preventive medicine ????

[Atripla_User]

What do you all think about some governments giving meds to people who are NEG in order to prevent the virus from occuring? I am appalled at the thought, because I am afraid of it mutating and I don't think it is a good idea to put healthy people on meds like ours. I just think its the wrong direction and bad for mankind and all of us who are POZ. It may make it harder to treat those who really do need the meds when they become infected.

[spacebarsux]

What do you all think about some governments giving meds to people who are NEG in order to prevent the virus from occuring?

I do not understand this question.

Which Government does this?

If you mean putting people, who have had a real transmission risk, on PrEP- then I think there is nothing wrong with that.

[Ann]

If you mean putting people, who have had a real transmission risk, on PrEP- then I think there is nothing wrong with that.

People who have HAD a real transmission risk go on PEP, not PrEP.

PrEP is taken BEFORE the risk occurs. PEP is taken AFTER the risk occurs.

PEP is Post Exposure Prophylaxis, while PrEP is PRe Exposure Prophylaxis.

[spacebarsux]

Oh sorry. I was under the wrong impression that the two are one and the same.

[Atripla_User]

this article on CNN is why I am asking, it is not the first time I have seen this in the headlines, and that is why I am concerned, The media has been doing stories about this alot lately.




http://thechart.blogs.cnn.com/2011/07/13/taking-meds-before-exposure-cuts-hiv-risk-for-heterosexuals/?iref=allsearch

[klassykitty]

I agree with spacebar. 

If Mary is positive and John is negative then to me it makes sense to have him take one pill,  rather then him possibly getting it and taking more. 

My question would be if someone is  taking this because they are  + and partner -,   what happens if they are no longer together?  Does the - person keep taking it or can they go off of it?

I wish I had known about this when I was with my ex,(he was positive and I was negative).  Not sure when they did the trials, but if there had been one in U.S. at the time I would have signed up.

Michelle    

[Grasshopper]

 Not sure when they did the trials, but if there had been one in U.S. at the time I would have signed up.

Michelle    

The trials: http://www.aidsmeds.com/articles/hiv_prep_prevention_1667_20809.shtml

My question would be, what if the positive partner's virus is resistant to one or both ingredients of Truvada or the generic equivalent Tenvir EM , are there any alternatives/substitutes ?

[LM]

I think it makes sense for someone who is a relationship with someone who is poz and wants to drop the condom. Or someone who wants to bareback and reduce the risk.

In other cases, condoms are still the best way to go.

[Valmont]

In think that PEP have sense only for serodivergent couple that want to have a baby.

Is this existing in third world countries?

[mecch]

I thought the latest news was the trials in the US have been stopped because it wasn't effective enough.

Could people make an effort to note the difference between PEP and PrEP.  

So the OP Atripla User is asking about PrEP.

I don't know about the resistance threats the OP is concerned about.   It seems the trials wouldn't have happened if this was a known risk.

I could imagine scenarios in which PrEP makes sense.  

OP - I don't know any governments who are "giving" PrEP, do you?

If I were a public health worker in a locale where sex workers aren't allowed to have safe sex, it might make sense to argue for a NGO or government to try distributing PrEP for free.  Just one example.

Or as above, couples in serodiscordant relationships opting for it.  

Also I thought it was progressive enough, on one hand, to think about gay guys at risk because of some self-chosen lifestyle.  Its long been reported here in this forum that Truvada was used on the "circuit" scene - if that prevented some transmissions, where is the harm to anyone??   On the other hand, if PrEP is only partially effective it might backfire giving people a feeling of security to do whatever they want.  

I think HIV educators have challenges already with the "one pill a day - HIV is no big deal" belief.  

I dunno finally.  

[Grasshopper]

perhaps read this, interesting :
http://www.cdc.gov/nchhstp/newsroom/PrEPHeterosexuals.html?source=govdelivery

&

http://depts.washington.edu/uwicrc/research/studies/files/PrEP_PressRelease-UW_13Jul2011.pdf

[mecch]

Yes I certainly got that wrong. Just saw an article on the NYT website says more and more studies are going on.

http://www.nytimes.com/2011/07/14/health/research/14aids.html?src=recg
Two Studies Show Pills Can Prevent H.I.V. Infection

[leatherman]

Or someone who wants to bareback and reduce the risk.

In other cases, condoms are still the best way to go.

considering the costs (over $1k a month), daily adherence issues*, and side effects, all with only 63% to 74% effectiveness, I think it more realistic to advocate that condoms are always the best way to go.

*recently while discussing these studies with friends, we questioned the reality of there being that many people who were going to bareback with people with unknown statuses enough times in a month to make it "effective" to take an antiretroviral daily to ward off getting infected. I mean, who gets laid that much?!? LOL Of course sero-discordant couples might and for them this might be a consideration; but i would posit that most single people don't engage in enough sex per month to make taking a pill daily a very feasible alternative. Condoms seem so much more effective, practical, and cost efficient for the limited times a month most people would reasonably have sex.

[Assurbanipal]

Some people are good at negotiating sex and protection up front.  Some aren't.

Other people are good about taking pills to protect themselves.  Look at how popular supplements are.

It is important to have multiple strategies -- all these people who say that condoms are effective seem to be ignoring the fact that ... well, that strategy isn't working as a standalone and jawboning has not made it work in the past.  We need multiple strategies for complex issues.

[leatherman]

We need multiple strategies for complex issues.

though the truvada strategy seems very expensive for this war - especially when over-shadowed of poor countries and poor (American) counties where treatment is in short supply - you make a very good point about needing many weapons in the arsenal.

[le_liseur]

What I am wondering is if this will make ARVs more "common", if it starts to get manufactured as preventive drugs. Would this, in a way, force pharmaceutical companies to lower their prices? Imagine, if they get to a point where ARVs of new generation can be used the same ways birth-control pills are? Tho I don't like the analogy, as both kind of pills are not linked to the same realities/consequences.

[Grasshopper]

Regan Hofmann's article:

http://blogs.poz.com/regan/archives/2011/07/not_drinking_the_pre.html