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Damien Hirst
HIV Aids, Drugs Combination, 2006via Damienhirst.com

Unpacking the truth about one of the most major HIV-prevention drugs

An expert busts the madness, myths, and misconceptions around PrEP

When a little-known virus began spreading through queer communities worldwide a few decades ago, snatching lives at breakneck speed, it seemed impossible to think the epidemic could ever be stopped. But now, thanks to endless research and medical breakthroughs, we have some growing solutions to HIV/Aids.

The first is ART (anti-retroviral therapy), a combination of drugs proven to reduce the viral load of HIV+ patients to ‘undetectable’. Essentially, this keeps the virus under control and – as the CDC finally admitted last year – means that it can’t be transmitted even through unprotected sex. This was a huge step-up, especially for the HIV+ people who had long been labelled with nasty language and burdened with stigma.

Then, there’s PEP (post-exposure prophylaxis), a kind of morning-after pill for HIV, and the controversial PrEP (pre-exposure prophylaxis). Why is it controversial? Unsurprisingly, some press were quick to label it a ‘lifestyle drug’, as if its sole existence is some ploy to allow queer people to fuck each other into a frenzy. The conversation quickly became homophobic, much in the same way that initial coverage of the pill was misogynistic and steeped in slut-shaming language. We should all have the right to preventative drugs like these, and this right should never be up for debate.

On the other hand, it’s crucial not to treat PrEP as a miracle drug; at the risk of sounding like a nagging parent, caution needs to be exercised and individual research must be done. Still, it’s a positive new action, and one which is currently available to 10,000 people as part of an NHS trial. There are myths and misconceptions we need to talk about though. We rooted around for some of the most common – some anecdotal, others borne from media misinformation – and reached out to Liam Beattie, PrEP Policy Lead at HIV charity Terrence Higgins Trust, to clear them up.

PrEP 100 PER CENT EFFECTIVE

“PrEP is a brilliant innovation and highly effective at preventing HIV transmissions, but it’s important that it’s taken as prescribed and, ideally, that you have regular contact with your clinic.

There have been four cases where someone taking PrEP has become infected with HIV – however, it’s extremely important to put this in the context of its hundreds of thousands of global users. That’s why we are confident in saying that PrEP works, and why we are advocating for its key role in HIV prevention. Over time there may be more cases of PrEP failure, but clinicians will learn from these and work to make sure it becomes even safer than it is already.”

PrEP INVOLVES TAKING JUST ONE PILL

“Yes, PrEP is just one daily pill, but there are a number of different ways to take PrEP and it’s important to find out what’s best for you. Key considerations include how far in advance you plan on having sex, as well as how regularly you have sex. IwantPrEPnow – which is part of Terrence Higgins Trust – recently published a series of videos with more detail on these dosing options. It’s important to speak to a clinician about which option works best for you.”

IT’S EASILY ACCESSIBLE

“Not yet. There’s currently a national PrEP trial taking place across England to investigate how it could be administered via the NHS, not how effective it is: we already know how effective it is. 10,000 places (8000 for gay and bisexual men, 2000 for other groups at disproportionately high risk of HIV contraction, such as BAME people and trans women) have been made available on the trial, which started in October 2017 and is due to last for three years.

There’s already been a big uptake among gay and bisexual men, but there are fewer BAME people and cisgender women coming forward – to change this, either talk to your local clinic or visit this website. There are other options, too; this site lists verified online pharmacies which have undergone an extensive series of tests to ensure they’re reliable, and London’s 56 Dean Street has also started selling PrEP via the NHS.”

ENGLAND IS LAGGING BEHIND ITS NATIONAL PEERS

“Unlike Scotland, where the NHS has routinely provided PrEP since last June, or Wales, where there’s a national pilot with no cap on numbers taking, NHS England has previously resisted making the drug available; that’s why we’re calling on the UK government to ensure PrEP has a sustainable home on the NHS.”

YOU DON’T NEED A CONDOM

“No! While PrEP is highly effective in preventing HIV, it does not prevent from other STIs.”

“These same arguments against PrEP were also used when the contraceptive pill was introduced several decades ago, but this moral outrage has been rightly consigned to the history books; so, too, should the panic around PrEP”

PrEP IS A ‘LIFESTYLE DRUG’

“Absolutely not! Despite the efforts of some media outlets to present it as a ‘lifestyle drug’, there’s a clear medical and societal argument that PrEP just allows people to be empowered with regards to their sexual health; taking it means they’re being responsible. Those taking it via the NHS are also required to have regular sexual health screenings.

Messages promoting condom use continue to be important, but PrEP allows us to potentially reach zero new HIV infections – which would have been seen only as a dream at the start of the AIDs epidemic, and essentially is still a long way off in many, many other countries. That’s why we must fully embrace PrEP. Prevention has always been a cornerstone of the NHS, and that’s highlighted in the range of preventative medicines made available; PrEP is just that, another way to prevent a lifelong condition.

These same arguments against PrEP were also used when the contraceptive pill was introduced several decades ago, but this moral outrage has been rightly consigned to the history books; so, too, should the panic around PrEP.”

IT’S ONLY BEING PRESCRIBED TO GAY MEN

“No. While gay and bisexual men account for the highest proportion of HIV infections, trans women, sex workers and BAME communities also continue to be at increased risk of contracting HIV, and that’s why a proportion of the places on the NH trial have been assigned for individuals other than gay and bisexual men. It’s really important that PrEP is promoted to everyone to ensure nobody is left behind; as a charity, we should and will do more to help achieve this.”

IF YOU USE PrEP, THERE’S NO NEED TO USE PEP

“Correct. PEP (post-exposure prophylaxis) is only prescribed when someone might have been exposed to HIV. As PrEP is highly effective at preventing HIV, PEP wouldn’t be needed.”

IT CAUSES NASTY SIDE EFFECTS

“Most people don’t experience any side effects, but it is recommended that regular PrEP users undergo frequent kidney checks. Concerns about the side effects of PrEP often come from the unpleasant experiences people had when taking PEP a number of years ago, but the drugs prescribed as both PrEP and PEP have improved enormously since then. And, as always, if you do have concerns – speak to a clinician!”

f you have any questions about PrEP, get in touch with THT Direct on their website or 0808 812 1221

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