It’s been hailed as a significant breakthrough and one of many much-needed instruments to “finish HIV”. However there are additionally issues about pre-exposure prophylaxis (PrEP), the usage of antiretroviral medication by HIV-negative folks to forestall them from turning into contaminated with the virus. Will folks taking PrEP cease utilizing condoms and will this really result in a rise in HIV and sexually transmitted infections (STIs)?
PrEP seems to be a extremely efficient technique of decreasing threat of HIV transmission. Including to rising worldwide proof, the Proud trial examined the usage of PrEP with homosexual and bisexual males in England and located a discount in HIV transmission of 86% amongst males who took PrEP daily. Truvada, the drug used within the Proud trial, just isn’t presently licensed to be used as PrEP within the UK. Nevertheless, on account of the findings, there was a concerted effort by HIV policymakers and neighborhood activists to make Truvada obtainable as PrEP on the NHS as quickly as attainable.
Proof to this point has proven blended outcomes with regards to continued condom use with PrEP. The Proud trial, which recruited members reporting some however not unique use of condoms, discovered the variety of folks not utilizing condoms remained the identical all through the research. STI charges throughout each trial arms – the group that acquired PrEP instantly and the group that needed to wait 12 months – additionally remained comparable. Proof from three areas from the iPrEX research within the US means that, though some youthful members lowered condom use, most often PrEP didn’t cut back condom use however did cut back stress, concern, and guilt.
We have to think about who is perhaps keen to make use of PrEP. Plenty of surveys with homosexual and bisexual males within the UK have proven that males reporting decrease ranges of condom use and who’re at larger threat of HIV are keen on PrEP. Introducing PrEP to this group may not essentially cut back condom use, however might shield towards HIV infections the place condoms aren’t already getting used. On this means, PrEP might fill a niche in HIV prevention for these people who discover it tough, or are unable, to make use of condoms as their essential technique of stopping HIV.
Our PrEP analysis in Scotland with homosexual and bisexual males, and women and men from migrant African communities, discovered that issues about PrEP went past condom use. Contributors in our qualitative research highlighted anxieties across the instant and long-term side-effects of PrEP, an absence of belief that PrEP would work, and a perception that they weren’t at high-enough threat to benefit taking a each day capsule to forestall HIV. As well as, provided that PrEP just isn’t 100% efficient, expertise amongst members in calculating threat discount in relation to PrEP gave the impression to be blended and will probably be an vital issue within the efficient “real-world” use of PrEP.
However our research additionally highlighted the concern that others would cease utilizing condoms on account of PrEP. One man in contrast the influence of PrEP to “girls burning their bras” as a result of he was involved that different males would cease utilizing condoms and threaten a 30-year historical past of HIV-prevention based mostly on condom use. This implies that many individuals nonetheless see condoms as the principle HIV-prevention instrument and demonstrates the necessity to have interaction with these fears and determine how PrEP would possibly match into, moderately than disrupt, present HIV prevention methods.
Given the seemingly introduction of PrEP within the UK within the not-too-distant future, we have to draw on present proof to encourage its equitable introduction into well being providers and entry by these most prone to HIV. There must be clear steerage and assist for utilizing PrEP together with present HIV-prevention methods, together with condoms. We have to discover acceptable, efficient and clear methods of explaining PrEP to potential customers and work to enhance understandings and expertise in assessing and decreasing threat.
Lastly, we have to tackle present – and generally conflicting – neighborhood issues about PrEP . We have to discover methods of speaking brazenly about what a variety of HIV prevention choices would possibly seem like, with out moralising or judging particular person practices. Good sexual well being must recognise the dynamic lives of individuals affected by HIV. Regardless of how effectively PrEP would possibly work, it alone won’t be the magic bullet to finish HIV.
Lisa McDaid receives funding from the UK Medical Analysis Council, Scottish Chief Scientist Workplace and the Nationwide Institute for Well being Analysis.
Ingrid Younger holds a fellowship funded by the Scottish Chief Scientist Workplace (CSO).