PrEP Version 1.1, 2.0, and Beyond

One of the most often repeated falsehoods about PrEP -- pre-exposure prophylaxis, a treatment that prevents HIV infections -- is that it's a Big Pharma plot that lures gay men to take a pill the rest of their lives. It's a ridiculous assumption. How many gay men will have anal sex on a regular basis with no long-term monogamous relationships for the rest of their lives? I'm sure there are some lucky-in-bed, unlucky-in-love studs who accomplish that feat, but I have yet to meet any of these elderly sex machines.

Even if those people do exist, please find me the AIDS researchers who think today's daily Truvada PrEP will be the last form of the drug ever developed and brought to market. Looking at AIDS drug development in general will quickly put this idea to rest. How many people with HIV are still taking AZT and Crixivan? There are now over 30 anti-HIV medications that have been brought to market since AZT was first approved in 1987, and more are in the pipeline. Each new one is usually easier to take and is less toxic than its predecessors.

Historical comparisons to the introduction of a contraceptive pill for women in 1960 persist. Do today's PrEP critics also claim that oral contraception commits millions of women to a daily pill the rest of their lives? Of course not. Women use contraception during periods of their lives when they believe they might need it. They can choose from a variety of options, from a daily pill to intrauterine devices, implantable contraceptives, patches, vaginal rings, and injections.

PrEP will have the same future. We just got a glimpse of PrEP version 1.1 from a European trial called IPERGAY. (Ah, those French, putting "gay" right in the trial's acronym.) Instead of daily Truvada, trial participants have been taking intermittent, or on-demand, Truvada PrEP, consisting of two pills taken in the 24-hour period before anticipated sex and two pills during the two days after sex. The results thus far have been so dramatic, lowering HIV infections by approximately 80 percent, that the placebo arm has been halted early. Final results are due in early 2015.

These are far better results than earlier PrEP trials in gay men, and the most likely reason is better compliance. Participants in the earlier trials didn't even know whether PrEP worked if used as prescribed, so compliance was an issue. Michael Weinstein, president of the AIDS Healthcare Foundation and our community's anti-science heretic (every movement has one), has tried to make much hay out of these earlier compliance issues, but both IPERGAY and PROUD (a British PrEP trial) have now demolished his arguments. PrEP works, and gay men who want PrEP are perfectly able to use it as prescribed.

PrEP 2.0 and beyond are in development, including an injectable that lasts three months. PrEP's detractors are sounding more and more like Tom Cruise's Scientology-fueled attack on Brooke Shields for using postpartum antidepressants. Cruise was rightfully shamed for his views. Maybe it's time for the anti-science PrEP critics to shut their traps, too.

Peter Staley has been a longtime AIDS and gay rights activist, first as a member of ACT UP New York, then as the founding director of the Treatment Action Group. He served on the board of amfAR, The Foundation for AIDS Research, for 13 years and founded AIDSmeds.com, an educational website for people living with HIV. Staley is a leading subject in the Oscar-nominated documentary How to Survive a Plague.