HIV Talk: Study Finds Alarming 45% Increase In BB Sex Among Gay Men On PrEP

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December 11, 2014
6:00 a.m.

B1lKIJcCIAEzgzyStory Courtesy Of Adrian Garcia

A new alarming survey conducted by Kaiser Permanente has raised concerns about gay men who are using a daily pill which stops HIV infection as a condom substitute, putting them at risk of contracting other sexually transmitted diseases.

The survey of 90 patients taking Truvada once a day as a pre-exposure prophylaxis (PrEP) in a Kaiser Permanente AIDS prevention program, found a shocking 45 percent increase in condom-less sex. The survey also found a majority of PrEP users in the Kaiser program are men having sex with multiple men. The program also includes some women, transgender individuals and injection drug users.

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The AIDS Healthcare Foundation — a Los Angeles-based organization that has criticized the FDA for approving Truvada as PrEP and the Centers for Disease Control and Prevention for its PrEP use guidelines— had warned that Truvada as a preventative drug would lead to condom-less sex. “Why would men take this medication if they intended to use a condom?” said Michael Weinstein, president of the AHF. “It’s utterly predictable.”Truvada, a combination of the drugs emtricitabine and tenofovir, was approved in 2004 as a treatment for people already infected with HIV. It was approved for PrEP in July 2012.PrEP has been hailed by public health officials and researchers as a breakthrough strategy — but not the only way — to prevent AIDS. They stress that PrEP patients wear condoms.

Truvada’s uptake for PrEP, however, has been slow, in part because of culture and its roughly $14,000-a-year cost. But the number of people starting a PrEP regimen has increased since the start of the year, Hare said Dec. 1 at a World AIDS Day community forum at the San Francisco Department of Public Health.

That uptick may be tied to a disappearing stigma around PrEP use. In September, for example, San Francisco Supervisor Scott Wiener wrote a Huffington Post item about his experience with PrEP.

“The reasons people are coming in are different,” Hare said. “People are seeking PrEP because their friends are on it and they’re sharing stories about it changing their lives. Patients are coming in and saying, ‘It must be for me, too.’ “

Still, one-third of those referred to Kaiser’s program choose not to start PrEP after speaking with a counselor, Hare said. Cost, insurance coverage and, to a lesser degree, kidney toxicity in 1 percent to 1.5 percent of users, he said, remain as issues.

In clinical trials — including one overseen by the University of California, San Francisco-affiliated Gladstone Institutes — PrEP has staved off HIV infection in more than 90 percent of users. But Weinstein’s AHF has argued that the efficacy numbers drop sharply — below 50 percent — when accounting for study enrollees that didn’t take Truvada as they should have.

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