Close to 100 openly HIV-positive gay and bisexual men from across the United States and around the world have signed a new letter ( tinyurl.com/pozPrEPletter ) calling for an open discussion, "based on facts rather than on fear or misinformation," of the challenges and opportunities presented by pre-exposure prophylaxis ( PrEP ) for HIV prevention in gay and bisexual men and transgender women. The new open letter is designed in part to urge FDA review of PrEP and to clarify facts about important PrEP research that advocates say have been misrepresented in a paid ad campaign sponsored by the AIDS Healthcare Foundation ( AHF ) .
Pre-exposure prophylaxis, or PrEP, is a new HIV prevention method in which an uninfected person takes a daily HIV medication to reduce HIV infection risk. Data from an international study released in November, 2010 called iPrEx found that men and transgender women who have sex with men who received a daily single-tablet dose of the HIV drugs tenofovir and emtricitabine along with condoms and safe sex counseling had an average of 42% fewer HIV infections than those who received condoms and counseling alone. Much higher rates of protection were achieved among participants who took PrEP consistently.
Most of the HIV prevention community welcomed the news of a new tool that could significantly reduce infections in the populations at highest risk for HIV in many parts of the world. One HIV treatment provider, however, the AIDS Healthcare Foundation, has taken out an extensive series of full-page advertisements in gay papers around the country claiming that gay and bisexual men will act recklessly and will spread HIV if they are allowed to use PrEP. The AHF ad campaign claims that it is supporting gay and bisexual health by urging the U.S. FDA to ignore the PrEP study.
Today's open letter challenges both the tone and content of the AHF communications and encourages "a full and factual discussion of the pros and cons of PrEP ... based on facts, not misinformation." Reminding the world that "gay and bisexual men invented safer sex … and have worked tirelessly to prevent new HIV infections," the letter also points out that gay and bisexual men account for more than half of new HIV infections in the United States and are in particular need of new HIV prevention approaches.
"As an HIV-positive gay man I signed this letter because I learned from experience we need all credible options to stop this epidemic. I owe my life to the fact that advocates and activists have pushed hard for decades to make effective AIDS drugs available to HIV-positive people," said Kali Lindsey. "Now we know that AIDS drugs can also play an important role in the health and well-being of HIV-negative gay men, how could we not move forward to reap the benefits of this research. It is not an option to ignore these findings."
In July of this year the results of two addition studies, Partners PrEP ( led by the University of Washington Department of Global Health ) and TDF2 ( led by the U.S. Centers for Disease Control and Prevention ) demonstrated that PrEP is also safe and effective in heterosexual women and men. The Partners study found that participants who received PrEP experienced an average of 62-73% fewer HIV infections than those who received placebo. The TDF2 trial, conducted by the U.S. Centers for Disease Control found that the risk of HIV infection dropped by an average of 63% among those who received PrEP in addition to condoms and counseling. Data expected from the FEM-PrEP trial, which was stopped in April after it was determined that the trial would not be able to provide an efficacy result, will also provide additional information about PrEP use among women.
The new letter acknowledges that the PrEP, "is no magic solution to the HIV crisis," and that research, "raises important questions … includ ( ing ) how to best support regular PrEP use; how to ensure the continued use of condoms and other precautions for those who decide to take PrEP; how to target PrEP to those who will benefit most; and how to pay for this new HIV prevention tool." Its signers express their commitment "to promoting safer sex and the open exchange of accurate information on HIV prevention," and to "clarify the facts about PrEP, open up community discussion and make clear our belief that we are entitled to respect, accurate information and new HIV prevention tools." The letter concludes by calling on all interested parties to "get the facts about PrEP, seek information, and express opinions … but to do so based on real information, not fear of the scientific process or prejudice against gay/bi men."
The letter was coordinated by a group of U.S.-based AIDS advocacy organizations, including AIDS Foundation of Chicago, AVAC, International Rectal Microbicide Advocates ( IRMA ) , and Project Inform.
Openly HIV-positive gay and bisexual men who wish to add their name to the letter can do so at: tinyurl.com/pozPrEPletter.