower still.\u003c/p>\n\u003cp>But the benefits of PrEP can only be reaped if people use it. Currently too few do. The CDC estimates that about 1.1 million people in the U.S. should be taking PrEP, including men who have sex with men, sex workers, and transgender women, a population with a highly elevated risk of contracting HIV. But only about 200,000 are actually using it, Redfield said.[contextly_sidebar id=\"cMA1JnuuPTnJDbxO5uh5Kz0WejZJ8v2u\"]\u003c/p>\n\u003cp>Paradoxically, doctors bear part of the blame for that gap.\u003c/p>\n\u003cp>“There is a large number of people who are not comfortable prescribing PrEP or have not been taught how to prescribe PrEP, whether it be in their residency, fellowship, or post-graduate training,” said Dr. Robert Goldstein, medical director of the transgender health program at Massachusetts General Hospital and an instructor at Harvard Medical School.\u003c/p>\n\u003cp>“We’re limited by stigma within the medical community and within the LGBT community. We’re limited by lack of provider knowledge. We’re limited by awareness among those at highest risk of HIV infection,” Goldstein said. “And those limitations result in rising rates of new HIV infections in men who have sex with men while we see across the country actually dropping rates of new HIV infections year after year.”\u003c/p>\n\u003cp>In some cases, the problem of too little PrEP prescribing is due to a lack of training, and in other cases, something else may be at play, suggested Dr. Demetre Daskalakis, the New York Department of Health’s deputy commissioner of disease control.\u003c/p>\n\u003cp>“We still have to sell this to [clinicians] who are like, ‘Why would I be offering people PrEP, if it’s going to encourage them to have condomless sex?’” he said. “And our answer tends to be, ‘They’re already having condomless sex and this prevents HIV.’”\u003c/p>\n\u003cp>New York is one of several cities — San Francisco and Washington, D.C., among them — that have moved aggressively to harness the power of the treatment and prevention, working to actively identify people who are HIV-positive but who haven’t yet been tested, or haven’t yet started taking antiretroviral drugs, as well as people who should be using PrEP, but are not.\u003c/p>\n\u003cp>New York has expanded the remit of its sexual health clinics to help identify these patients and get them into treatment, said Daskalakis, who explained it’s about “snagging” the people most at risk “where they come for service.”\u003c/p>\n\u003cp>Anyone who is newly diagnosed with HIV is offered antiretroviral drugs immediately. No waiting for a follow-up appointment, which increases the possibility the patient won’t return. And it’s working “with just staggering success,” said Daskalakis.\u003c/p>\n\u003cp>“What we’re finding is that they get virally suppressed faster,” he said. “It’s sort of the dream, that when you start people on medicines for infections they have on the day of their diagnosis, all of a sudden you see that they’re interested in connecting to care and actually follow through.”\u003c/p>\n\u003cp>Likewise, people who test negative for HIV but who are deemed at risk of becoming infected are offered a starter pack of PrEP. The efforts led to a sharp upswing in the number of people taking PrEP — and a swift decline in the number of new HIV diagnoses. In 2016, new infections dropped 10 percent overall, and 15 percent among men who have sex with men, Daskalakis said.\u003c/p>\n\u003cp>The cost of PrEP is steep — $1,500 a month without insurance or assistance from the manufacturer. But New York state has an assistance program that helps with the cost of the medical care PrEP use requires, and there’s a patient assistance program for those who can’t pay for the drug. At the end of the day, Daskalakis said, with a combination of programs, most patients can access PrEP.\u003c/p>\n\u003cp>“In New York, the answer is yes. But I would be more worried about talking to someone in Mississippi,” he said.\u003c/p>\n\u003cp>That isn’t an insignificant consideration. The epidemic in the United States is currently being driven, in large part, by infections among African-American and Latino men who have sex with men in several Southern states.\u003c/p>\n\u003cp>Fauci is a believer in the active style of HIV interventions New York and other cities are employing. “You can’t do business as usual,” he said. “You’ve got to have an aggressive approach.”\u003c/p>\n\u003cp>But he’s always cognizant that translating the successes of Washington or New York to less urban settings — where access to care is more limited and stigma may be greater — likely won’t be as simple as changing some wording on some brochures.\u003c/p>\n\u003cp>“Is that going to work in Alabama? In Georgia? In Mississippi and Louisiana? That’s where we’ve got to put the focus on,” Fauci said.\u003c/p>\n\u003cp>Another challenge that likely won’t be easily overcome relates to the opioid epidemic. The growth in the use of injectable drugs — specifically the sharing of syringes — has driven up HIV and hepatitis C rates in people using illicit substances.\u003c/p>\n\u003cp>Research shows that needle exchange programs reduce those infections. Separately, a number of cities — San Francisco, Philadelphia, New York, and Seattle, among them— have been exploring opening \u003ca href=\"https://www.statnews.com/2017/12/13/supervised-injection-facilities-doctor/\" target=\"_blank\" rel=\"noopener\">safe injection sites\u003c/a>.\u003c/p>\n\u003cp>But just as some doctors associate PrEP prescription with enabling unsafe behavior, the notion of sanctioned injection sites and syringe programs draws the ire of people who believe they encourage illegal activity.\u003c/p>\n\u003cp>In an opinion piece in the New York Times, Deputy Attorney General Rod Rosenstein warned the Department of Justice would take swift action against cities that open such facilities, calling them illegal.\u003c/p>\n\u003cp>“Americans struggling with addiction need treatment and reduced access to deadly drugs. They do not need a taxpayer-sponsored haven to shoot up,” he wrote.\u003c/p>\n\u003cp>Public health experts counter that criminalizing drug use hasn’t worked. Officials can’t “punish people into getting well,” said Dr. Sarah Wakeman, medical director of the substance use disorder program at Mass. General.\u003c/p>\n\u003cp>“At the highest levels of our government, there’s a lot of opposition and antipathy to the idea of harm reduction,” Wakeman said of Rosenstein’s commentary. “And in fact, in that op-ed, it was very clearly stated that these efforts are ‘enabling’ — which I think is one of the many kind of myths around harm reduction.”\u003c/p>\n\u003cp>“We’ll never get to a place where we can stop the spread of HIV unless we are willing to rethink the way we take care of, and our policy towards people who use drugs in this country,” she said.\u003c/p>\n\u003cp>Needle exchange programs have some high-profile supporters, including top officials who have had up-close experience with the problem. The CDC’s Redfield has a son \u003ca href=\"https://www.apnews.com/8cc276150f7e4860bc05bdd4ac04d5e0\" target=\"_blank\" rel=\"noopener\">who has struggled with opioid addiction\u003c/a>; Surgeon General Jerome Adams \u003ca href=\"https://www.statnews.com/2017/12/07/surgeon-general-and-his-brother/\" target=\"_blank\" rel=\"noopener\">has a younger brother who has fought addiction\u003c/a> for two decades.\u003c/p>\n\u003cp>“We believe there is clear evidence that needle exchange programs can reduce the risk of transmission of HIV infection,” said Redfield. Adams \u003ca href=\"https://www.statnews.com/2018/09/20/surgeon-general-jerome-adams-year-one/\" target=\"_blank\" rel=\"noopener\">told STAT\u003c/a> last week: “When I see a [needle exchange] program close, what that says to me is that we haven’t done a good enough job communicating to the community why this program is important and the value that it provides.”\u003c/p>\n\u003cp>The hardest sell yet may be to convince authorities that successfully containing the spread of HIV in the U.S. requires addressing transmission in prisons. Prisons, in theory, “should be easy, because it’s a confined population,” said Fauci. He acknowledged, however, the gap is wide here between theory and reality.\u003c/p>\n\u003cp>“You’ve just got to get really flexible in what you do and recognize that there is sex going on, there is injection drug use going on. And if you really want to address it, you really have to address it in those settings,” he said. “And that, I know, is going to raise a lot of eyebrows. But it’s got to be done.”\u003c/p>\n\u003cp>\u003ci>\u003cspan style=\"font-weight: 400\">This \u003c/span>\u003c/i>\u003ca href=\"https://www.statnews.com/2018/09/26/hiv-aids-end-of-transmission-goal/\" target=\"_blank\" rel=\"noopener\">\u003ci>\u003cspan style=\"font-weight: 400\">story\u003c/span>\u003c/i>\u003c/a>\u003ci>\u003cspan style=\"font-weight: 400\"> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/span>\u003c/i>\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n","blocks":[],"excerpt":null,"status":"publish","parent":0,"modified":1538001420,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":43,"wordCount":2173},"headData":{"title":"Is the End of HIV Transmission in the U.S. Near? | KQED","description":"A mere decade ago, 45,000 Americans a year were contracting HIV. Since the Centers for Disease Control and Prevention started collecting data on HIV-related deaths just over 30 years ago, more than half a million of those people have died from AIDS. And yet, today, the struggle against HIV may be undergoing a sea change.","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Is the End of HIV Transmission in the U.S. Near?","datePublished":"2018-09-26T22:32:50.000Z","dateModified":"2018-09-26T22:37:00.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"444621 https://ww2.kqed.org/futureofyou/?p=444621","disqusUrl":"https://ww2.kqed.org/futureofyou/2018/09/26/is-the-end-of-hiv-transmission-in-the-u-s-near/","disqusTitle":"Is the End of HIV Transmission in the U.S. Near?","source":"Health","nprByline":"Helen Branswell\u003cbr />STAT","path":"/futureofyou/444621/is-the-end-of-hiv-transmission-in-the-u-s-near","audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp class=\"danger-zone\">\u003cspan class=\"big-cap-wrap\">\u003cspan class=\"big-cap\">A \u003c/span>\u003c/span>mere decade ago, 45,000 Americans a year were contracting HIV. Since the Centers for Disease Control and Prevention started collecting data on HIV-related deaths just over 30 years ago, more than half a million of those people have died from AIDS.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp class=\"danger-zone\">And yet, today, the struggle against HIV may be undergoing a sea change.\u003c/p>\n\u003cp class=\"danger-zone\">U.S. health officials and HIV experts are beginning to talk about a future \u003ca href=\"https://www.statnews.com/2018/03/29/cdc-director-hiv-remarks/\" target=\"_blank\" rel=\"noopener\">in which transmission in the United States could be halted\u003c/a>. And that future, they say, could come not within a generation, but in the span of just a few years.\u003c/p>\n\u003cp class=\"\">“We have the science to solve the AIDS epidemic,” Dr. Robert Redfield, the director of the CDC, himself a longtime HIV researcher and clinician, told STAT in a recent interview. “We’ve invested in it. Let’s put it into action.‘’\u003c/p>\n\u003cp class=\"\">Other leaders in the HIV field have been musing about the idea, buoyed by the astonishing impact effective HIV medications have wrought, both on the lives of people infected with or at risk of contracting the virus, and on the trajectory of the epidemic.\u003c/p>\n\u003cp class=\"\">“It’s certainly doable in the United States,” said Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and a researcher whose study focused on HIV from the earliest days of the AIDS epidemic.\u003c/p>\n\u003cp>Fauci and other health experts are quick to point out that the goal of stopping transmission entirely is largely theoretical. There will always be some new cases, and the barriers to providing treatment to existing cases remain significant. There are still just under 40,000 people in the U.S. each year contracting HIV. As Fauci put it: “We live in a real world, we don’t live in a theoretical world.”\u003c/p>\n\u003cp>But “if we implement all the tools that we have and if we can theoretically, conceptually, get everybody who’s HIV infected on antiretroviral drug so that they will not transmit the infection to anyone else, theoretically you could end the epidemic tomorrow by doing that,” he added.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>In the absence of a highly effective vaccine — and likely, even, in the presence of one — consigning the global HIV/AIDS epidemic to the history books would be impossible. And at the moment, that’s moot: Despite decades of research on HIV vaccines, the holy grail of HIV control remains an unmet goal.\u003c/p>\n\u003cp>Still, even without a vaccine, experts believe transmission could be largely stopped in this country — a goal that until the past few years would have been unthinkable.\u003c/p>\n\u003cp>In March, Redfield told CDC staff that he believed HIV transmission in the United States \u003ca href=\"https://www.statnews.com/2018/03/29/cdc-director-hiv-remarks/\" target=\"_blank\" rel=\"noopener\">could be halted over the next three to seven years\u003c/a>.\u003c/p>\n\u003cp>The foundation of the dream is the realization that, if taken correctly, today’s potent antiretroviral drugs will drive down the amount of virus in an HIV-infected person’s system to undetectable levels. People who reach that state, known as viral suppression, are not contagious — even, it seems, if they have unprotected sex.\u003c/p>\n\u003cp>Accumulated data from several studies show that in nearly 80,000 condomless sex acts between pairs of men who had discordant HIV status — one was negative, the other was positive, but virally suppressed — not a single new infection occurred.\u003c/p>\n\u003cp>In the HIV world, that finding has given rise to a slogan: U = U, or undetectable equals untransmissible. To maximize the benefits of viral suppression, though, people must know their HIV status and start treatment if they are infected. Currently the CDC estimates that 15 percent of infected Americans are unaware they are HIV positive.\u003c/p>\n\u003cp>“People with HIV infection need to be diagnosed, getting care, stay in care, get on antiretrovirals, and get their viral load down to undetectable,” Redfield said.\u003c/p>\n\u003cp>Pairing the power of viral suppression with another tool further increases the chances of stopping spread of the virus. That other tool is \u003ca href=\"https://www.statnews.com/2018/07/24/digital-pill-prep-truvada/\">PrEP\u003c/a>, pre-exposure prophylaxis — antiretroviral drugs used to prevent infection in people who are at high risk of contracting the virus.\u003c/p>\n\u003cp>Taken correctly, PrEP reduces the risk of contracting HIV from an infected partner by 95 percent. If the infected partner is virally suppressed, the risk is lower still.\u003c/p>\n\u003cp>But the benefits of PrEP can only be reaped if people use it. Currently too few do. The CDC estimates that about 1.1 million people in the U.S. should be taking PrEP, including men who have sex with men, sex workers, and transgender women, a population with a highly elevated risk of contracting HIV. But only about 200,000 are actually using it, Redfield said.\u003c/p>\u003cp>\u003c/p>\u003cp>\u003c/p>\n\u003cp>Paradoxically, doctors bear part of the blame for that gap.\u003c/p>\n\u003cp>“There is a large number of people who are not comfortable prescribing PrEP or have not been taught how to prescribe PrEP, whether it be in their residency, fellowship, or post-graduate training,” said Dr. Robert Goldstein, medical director of the transgender health program at Massachusetts General Hospital and an instructor at Harvard Medical School.\u003c/p>\n\u003cp>“We’re limited by stigma within the medical community and within the LGBT community. We’re limited by lack of provider knowledge. We’re limited by awareness among those at highest risk of HIV infection,” Goldstein said. “And those limitations result in rising rates of new HIV infections in men who have sex with men while we see across the country actually dropping rates of new HIV infections year after year.”\u003c/p>\n\u003cp>In some cases, the problem of too little PrEP prescribing is due to a lack of training, and in other cases, something else may be at play, suggested Dr. Demetre Daskalakis, the New York Department of Health’s deputy commissioner of disease control.\u003c/p>\n\u003cp>“We still have to sell this to [clinicians] who are like, ‘Why would I be offering people PrEP, if it’s going to encourage them to have condomless sex?’” he said. “And our answer tends to be, ‘They’re already having condomless sex and this prevents HIV.’”\u003c/p>\n\u003cp>New York is one of several cities — San Francisco and Washington, D.C., among them — that have moved aggressively to harness the power of the treatment and prevention, working to actively identify people who are HIV-positive but who haven’t yet been tested, or haven’t yet started taking antiretroviral drugs, as well as people who should be using PrEP, but are not.\u003c/p>\n\u003cp>New York has expanded the remit of its sexual health clinics to help identify these patients and get them into treatment, said Daskalakis, who explained it’s about “snagging” the people most at risk “where they come for service.”\u003c/p>\n\u003cp>Anyone who is newly diagnosed with HIV is offered antiretroviral drugs immediately. No waiting for a follow-up appointment, which increases the possibility the patient won’t return. And it’s working “with just staggering success,” said Daskalakis.\u003c/p>\n\u003cp>“What we’re finding is that they get virally suppressed faster,” he said. “It’s sort of the dream, that when you start people on medicines for infections they have on the day of their diagnosis, all of a sudden you see that they’re interested in connecting to care and actually follow through.”\u003c/p>\n\u003cp>Likewise, people who test negative for HIV but who are deemed at risk of becoming infected are offered a starter pack of PrEP. The efforts led to a sharp upswing in the number of people taking PrEP — and a swift decline in the number of new HIV diagnoses. In 2016, new infections dropped 10 percent overall, and 15 percent among men who have sex with men, Daskalakis said.\u003c/p>\n\u003cp>The cost of PrEP is steep — $1,500 a month without insurance or assistance from the manufacturer. But New York state has an assistance program that helps with the cost of the medical care PrEP use requires, and there’s a patient assistance program for those who can’t pay for the drug. At the end of the day, Daskalakis said, with a combination of programs, most patients can access PrEP.\u003c/p>\n\u003cp>“In New York, the answer is yes. But I would be more worried about talking to someone in Mississippi,” he said.\u003c/p>\n\u003cp>That isn’t an insignificant consideration. The epidemic in the United States is currently being driven, in large part, by infections among African-American and Latino men who have sex with men in several Southern states.\u003c/p>\n\u003cp>Fauci is a believer in the active style of HIV interventions New York and other cities are employing. “You can’t do business as usual,” he said. “You’ve got to have an aggressive approach.”\u003c/p>\n\u003cp>But he’s always cognizant that translating the successes of Washington or New York to less urban settings — where access to care is more limited and stigma may be greater — likely won’t be as simple as changing some wording on some brochures.\u003c/p>\n\u003cp>“Is that going to work in Alabama? In Georgia? In Mississippi and Louisiana? That’s where we’ve got to put the focus on,” Fauci said.\u003c/p>\n\u003cp>Another challenge that likely won’t be easily overcome relates to the opioid epidemic. The growth in the use of injectable drugs — specifically the sharing of syringes — has driven up HIV and hepatitis C rates in people using illicit substances.\u003c/p>\n\u003cp>Research shows that needle exchange programs reduce those infections. Separately, a number of cities — San Francisco, Philadelphia, New York, and Seattle, among them— have been exploring opening \u003ca href=\"https://www.statnews.com/2017/12/13/supervised-injection-facilities-doctor/\" target=\"_blank\" rel=\"noopener\">safe injection sites\u003c/a>.\u003c/p>\n\u003cp>But just as some doctors associate PrEP prescription with enabling unsafe behavior, the notion of sanctioned injection sites and syringe programs draws the ire of people who believe they encourage illegal activity.\u003c/p>\n\u003cp>In an opinion piece in the New York Times, Deputy Attorney General Rod Rosenstein warned the Department of Justice would take swift action against cities that open such facilities, calling them illegal.\u003c/p>\n\u003cp>“Americans struggling with addiction need treatment and reduced access to deadly drugs. They do not need a taxpayer-sponsored haven to shoot up,” he wrote.\u003c/p>\n\u003cp>Public health experts counter that criminalizing drug use hasn’t worked. Officials can’t “punish people into getting well,” said Dr. Sarah Wakeman, medical director of the substance use disorder program at Mass. General.\u003c/p>\n\u003cp>“At the highest levels of our government, there’s a lot of opposition and antipathy to the idea of harm reduction,” Wakeman said of Rosenstein’s commentary. “And in fact, in that op-ed, it was very clearly stated that these efforts are ‘enabling’ — which I think is one of the many kind of myths around harm reduction.”\u003c/p>\n\u003cp>“We’ll never get to a place where we can stop the spread of HIV unless we are willing to rethink the way we take care of, and our policy towards people who use drugs in this country,” she said.\u003c/p>\n\u003cp>Needle exchange programs have some high-profile supporters, including top officials who have had up-close experience with the problem. The CDC’s Redfield has a son \u003ca href=\"https://www.apnews.com/8cc276150f7e4860bc05bdd4ac04d5e0\" target=\"_blank\" rel=\"noopener\">who has struggled with opioid addiction\u003c/a>; Surgeon General Jerome Adams \u003ca href=\"https://www.statnews.com/2017/12/07/surgeon-general-and-his-brother/\" target=\"_blank\" rel=\"noopener\">has a younger brother who has fought addiction\u003c/a> for two decades.\u003c/p>\n\u003cp>“We believe there is clear evidence that needle exchange programs can reduce the risk of transmission of HIV infection,” said Redfield. Adams \u003ca href=\"https://www.statnews.com/2018/09/20/surgeon-general-jerome-adams-year-one/\" target=\"_blank\" rel=\"noopener\">told STAT\u003c/a> last week: “When I see a [needle exchange] program close, what that says to me is that we haven’t done a good enough job communicating to the community why this program is important and the value that it provides.”\u003c/p>\n\u003cp>The hardest sell yet may be to convince authorities that successfully containing the spread of HIV in the U.S. requires addressing transmission in prisons. Prisons, in theory, “should be easy, because it’s a confined population,” said Fauci. He acknowledged, however, the gap is wide here between theory and reality.\u003c/p>\n\u003cp>“You’ve just got to get really flexible in what you do and recognize that there is sex going on, there is injection drug use going on. And if you really want to address it, you really have to address it in those settings,” he said. “And that, I know, is going to raise a lot of eyebrows. But it’s got to be done.”\u003c/p>\n\u003cp>\u003ci>\u003cspan style=\"font-weight: 400\">This \u003c/span>\u003c/i>\u003ca href=\"https://www.statnews.com/2018/09/26/hiv-aids-end-of-transmission-goal/\" target=\"_blank\" rel=\"noopener\">\u003ci>\u003cspan style=\"font-weight: 400\">story\u003c/span>\u003c/i>\u003c/a>\u003ci>\u003cspan style=\"font-weight: 400\"> was originally published by STAT, an online publication of Boston Globe Media that covers health, medicine, and scientific discovery.\u003c/span>\u003c/i>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/444621/is-the-end-of-hiv-transmission-in-the-u-s-near","authors":["byline_futureofyou_444621"],"categories":["futureofyou_1062","futureofyou_1","futureofyou_73"],"tags":["futureofyou_141","futureofyou_1275","futureofyou_61","futureofyou_651","futureofyou_835"],"collections":["futureofyou_1097"],"featImg":"futureofyou_444626","label":"source_futureofyou_444621"},"futureofyou_134669":{"type":"posts","id":"futureofyou_134669","meta":{"index":"posts_1591205157","site":"futureofyou","id":"134669","score":null,"sort":[1459207219000]},"guestAuthors":[],"slug":"truvada-the-miracle-hiv-drug-few-people-take-suffers-another-setback","title":"Truvada, the Miracle HIV Drug Few People Take, Suffers Another Setback","publishDate":1459207219,"format":"standard","headTitle":"Future of You | KQED Future of You | KQED Science","labelTerm":{"term":54,"site":"futureofyou"},"content":"\u003cp>The first documented case of HIV infection by someone adhering to the prescribed regimen for the preventive HIV drug Truvada was reported at a medical conference last month.\u003c/p>\n\u003cp>Dr. David Knox, an HIV primary care physician at Toronto's Maple Leaf Medical Clinic, reported the case at the \u003ca href=\"http://www.croiconference.org/sessions/hiv-1-infection-multiclass-resistance-despite-preexposure-prophylaxis-prep\" target=\"_blank\" rel=\"nofollow\">Conference on Retroviruses and Opportunistic Infections in Boston\u003c/a>. (You can listen to his full presentation \u003ca href=\"http://streamst3.capitalreach.com/c/croi/2016croi/29737.mp3?isMobileView=false&detectedMobile=false\" target=\"_blank\">here\u003c/a>.)\u003c/p>\n\u003cp>Truvada, called PrEP for \"pre-exposure prophylaxis\" when used as a prophylactic, is an FDA-approved combination of two drugs that is also used to treat HIV. Since 2012, it's also been prescribed to HIV-negative individuals in high-risk populations who want to prevent infection.\u003c/p>\n\u003cp>The patient who represents the first PrEP failure was a 43-year-old man who had taken Truvada for approximately two years, Knox said in an email. Before his infection, the man had multiple encounters in which he engaged in high-risk sexual behavior.\u003c/p>\n\u003cp>Knox said his patient had \"a very resistant strain of virus\" and that the failure of PrEP was probably rare.\u003c/p>\n\u003cp>[ad fullwidth]\u003c/p>\n\u003cp>Just last September, an analysis by researchers at Kaiser San Francisco \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/09/02/no-new-infections-in-hundreds-taking-pill-to-prevent-hiv/\" target=\"_blank\">found no new HIV infections \u003c/a>in over a two-and-a-half-year period among patients who took PrEP.\u003c/p>\n\u003cp>Ryan McKeel, a spokesman for Gilead Sciences, Truvada's manufacturer, said in an email that \"no single intervention is 100 percent effective in preventing HIV. In this case, the individual contracted HIV while taking PrEP due to exposure to a rare strain of HIV that is resistant to both of the drugs included in Truvada.\"\u003c/p>\n\u003cp>\u003cb>Truvada: The Miracle Drug No One's Taking\u003c/b>\u003c/p>\n\u003cp>Before the FDA approval of PrEP, in 2011, I \u003ca href=\"http://ww2.kqed.org/news/2011/07/15/interview-new-studies-show-anti-hiv-drug-prevents-transmission\" target=\"_blank\">interviewed the seminal AIDS researcher Dr. Paul Volberding\u003c/a> about studies showing Truvada's effectiveness in preventing HIV transmission. He was tremendously excited about the possibilities of a prophylactic drug. \"This is the kind of effect we might expect from a very good vaccine,\" he said.\u003c/p>\n\u003cp>That enthusiasm has spread to both the Centers for Disease Control and the World Health Organization. CDC now says\u003ca href=\"https://www.washingtonpost.com/news/to-your-health/wp/2015/11/24/cdc-on-hiv-prevention-pill-how-to-tell-whether-you-should-be-taking-the-medication/\" target=\"_blank\"> about 1.2 million people \u003c/a>should at least consider PrEP, and four months ago the World Health Organization broadened its recommendation of who should take the medication, from men who have sex with men to \"all population groups at substantial risk of HIV infection.\"\u003c/p>\n\u003cp>Yet, what some have called a \"\u003ca href=\"https://www.washingtonpost.com/opinions/the-miracle-aids-drug-that-people-refust-to-take/2016/01/29/ba2b9460-b88a-11e5-b682-4bb4dd403c7d_story.html\" target=\"_blank\">miracle drug\u003c/a>\" that \u003ca href=\"http://www.nytimes.com/2014/07/17/upshot/is-truvada-the-pill-to-prevent-hiv-99-percent-effective-dont-be-so-sure.html?_r=0\" target=\"_blank\">works better\u003c/a> than \u003ca href=\"http://www.aidsmap.com/Consistent-condom-use-in-anal-sex-stops-70-of-HIV-infections-study-finds-but-intermittent-use-has-no-effect/page/2586976/\" target=\"_blank\">condoms\u003c/a> has been a bust in terms of adoption by the public.\u003c/p>\n\u003cp>\"\u003ca href=\"http://www.newyorker.com/tech/elements/why-is-no-one-on-the-first-treatment-to-prevent-h-i-v\" target=\"_blank\">Why Is No One On the First Treatment To Prevent H.I.V.?\u003c/a>\" The New Yorker asked in 2013.\u003c/p>\n\u003cp>\"Why have \u003ca href=\"http://www.natap.org/2013/ICAAC/ICAAC_04.htm\" target=\"_blank\">only 1,774 people\u003c/a>—half of whom are women—filled Truvada prescriptions over the last two years?\" \u003ca href=\"http://www.slate.com/blogs/outward/2014/01/06/truvada_prep_hiv_gay_men_should_take_pre_exposure_prophylaxis.html\" target=\"_blank\">Slate\u003c/a> asked in 2014.\u003c/p>\n\u003cp>\"Gilead’s Pill Can Stop HIV. So Why Does Almost Nobody Take It?\" \u003ca href=\"http://www.bloomberg.com/news/articles/2015-02-18/gilead-s-pill-can-stop-hiv-so-why-does-almost-nobody-take-it-\" target=\"_blank\">Bloomberg asked\u003c/a> in 2015.\u003c/p>\n\u003cp>\"\u003ca href=\"https://www.washingtonpost.com/opinions/the-miracle-aids-drug-that-people-refust-to-take/2016/01/29/ba2b9460-b88a-11e5-b682-4bb4dd403c7d_story.html\" target=\"_blank\">The miracle AIDS drug that people refuse to take,\u003c/a>\" an op-ed headline in The Washington Post read just two months ago.\u003c/p>\n\u003cp>\"Truvada’s been a financial success, bringing Gilead $1.79 billion in the U.S last year,\" Bloomberg reported in July. But that is due to its use by HIV-positive patients, not in those taking it for prevention. The report cited a \u003ca href=\"http://www.jiasociety.org/index.php/jias/article/view/19730/html\" target=\"_blank\">study\u003c/a> published in the November 2014 Journal of the International AIDS Society that found an unbelievably low 3,253 people, in the U.S., had used Truvada for PrEP between January 2012 and March 2014 -- only about 1,900 of those men.\u003c/p>\n\u003cp>The CDC says that figure is now about 21,000. According to an October 2015 \u003ca href=\"http://www.iapac.org/tasp_prep/presentations/TPSparis15-Panel-Grant.pdf\" target=\"_blank\">presentation\u003c/a> by Dr. Robert Grant, the protocol chair for a \u003ca href=\"https://www.google.com/search?q=iprex+study\" target=\"_blank\">multinational study on PrEP\u003c/a>, the number of U.S. users is about 22,000, and use of the drug \"has reached a tipping point.\"\u003c/p>\n\u003cp>Not according to Michael Weinstein, president of AIDS Healthcare Foundation, a global HIV/AIDS organization. Weinstein has been \u003ca href=\"https://www.frontiersmedia.com/frontiers-blog/2016/01/07/aids-healthcare-foundation-continues-to-wage-war-against-prep-reignites-party-drug-rhetoric/\" target=\"_blank\">outspoken\u003c/a> against mass adoption of Truvada, arguing it's a poor public health solution and drawing the wrath of some in the HIV health community. (The New York Times' Upshot \u003ca href=\"http://www.nytimes.com/2014/11/17/upshot/aids-group-wages-lonely-fight-against-pill-to-prevent-hiv.html\" target=\"_blank\">column\u003c/a> called him \"the most hated man in the AIDS business\" in 2014.)\u003c/p>\n\u003cp>Weinstein is well aware that the number of people taking Truvada is trivial.\u003c/p>\n\u003cp>\"The bottom line is we are now almost four years since the approval of this, and the last report from the CDC was that 21,000 people were taking it. Really, it's an insignificant number.\"\u003c/p>\n\u003cp>He said he thought the recent report about the Truvada failure out of Toronto \"will give some people pause\" about the drug. And he thinks the focus on Truvada is wrongheaded:\u003c/p>\n\u003cp>\"The messaging coming out is all about Truvada and PrEP, and not about condoms,\" he said. \"So we're seeing this huge s\u003ca href=\"http://www.cdc.gov/nchhstp/newsroom/2015/std-surveillance-report-press-release.html\" target=\"_blank\">pike in STDs\u003c/a> across the country. And I think it's because the CDC has really taken their foot off the gas and they're not saying anything about safer sex.\"\u003c/p>\n\u003cp>Dana Van Gorder is the executive director of Project Inform, which advocates for new HIV and hepatitis C treatments. He agrees that reduced condom use is a big factor in the rise of STDs. But he says PrEP use is so minimal, it can't be the culprit. Plus PrEP is better.\u003c/p>\n\u003cp>\"Condoms have been a great device, but on a statistical level, they're not as effective as PrEP can be in preventing infections, and the reality is just that not everyone is going to use them, for a variety of different reasons. So it feels unethical to us to not provide people with another option.\u003c/p>\n\u003cp>\"We can't just wish that people are going to use condoms more than they are.\"\u003c/p>\n\u003cp>Van Gorder said those who support Truvada were \"disappointed\" over the news it had failed for someone. But, he said, \"We'll continue to encourage PrEP use and stress it is highly effective but not necessarily 100 percent effective.\"\u003c/p>\n\u003cp>\u003cstrong>What, Exactly, is the Problem?\u003c/strong>\u003c/p>\n\u003cp>The reasons for PrEP's failure to catch on are manifold, Van Gorder said: Lack of effective education campaigns among \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/08/01/why-latinos-arent-taking-the-anti-hiv-pill-and-why-they-should-consider-it/\" target=\"_blank\">people of color\u003c/a> and injection drug users, for one; the need for follow-up appontments and testing, for another.\u003c/p>\n\u003cp>Also, he said, health care providers are not talking enough about PrEP to their patients. Some \"are actually hostile to it,\" he said.\u003c/p>\n\u003cp>Finally, Van Gorder said, PrEP is expensive. \"Covering its cost is not a small matter. While many insurers if not most are covering it, people often have high cost of sharing with deductibles and copays. Not everyone is in a position to [use] it.\"\u003c/p>\n\u003cp>But as Lisa Aliferis reported in KQED's \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/09/02/no-new-infections-in-hundreds-taking-pill-to-prevent-hiv/\" target=\"_blank\">State of Health blog\u003c/a> last September, there's another reason PrEP has failed to take off:\u003c/p>\n\u003cp>\"Despite the success of PrEP as a preventive, stigma remains,\" Aliferis wrote. \"People who take PrEP are sometimes viewed as promiscuous, [A PrEP patient] told me. “People say, ‘Why are you not just using condoms?’ … Sometimes people say, ‘You must be a slut.’\u003c/p>\n\u003cp>In fact, the term \"\u003ca href=\"http://www.advocate.com/health/2014/08/11/truvada-whore-stigma-endures-among-doctors-and-lgbts\" target=\"_blank\">Truvada whore\u003c/a>\" has often been used to describe PrEP users ... and not in a nice way, either. (The term has been\u003ca href=\"http://www.out.com/entertainment/popnography/2014/05/20/why-i-am-truvada-whore\" target=\"_blank\"> co-opted\u003c/a> by some Truvada fans.)\u003c/p>\n\u003cp>\u003cstrong>The Patient Speaks\u003c/strong>\u003c/p>\n\u003cp>Earlier this month, POZ, a magazine for people who are HIV-positive, published an \u003ca href=\"https://www.poz.com/article/meet-man-got-hiv-daily-prep\" target=\"_blank\">anonymous-yet-candid interview\u003c/a> with the Canadian PrEP user who still became infected.\u003c/p>\n\u003cp>When asked if PrEP altered his sexual behavior or attitudes, he answered:\u003c/p>\n\u003cp>\"Yes. I became more sexually liberated. It took away the fear. I mean, that’s really one of the reasons why people behave themselves [sexually]. It’s not because of morals or religion or society; it’s just the fear of getting sick—especially the fear of HIV. But once you’re on PrEP you’re more comfortable. You feel safer.\"\u003c/p>\n\u003cp>\u003cspan style=\"line-height: 1.5\">He said he's still a fan of the drug, despite its failure.\u003c/span>\u003c/p>\n\u003cp>\"PrEP’s a calculated risk,\" he said. \"It’s important for people to know that there is the possibility as opposed to the fantasy that there have been no recorded infections on PrEP. At least now there is one, so it makes it more real.\"\u003c/p>\n\u003cp>[ad floatright]\u003c/p>\n\u003cp> \u003c/p>\n\n","blocks":[],"excerpt":"Truvada, or PrEP, prevents HIV infection in healthy people. It's been foolproof, until now. ","status":"publish","parent":0,"modified":1459277166,"stats":{"hasAudio":false,"hasVideo":false,"hasChartOrMap":false,"iframeSrcs":[],"hasGoogleForm":false,"hasGallery":false,"hasHearkenModule":false,"hasPolis":false,"paragraphCount":41,"wordCount":1442},"headData":{"title":"Truvada, the Miracle HIV Drug Few People Take, Suffers Another Setback | KQED","description":"Truvada, or PrEP, prevents HIV infection in healthy people. It's been foolproof, until now. ","ogTitle":"","ogDescription":"","ogImgId":"","twTitle":"","twDescription":"","twImgId":"","schema":{"@context":"http://schema.org","@type":"Article","headline":"Truvada, the Miracle HIV Drug Few People Take, Suffers Another Setback","datePublished":"2016-03-28T23:20:19.000Z","dateModified":"2016-03-29T18:46:06.000Z","image":"https://cdn.kqed.org/wp-content/uploads/2020/02/KQED-OG-Image@1x.png"}},"disqusIdentifier":"134669 http://ww2.kqed.org/futureofyou/?p=134669","disqusUrl":"https://ww2.kqed.org/futureofyou/2016/03/28/truvada-the-miracle-hiv-drug-few-people-take-suffers-another-setback/","disqusTitle":"Truvada, the Miracle HIV Drug Few People Take, Suffers Another Setback","path":"/futureofyou/134669/truvada-the-miracle-hiv-drug-few-people-take-suffers-another-setback","audioUrl":"http://streamst3.capitalreach.com/c/croi/2016croi/29737.mp3?isMobileView=false&","audioDuration":null,"audioTrackLength":null,"parsedContent":[{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003cp>The first documented case of HIV infection by someone adhering to the prescribed regimen for the preventive HIV drug Truvada was reported at a medical conference last month.\u003c/p>\n\u003cp>Dr. David Knox, an HIV primary care physician at Toronto's Maple Leaf Medical Clinic, reported the case at the \u003ca href=\"http://www.croiconference.org/sessions/hiv-1-infection-multiclass-resistance-despite-preexposure-prophylaxis-prep\" target=\"_blank\" rel=\"nofollow\">Conference on Retroviruses and Opportunistic Infections in Boston\u003c/a>. (You can listen to his full presentation \u003ca href=\"http://streamst3.capitalreach.com/c/croi/2016croi/29737.mp3?isMobileView=false&detectedMobile=false\" target=\"_blank\">here\u003c/a>.)\u003c/p>\n\u003cp>Truvada, called PrEP for \"pre-exposure prophylaxis\" when used as a prophylactic, is an FDA-approved combination of two drugs that is also used to treat HIV. Since 2012, it's also been prescribed to HIV-negative individuals in high-risk populations who want to prevent infection.\u003c/p>\n\u003cp>The patient who represents the first PrEP failure was a 43-year-old man who had taken Truvada for approximately two years, Knox said in an email. Before his infection, the man had multiple encounters in which he engaged in high-risk sexual behavior.\u003c/p>\n\u003cp>Knox said his patient had \"a very resistant strain of virus\" and that the failure of PrEP was probably rare.\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"fullwidth"},"numeric":["fullwidth"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp>Just last September, an analysis by researchers at Kaiser San Francisco \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/09/02/no-new-infections-in-hundreds-taking-pill-to-prevent-hiv/\" target=\"_blank\">found no new HIV infections \u003c/a>in over a two-and-a-half-year period among patients who took PrEP.\u003c/p>\n\u003cp>Ryan McKeel, a spokesman for Gilead Sciences, Truvada's manufacturer, said in an email that \"no single intervention is 100 percent effective in preventing HIV. In this case, the individual contracted HIV while taking PrEP due to exposure to a rare strain of HIV that is resistant to both of the drugs included in Truvada.\"\u003c/p>\n\u003cp>\u003cb>Truvada: The Miracle Drug No One's Taking\u003c/b>\u003c/p>\n\u003cp>Before the FDA approval of PrEP, in 2011, I \u003ca href=\"http://ww2.kqed.org/news/2011/07/15/interview-new-studies-show-anti-hiv-drug-prevents-transmission\" target=\"_blank\">interviewed the seminal AIDS researcher Dr. Paul Volberding\u003c/a> about studies showing Truvada's effectiveness in preventing HIV transmission. He was tremendously excited about the possibilities of a prophylactic drug. \"This is the kind of effect we might expect from a very good vaccine,\" he said.\u003c/p>\n\u003cp>That enthusiasm has spread to both the Centers for Disease Control and the World Health Organization. CDC now says\u003ca href=\"https://www.washingtonpost.com/news/to-your-health/wp/2015/11/24/cdc-on-hiv-prevention-pill-how-to-tell-whether-you-should-be-taking-the-medication/\" target=\"_blank\"> about 1.2 million people \u003c/a>should at least consider PrEP, and four months ago the World Health Organization broadened its recommendation of who should take the medication, from men who have sex with men to \"all population groups at substantial risk of HIV infection.\"\u003c/p>\n\u003cp>Yet, what some have called a \"\u003ca href=\"https://www.washingtonpost.com/opinions/the-miracle-aids-drug-that-people-refust-to-take/2016/01/29/ba2b9460-b88a-11e5-b682-4bb4dd403c7d_story.html\" target=\"_blank\">miracle drug\u003c/a>\" that \u003ca href=\"http://www.nytimes.com/2014/07/17/upshot/is-truvada-the-pill-to-prevent-hiv-99-percent-effective-dont-be-so-sure.html?_r=0\" target=\"_blank\">works better\u003c/a> than \u003ca href=\"http://www.aidsmap.com/Consistent-condom-use-in-anal-sex-stops-70-of-HIV-infections-study-finds-but-intermittent-use-has-no-effect/page/2586976/\" target=\"_blank\">condoms\u003c/a> has been a bust in terms of adoption by the public.\u003c/p>\n\u003cp>\"\u003ca href=\"http://www.newyorker.com/tech/elements/why-is-no-one-on-the-first-treatment-to-prevent-h-i-v\" target=\"_blank\">Why Is No One On the First Treatment To Prevent H.I.V.?\u003c/a>\" The New Yorker asked in 2013.\u003c/p>\n\u003cp>\"Why have \u003ca href=\"http://www.natap.org/2013/ICAAC/ICAAC_04.htm\" target=\"_blank\">only 1,774 people\u003c/a>—half of whom are women—filled Truvada prescriptions over the last two years?\" \u003ca href=\"http://www.slate.com/blogs/outward/2014/01/06/truvada_prep_hiv_gay_men_should_take_pre_exposure_prophylaxis.html\" target=\"_blank\">Slate\u003c/a> asked in 2014.\u003c/p>\n\u003cp>\"Gilead’s Pill Can Stop HIV. So Why Does Almost Nobody Take It?\" \u003ca href=\"http://www.bloomberg.com/news/articles/2015-02-18/gilead-s-pill-can-stop-hiv-so-why-does-almost-nobody-take-it-\" target=\"_blank\">Bloomberg asked\u003c/a> in 2015.\u003c/p>\n\u003cp>\"\u003ca href=\"https://www.washingtonpost.com/opinions/the-miracle-aids-drug-that-people-refust-to-take/2016/01/29/ba2b9460-b88a-11e5-b682-4bb4dd403c7d_story.html\" target=\"_blank\">The miracle AIDS drug that people refuse to take,\u003c/a>\" an op-ed headline in The Washington Post read just two months ago.\u003c/p>\n\u003cp>\"Truvada’s been a financial success, bringing Gilead $1.79 billion in the U.S last year,\" Bloomberg reported in July. But that is due to its use by HIV-positive patients, not in those taking it for prevention. The report cited a \u003ca href=\"http://www.jiasociety.org/index.php/jias/article/view/19730/html\" target=\"_blank\">study\u003c/a> published in the November 2014 Journal of the International AIDS Society that found an unbelievably low 3,253 people, in the U.S., had used Truvada for PrEP between January 2012 and March 2014 -- only about 1,900 of those men.\u003c/p>\n\u003cp>The CDC says that figure is now about 21,000. According to an October 2015 \u003ca href=\"http://www.iapac.org/tasp_prep/presentations/TPSparis15-Panel-Grant.pdf\" target=\"_blank\">presentation\u003c/a> by Dr. Robert Grant, the protocol chair for a \u003ca href=\"https://www.google.com/search?q=iprex+study\" target=\"_blank\">multinational study on PrEP\u003c/a>, the number of U.S. users is about 22,000, and use of the drug \"has reached a tipping point.\"\u003c/p>\n\u003cp>Not according to Michael Weinstein, president of AIDS Healthcare Foundation, a global HIV/AIDS organization. Weinstein has been \u003ca href=\"https://www.frontiersmedia.com/frontiers-blog/2016/01/07/aids-healthcare-foundation-continues-to-wage-war-against-prep-reignites-party-drug-rhetoric/\" target=\"_blank\">outspoken\u003c/a> against mass adoption of Truvada, arguing it's a poor public health solution and drawing the wrath of some in the HIV health community. (The New York Times' Upshot \u003ca href=\"http://www.nytimes.com/2014/11/17/upshot/aids-group-wages-lonely-fight-against-pill-to-prevent-hiv.html\" target=\"_blank\">column\u003c/a> called him \"the most hated man in the AIDS business\" in 2014.)\u003c/p>\n\u003cp>Weinstein is well aware that the number of people taking Truvada is trivial.\u003c/p>\n\u003cp>\"The bottom line is we are now almost four years since the approval of this, and the last report from the CDC was that 21,000 people were taking it. Really, it's an insignificant number.\"\u003c/p>\n\u003cp>He said he thought the recent report about the Truvada failure out of Toronto \"will give some people pause\" about the drug. And he thinks the focus on Truvada is wrongheaded:\u003c/p>\n\u003cp>\"The messaging coming out is all about Truvada and PrEP, and not about condoms,\" he said. \"So we're seeing this huge s\u003ca href=\"http://www.cdc.gov/nchhstp/newsroom/2015/std-surveillance-report-press-release.html\" target=\"_blank\">pike in STDs\u003c/a> across the country. And I think it's because the CDC has really taken their foot off the gas and they're not saying anything about safer sex.\"\u003c/p>\n\u003cp>Dana Van Gorder is the executive director of Project Inform, which advocates for new HIV and hepatitis C treatments. He agrees that reduced condom use is a big factor in the rise of STDs. But he says PrEP use is so minimal, it can't be the culprit. Plus PrEP is better.\u003c/p>\n\u003cp>\"Condoms have been a great device, but on a statistical level, they're not as effective as PrEP can be in preventing infections, and the reality is just that not everyone is going to use them, for a variety of different reasons. So it feels unethical to us to not provide people with another option.\u003c/p>\n\u003cp>\"We can't just wish that people are going to use condoms more than they are.\"\u003c/p>\n\u003cp>Van Gorder said those who support Truvada were \"disappointed\" over the news it had failed for someone. But, he said, \"We'll continue to encourage PrEP use and stress it is highly effective but not necessarily 100 percent effective.\"\u003c/p>\n\u003cp>\u003cstrong>What, Exactly, is the Problem?\u003c/strong>\u003c/p>\n\u003cp>The reasons for PrEP's failure to catch on are manifold, Van Gorder said: Lack of effective education campaigns among \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/08/01/why-latinos-arent-taking-the-anti-hiv-pill-and-why-they-should-consider-it/\" target=\"_blank\">people of color\u003c/a> and injection drug users, for one; the need for follow-up appontments and testing, for another.\u003c/p>\n\u003cp>Also, he said, health care providers are not talking enough about PrEP to their patients. Some \"are actually hostile to it,\" he said.\u003c/p>\n\u003cp>Finally, Van Gorder said, PrEP is expensive. \"Covering its cost is not a small matter. While many insurers if not most are covering it, people often have high cost of sharing with deductibles and copays. Not everyone is in a position to [use] it.\"\u003c/p>\n\u003cp>But as Lisa Aliferis reported in KQED's \u003ca href=\"http://ww2.kqed.org/stateofhealth/2015/09/02/no-new-infections-in-hundreds-taking-pill-to-prevent-hiv/\" target=\"_blank\">State of Health blog\u003c/a> last September, there's another reason PrEP has failed to take off:\u003c/p>\n\u003cp>\"Despite the success of PrEP as a preventive, stigma remains,\" Aliferis wrote. \"People who take PrEP are sometimes viewed as promiscuous, [A PrEP patient] told me. “People say, ‘Why are you not just using condoms?’ … Sometimes people say, ‘You must be a slut.’\u003c/p>\n\u003cp>In fact, the term \"\u003ca href=\"http://www.advocate.com/health/2014/08/11/truvada-whore-stigma-endures-among-doctors-and-lgbts\" target=\"_blank\">Truvada whore\u003c/a>\" has often been used to describe PrEP users ... and not in a nice way, either. (The term has been\u003ca href=\"http://www.out.com/entertainment/popnography/2014/05/20/why-i-am-truvada-whore\" target=\"_blank\"> co-opted\u003c/a> by some Truvada fans.)\u003c/p>\n\u003cp>\u003cstrong>The Patient Speaks\u003c/strong>\u003c/p>\n\u003cp>Earlier this month, POZ, a magazine for people who are HIV-positive, published an \u003ca href=\"https://www.poz.com/article/meet-man-got-hiv-daily-prep\" target=\"_blank\">anonymous-yet-candid interview\u003c/a> with the Canadian PrEP user who still became infected.\u003c/p>\n\u003cp>When asked if PrEP altered his sexual behavior or attitudes, he answered:\u003c/p>\n\u003cp>\"Yes. I became more sexually liberated. It took away the fear. I mean, that’s really one of the reasons why people behave themselves [sexually]. It’s not because of morals or religion or society; it’s just the fear of getting sick—especially the fear of HIV. But once you’re on PrEP you’re more comfortable. You feel safer.\"\u003c/p>\n\u003cp>\u003cspan style=\"line-height: 1.5\">He said he's still a fan of the drug, despite its failure.\u003c/span>\u003c/p>\n\u003cp>\"PrEP’s a calculated risk,\" he said. \"It’s important for people to know that there is the possibility as opposed to the fantasy that there have been no recorded infections on PrEP. At least now there is one, so it makes it more real.\"\u003c/p>\n\u003cp>\u003c/p>\u003c/div>","attributes":{"named":{},"numeric":[]}},{"type":"component","content":"","name":"ad","attributes":{"named":{"label":"floatright"},"numeric":["floatright"]}},{"type":"contentString","content":"\u003cdiv class=\"post-body\">\u003cp>\u003c/p>\n\u003cp> \u003c/p>\n\n\u003c/div>\u003c/p>","attributes":{"named":{},"numeric":[]}}],"link":"/futureofyou/134669/truvada-the-miracle-hiv-drug-few-people-take-suffers-another-setback","authors":["80"],"programs":["futureofyou_54"],"categories":["futureofyou_452","futureofyou_1","futureofyou_73"],"tags":["futureofyou_650","futureofyou_651","futureofyou_80","futureofyou_835","futureofyou_834"],"featImg":"futureofyou_134902","label":"futureofyou_54"}},"programsReducer":{"possible":{"id":"possible","title":"Possible","info":"Possible is hosted by entrepreneur Reid Hoffman and writer Aria Finger. Together in Possible, Hoffman and Finger lead enlightening discussions about building a brighter collective future. The show features interviews with visionary guests like Trevor Noah, Sam Altman and Janette Sadik-Khan. Possible paints an optimistic portrait of the world we can create through science, policy, business, art and our shared humanity. It asks: What if everything goes right for once? How can we get there? 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