The top official from Howard Brown Health Center ( HBHC ) responded to a new nationwide advertise campaign that questions the effectiveness of Pre-Exposure Prophylaxis ( PrEP ) with an assertion that PrEP remains a viable option for persons who might be at risk for HIV infection.
"We're coming from a completely different position than those ads," said David Munar, president and CEO of HBHC. "We think people should be given all the information they need to make an informed decision about PrEP."
Los Angeles-based AIDS Healthcare Foundation ( AHF )—whose president, Michael Weinstein, has spoken out against PrEP—paid for the ads, which launched Aug. 22. Though AHF does not have a presence in Chicago, Munar said that news about the ads, which are scheduled to appear in a number of publications, would contribute to widespread misinformation about PrEP, which is largely available as the pill Truvada.
According to one of the ads, "AIDS Healthcare Foundation has taken the position that the scientific data do not support the large-scale use of Truvada as a community-wide public health intervention. Overall efficacy was low in all studies due to low adherence. Even in carefully monitored clinical trials, most participants did not take Truvada as prescribed by medical professionals. Low adherence means low effectiveness in preventing HIV."
Munar said, "AHF highlights adherence as an issue, but that's fundamental to any intervention for any condition."
According to a study whose findings were released in July, known as the iPrex OLE study, Truvada was over 90% effective at preventing HIV infection, provided the patient took the medication at least 4 times a week. Researchers, however, have not yet determined any kind of strategy to support taking the pill intermittently, so the recommendation remains taking the pill every day.
Munar added that much of the information cited in the AHF ads make use of old data as well. "We're just concerned that there's misinformation floating around," said Munar. "Some of those were old studies from before anyone knew how PrEp worked. PrEP is endorsed by both the FDA and the CDC, both of them conservative agencies in terms of their recommendations."
About 200 people have obtained PrEP through HBHC, according to Munar. Over the past summer the organization has been delivering information on PrEP through online dating and hookup sites such as Manhunt and Jack'd. Thanks to links from those ads, about 2300 people visited the HBHC website for information about PrEP.
Munar said service providers have "a duty to let people know the facts and let them make their own decisions." He added that few people using PrEP take the decision lightly, since a Truvada prescription requires regular HIV testing and facing many potential hurdles, among them the drug's high costs and their insurance carrier's scope of coverage.
"A lot of people don't have a primary care physician, or at least one that they fully trust," he noted. "Many people are unaccustomed to going in and asking about any drug, so that's a barrier too."
He recommended that anyone interested in PrEP contact HBHC, where they can be set up with a counselor. "They are dedicated to helping people learn about it. We counsel them about access and adherence. PrEP is not for everyone, but we can help navigate those issues should it be the right thing for you."
Munar added, "Frankly, we should give props to the people who use PrEP. They're doing something important for themselves and are taking charge of their own health. Preventing HIV infection is still optimal. It's still incurable, lifelong and, if untreated, deadly. Staying HIV-negative is still an important goal for anybody."
