Two of us have managed to wrangle funding to get to the biggest conference on HIV in the world – the International AIDS Society (IAS) in Vienna 17 – 23 July. It is great to know that Body Positive, INA and Positive Women are to have a presence there to – though with over 30,000 delegates expected I wonder if we will ever find each other there!
This is the first I have been to since 2004 and the debate and controversy has started already! PEP (Post Exposure Prophylactic*) and PREP (Pre Exposure Prophylactic*) are right in the middle of it. Last week we were given a global survey for individual MSM and organisations working with MSM that would feed into the conference. BUT as we worked through it as a provider I was stunned by the ‘leading’ questions on PEP and PREP. It was presented as if PEP/PREP were well evidenced, effective and safe strategies to reduce HIV transmissions. The questions were posed as if HIV negative people had a ‘right’ to these expensive treatments.
I and others have been increasingly worried about the growing bias towards stopping HIV through medications instead of condoms. Whilst there is 25 years of really solid evidence that condoms are the single most effective way to avoid HIV transmission (after no sex!) it is scary to see how quickly there is a call to abandon what works and replace it with what we know so little about. PEP has just got extremely limited funding in NZ. Only an HIV negative person who has had unsafe anal sex (receptive) with a HIV positive man (who is known to the ID clinician so they can be sure of treatments and viral load status) in the last 72 hours. It is so limited because; the evidence is very unclear on how effective PEP is; it is almost impossible to know if the infection actually happened and the short/long term risks of taking ARVs when HIV negative for 28 days, every day, is not well known. The main reasons clinicians wanted it funded for this limited profile is because it has both the highest risk of actual infection and of their being able to assess that risk.
What seems to be an emerging view from some vocal gay and bisexual men in wealthy countries is that they have a ‘right’ to not have to use condoms if ‘pills’ exist, even if unproven; a ‘right’ to the funding for those pills and a ‘right’ to the support needed through the 28 days of the treatment.
One simple problem for me is this. In effect the western world has been an experiment that tested the assumption that once everyone diagnosed with HIV gets ARVs when they need it, then HIV infections will drop. That test has failed. No wealthy country has seen a decrease in new infections after ARVs were funded. Most have seen a jaw dropping increase. Whilst ARVs are as close to the silver bullet of a cure we have got for keeping people with HIV alive, they are more disco balls then silver bullets for HIV prevention. ‘Why’ this is so is what the conference, I hope, will be focusing on – not who has the right to avoid using a condom.
For more information about Rachael please click here.
