PrEP is about HIV prevention, not good or bad behavior

There is a pill that prevents HIV. Known commonly as PrEP — “pre-exposure prophylaxis” — this treatment is a de facto daily vaccination against the virus. So, why does PrEP bother people so much?

There is a pill that prevents HIV. When taken precisely as prescribed, it prevents transmission of the virus with an efficacy as close to 100 percent as science will allow. I feel comfortable saying that, particularly when used together with condoms, this pill is a de facto daily vaccination against HIV.

So why do some people have such a problem with it?

The treatment is known commonly as PrEP — a marketable acronym that stands for “pre-exposure prophylaxis.” The only drug approved for this use is marketed under the name Truvada. The pill works. That is not in dispute. In fact, several research studies of PrEP have ended early, with researchers saying that it was so effective that it was unethical to allow others in the experiment to take the placebo and continue to expose themselves to HIV.

Some folks are asking a question, however, about whether or not this pill is a good thing for American society. Like past pharmacological advancements that surround sexual activity (birth control and the cancer-preventing HPV vaccinations come to mind) there are individuals today abjectly refusing to endorse PrEP. Some are even going so far as to say it is reckless or dangerous.

This puzzles me, frankly, because I’m an HIV+ man who thinks we should do everything possible to try to prevent other HIV infections.

Here in Philadelphia, 20,000 people live with HIV just like I do. If we have yet another way to prevent HIV, and it’s actually the most effective tool to date, why aren’t we singing its praises instead of tut-tutting?

PrEP reduces HIV transmission risk to nearly zero

The controversy surrounding PrEP has, so far, been a fight within the HIV treatment and prevention community and, by logical extension, the LGBT community. A firestorm erupted when a well-known head of an HIV service organization stated flatly that PrEP was a “party drug,” presumably implying that licentious types could pop a pill and go to town in between quaaludes and jamming to electro-house music.

To be fair, as I already stated, PrEP does technically give people the option to no longer rely exclusively on condoms to prevent HIV. That is, if you’re on PrEP and take it precisely as prescribed, that will be enough to prevent acquiring HIV. To put it in a more lurid way, you can have unprotected sex. Of course, you still need condoms to prevent all manner of other STIs, like gonorrhea or chlamydia. In addition, if you can get pregnant, PrEP will not protect you against that, either.

PrEP prevents HIV. Still, given that human beings are human beings and rarely adhere to any medication regimens precisely as directed every day, the best HIV prevention policy today likely involves a combination of PrEP and condom use and even other risk-reduction strategies.

For instance, if an HIV-negative person on PrEP has an HIV-positive partner — like me — in treatment who maintains an undetectable viral load — like I do — there exists no real risk of transmission, either. (Last year, I explained all that here at NewsWorks, too.)

So, what’s the deal? Why does PrEP bother people so much?

PrEP is not immoral

Simply put, Americans are strange, moralistic hypocrites. Every single time a prescription comes out that in some way relates to sex, folks will issue many diktats about how other people should be using their private time.

Some folks seem to think that only those who behave a certain way are entitled to be protected against HIV. The rest of society, well, we’re all sinners in the hands of an angry god, I guess, to borrow a phrase from 18th century evangelist Jonathan Edwards.

These opinions are garbage. They’re disguised as concern, but in reality, they allow for a small group of small-minded people to self-righteously condemn the private behavior of other people. In many cases, it’s outright psychological projection, too. This is why, despite PrEP being so effective, some people will say, “Yeah, it prevents HIV, but it’ll get people to have sex without condoms, and that’s a bad thing.”

That’s flatly not true. When people are prescribed PrEP, it actually seems to reduce their sexual risk behaviors, probably because PrEP is a healthy way to prevent HIV transmission during healthy sexual expression. Last week at the Trans Health Conference here in Philly, Dr. John Vaz, an infectious disease physician specializing in HIV, reported that in one study, “PrEP did not increase riskier sexual behavior.” Instead, “people started to make empowered, informed decisions about their sexual health and really started to become more thoughtful as opposed to pushing riskier behaviors.”

Whether PrEP should be used is the wrong question

There are valid questions surrounding PrEP, though, like how people can access it, how affordable it is, how feasible it is as a mass treatment effort. Getting HIV-positive people to adhere to their medication is already a hurdle, to say nothing of a preemptive treatment for HIV-negative people. The ethical question of whether PrEP should be available or used as an HIV prevention tool, though, is not valid.

Besides, people are already not using existing HIV prevention tools, like condoms, consistently or properly. If they were, nobody would be acquiring HIV anymore. Since people are acquiring HIV, I’m left to surmise that we need more tools, like PrEP, in our overall prevention toolbox.

What other people do with their genitals is none of your business. It’s none of my business, either. Personally, I’m concerned with preventing HIV and making society just a little bit better. If we can prevent HIV, that will make society better.

Slut-shaming, conflating PrEP with reckless behavior, resentfully projecting onto others your own desire to act out — these things will not prevent HIV.

PrEP, however, actually does.