Recent studies have proven the effectiveness of taking Truvada at pre-exposure prophylaxis (PrEP) to prevent HIV infection in at-risk individuals and the CDC last week announced who it thinks should be on the PrEP regimen: 1.2 million people including 25 percent of sexually active gay and bisexual adult men, nearly 20 percent of adults who inject drugs, and less than 1 percent of heterosexually active adults.
So, in honor of World AIDS Day earlier this week, we decided to poll the SERMO community about PrEP to find out if doctors think it will be effective in reducing new HIV infections, whether or not they would recommend it to patients, and whether or not they felt it would lead to more people being less careful when they’re sexually active.
The results were as follows:
- 74% of doctors from around the world believe that pre-exposure prophylaxis (PrEP) will be effective in reducing the number of HIV infections worldwide (poll of 2,672 doctors)
- 86% would share information about PrEP with their patients (poll of 1,249 doctors)
- 91% would recommend PrEP to an at-risk individual (poll of 1,249 doctors)
- 59% said they think PrEP will lead more people to be less careful when they are sexually active (poll of 1,249 doctors)
- 60% of the doctors thought that a cure would come in the next fifteen years
“Multiple studies have shown that taking Truvada for PrEP works,” said Dr. James Wilson, an American SERMO member and Ascel Bio infectious disease forecaster based out of the University of Nevada-Reno. “The hard part is getting it to the patients who need it most and getting those patients to adhere to their medication regimens.”
Although the vast majority of the doctors said that PrEP will reduce HIV infections and they would recommend it to patients, some doctors said there are both pros and cons to the therapy.
One geriatrician from the UK said, “I feel like there are a group of people that will benefit from PrEP but the feeling is that in the gay community it’s become a means of making promiscuous behavior easier. Those with sex addictions will certainly benefit and I can see this as a population we can protect. It does however seem that people forget that other STIs are not protected against and I wonder if we will see a rise in demand for treatment for these. Also reckless unsafe sex can go in hand with other reckless behaviour and psychological issues which I feel we may be missing on dealing with.”
Another doctor, a surgeon from the US, worried that the patients who need it might not take it and expressed fears that the virus will be around for a long time.
He said, “The people who would need this aren’t the greatest planners and risk reducers. HIV treatment is an area that has suffered from its own success, so many with the diagnosis are living so long, with so few sequelae, that there is no motivation among the target population to reduce risk. Incidence of syphilis and gonorrhea are soaring, and with drug resistant HIV and TB out there, this epidemic is going to show a multimodal resurgence.”
A family physician noted that there are financial barriers that prevent the therapy from being effective in reducing instances of HIV as well.
She said, “It is unaffordable in Africa where there is still an HIV epidemic.”
San Francisco has taken bold steps to overcome the cost hurdle, offering Truvada at no cost for at risk people who do not have insurance. In the SERMO poll, 75 percent of 1,249 doctors believed that other cities and states should offer similar programs.