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PrEP, Truvada take center stage at forum
By Michael Gipson

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Nervous energy flowing throughout the Center on Halsted's Hoover-Leppen Theater among the 60 participants for the May 22 event, "Ready, Set, PrEP! My PrEP Experience." Most of the anxious were HIV/AIDS service providers and advocates who came to hear what they hoped would be some good news in a field often plagued by setbacks.

A collective of Chicago AIDS service providers, club and bar promoters, community groups and the company Gilead Sciences, makers of Truvada, the antiretroviral (ARV) approved for PrEP, sponsored this event.

This educational community forum featured clinical psychologist and HIV researcher Sybil Hosek of Stroger Hospital of Cook County; program coordinator Gustavo Varela of the Generation L program at Vida/SIDA; and New York performance artist ButtaflySoul, with moderators David Dodd of K Dock Media and Ken "Like Barbie" Williams of Test Positive Awareness Network. The panel was intended to deliver the facts and dispel the myths about pre-exposure prophylaxis (PrEP), the newest, somewhat rebooted weapon in the arsenal against HIV. More than a strategy, PrEP is being hailed as the best tool devised against HIV since the condom.

"We're discussing viable, prevention options with the hope to one day curb, if not stop, the HIV/AIDS epidemic," said Williams, whose popular video blog recently featured a viral video on PrEP. "This dialogue and event could potentially save a life."

While PrEP's preventative use is not new—pilot programs for the "party and play" set of gay and bisexual men have existed in cities like New York for years—fresh research and the Food and Drug Administration July 2012 approval of Truvada, an HIV antiretroviral drug to be used by HIV-negative individuals as a prescribed prevention pill against HIV are potential game-changers. If widely accepted and utilized by those most impacted, there could be the kind of new HIV-infection declines not seen in more than a decade, when HIV rates stabilized to 55,000 new inflections annually. Those are the converteds' claims, but not everyone is convinced.

The audience asked panelists questions that seemingly reflected skepticism. Panelists and the moderators pushed hard to state that while PrEP is not the cure or vaccine hoped for, at last something substantive was finally here.

"Truvada is not full HIV treatment," one panelist said. "PrEP will not help after you're HIV-positive. If you become HIV-positive while on PrEP, you will have to stop taking Truvada and still have to come in for blood work and to get on a full treatment regiment."

While it is not the HIV Holy Grail, PrEP positions itself as awfully close. For those HIV-negative individuals who take Truvada daily, PrEP purports to protect against HIV at a rate of 92 percent to 94 percent, even when a person is in a sexual, serodiscordant relationship with an HIV-positive individual, placing PrEP on par with condoms in HIV prevention effectiveness. If an HIV-positive person is virally suppressed, which can prevent HIV transmission by 96 percent, and an HIV-negative individual is taking Truvada as prescribed, theoretically HIV is unlikely to be transmitted, even if they use no condoms between them.

"What about those who don't take PrEP every day and only take it when they have sex? Is it still effective then?," one respondent asked.

"We can't even get HIV-positives to take meds every day, and they need those to live! So, how do we get HIV negatives to take PrEP everyday?" another charged.

"What about youth? Can youth be trusted to take PrEP? What happens when they stop using condoms because of Truvada and get other STDs?" asked another.

In fact, concerns about youth access, utilization and adherence to Truvada as PrEP dominated a third of the conversation, most suggesting little faith in youth adherence. Those concerns are not without merit, since HIV-positive youth adherence to medication has proven an ongoing challenge.

"Truvada doesn't protect against everything," Hosek told the audience.

Truvada also does not protect against any other sexually transmitted disease (STD) but HIV, leading to audience fears of an STD explosion among those who'll abandon condoms for PrEP. Partially rebutting those fears, a representative of the AIDS Foundation of Chicago said, "Multiple studies have shown about 50 percent of gay men consistently do not use condoms anyway, a fact that hasn't changed in years."

People also expressed concerns about the cost and messaging PrEP as akin to taking a birth-control pill, pointing to decades of science concerning birth control and its side effects. However, panelists said in trials Truvada proved to have minimal side effects and toxicity.

However, there is still the question of cost as well. As stated at the forum, Gilead is currently willing to assist the eligible and interested, but economically challenged, in accessing Truvada through Gilead's patient-assistance program. The Affordable Care Act is also expected to cover PrEP. In the meantime, a discussion with a primary care physician to determine eligibility is the best way to access PrEP, although insurance coverage cannot yet be assured.

By the end, some remained unconvinced that the long-term cost and unknowns of PrEP weren't too much of a hurdle to overcome. Others expressed burgeoning excitement.

"The hope is to get everyone in the room to go out and be comfortable enough to disseminate what they've learned," said Williams.

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