For the first time in history the World Health Organization (WHO) has issued a call to all gay men that they should start taking anti-HIV drugs as a preventative measure, but why do this and will it help?
The statement comes as part of a raft of recommendations WHO recently released that it says will be necessary to cut HIV among a number of high-risk groups like men who have sex with men (MSM), sex workers, transgender women and intravenous drug users. WHO believes that, overall, global HIV death rates have fallen by as much as 20 percent, but new infection rates among at risk groups in particular continue to sore.
When it comes to MSM populations WHO “strongly recommends men who have sex with men consider taking antiretroviral medicines as an additional method of preventing HIV infection.”
Specifically, WHO is referring to using Pre-Exposure Prophylaxis (PrEP), whose brand name is Truvada. The pill, which must be taken every day, contains two medicines in combination, tenofovir and emtricitabine. The drug works by preventing HIV from being able to take hold in the body’s cells and begin replicating itself, thus dramatically reducing the risk of infection. PrEP medication isn’t foolproof but it offers a way to easily and substantially cut HIV infection risk by as much as 92 percent–a figure that is based on an in depth and broad study carried out in 2010 called the Pre-Exposure Prophylaxis as HIV Prevention Among Men who Have Sex with Men study and supported by follow up tests.
WHO, supported by a range of scientists, believe that if at-risk groups started taking PrEP in tandem with condom use, we could see a fall in new global HIV infection rates by as much as 20 to 25 percent. Obviously that’s only a prediction based on the information we have available to us now, but it’s hard to argue with that promise.
To put into perspective why WHO is focusing energy on MSM in particular, as it stands today this population has an overall risk of contracting HIV that is 19 times higher than that of the average population. It should also be noted trans women suffer rates 50 times higher than the population average, and that explains WHO’s wanting to enumerate them as well.
We might say, so what? With modern medicines, HIV is not a death sentence. Well, this might be true in many so-called developed nations, but the same cannot be said of other regions where access to antiretroviral treatment is expensive and logistically difficult.
Furthermore, MSM populations may still interact with women–that is why they aren’t labelled “gay men” as such, because they may not identify that way and it doesn’t accurately describe their sexual habits. As a result of interactions with both sexes, for whatever reason, infection rates among MSM can pose a significant threat to the overall progress made in fighting infection rates.
Regarding this, Dr. Gottfried Hirnschall of the World Health Organization is quoted as saying: “Failure to provide services to the people who are at greatest risk of HIV jeopardizes further progress against the global epidemic and threatens the health and well-being of individuals, their families and the broader community.”
There are some drawbacks to PrEP, for instance there is a chance of bone density loss and some users have shown reduced renal function, but WHO is satisfied that, based on the quite large body of data the organization has gathered, these risks are relatively low and that PrEP use could play a significant part in fighting what have been called “exploding” HIV rates among at-risk populations.
There is, however, one large fly in this ointment.
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The governing health body in the United States, the CDC, said back in May that it believes “at risk” gay men would benefit from taking PrEP daily, however for many LGBT people this isn’t feasible at the moment because it’s simply too expensive.
The drug can cost as much as $10,000, and requires additional expenses to cover follow up and monitoring to track whether the PrEP is working as expected and that there are no unforeseen side-effects. That said, more insurance companies are now covering PrEP and so access to and use of the drug is expected to become more widespread.
It’s worth noting here that there was the fear that use of PrEP would drive down safe sexual health practices and lead people to be more reckless. The research hasn’t shown that to be the case: usually, those who didn’t take precautions before using PrEP still don’t after, but those who did tended to add PrEP to their sexual wellness practices rather than abandon other forms of protection. Over time that might change, but for the moment the worry about a sudden sexual health dive as a result of PrEP appears overblown.
That’s all great for the U.S., but what about poorer nations who can’t afford to import the drug? Well, there is some good news there too. The makers of Truvada, Gilead Sciences, is now licensing the drug for manufacture in several lower income countries such as South Africa and India. HIV is far more prevalent in nations like this and getting HIV medications to the people who need them, as well as testing people and tracking HIV rates, is already very difficult. However, because these countries have now been given licenses to manufacture domestically, it would cut PrEP costs from about $100 to maybe as little as 25 cents. That would put treatment, on average, at about the same as it would cost in the U.S., giving these poorer nations at least a chance of rolling out this treatment.
All that said, it would be down to these nations–as it is to all nations–to properly track and provide support for at risk groups, and that will require creating better and more consistent health frameworks.
WHO recommends therefore that governments around the globe dedicate resources to properly monitoring HIV infection rates and in particular among the groups most susceptible. For nations like Uganda and Russia, and many others, that would first mean putting to one side a great deal of anti-LGBT hostility that means LGBT people cannot get the medical care they need, something that many North African, Eastern European, and Asian governments have heavily resisted. Tackling HIV and ending the global epidemic may depend on it, though.
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