Recent large trials have shown some positive evidence that pre-exposure prophylaxis for HIV works. The first was the iPrEx trial showing it worked in men who have sex with women. Then we have the HTPN 052 trial showing it works in preventing transmission from one HIV+ partner to his/her HIV- partner in heterosexual couples.
As these positive results have seeped into the mainstream press, inevitably, there's been a run on anti-retrovirals, as reported here by marketwatch:
The State of Florida Agency for Health Care Administration (AHCA) recently sent out an alert to Florida health care providers and pharmacies notifying them of stricter requirements for incoming pharmacy claims for HIV/AIDS medications. AHCA informed AHF that the change is in response to an increase in demand for Truvada for use as a prevention pill by HIV-negative individuals and the fraudulent prescriptions that are appearing as a result.
And while the state of Florida is absolutely right to maintain legitimacy and control over prescription medicines, there's a larger story here. What we see here is an excess of demand for HIV medications over the supply. Good. This reflects the fear that HIV- negative individuals have of being infected with the virus and the hope they are clinging to that pre-exposure prophylaxis works. We want these individuals to take care for themselves and in doing so reduce the overall transmission of the disease. We've been working on this for 30 years!
The stated fear of opponents of wide-spread pre-exposure prophylaxis is that it will lead to more promiscuous behavior - which should perhaps be called the bare-back theory. And that used improperly, the virus will soon find resistance to the medications, making them less efficacious in other patients. But there are still lots more positive benefits to pre-exposure prophylaxis medications than negative ones. In vulnerable sex workers. In stable discordant couples - both heterosexual and homosexual. There are lots of people who would benefit.
The CDC has started the discussion on the proper use of pre-exposure prophylaxis (see below). Admittedly however, there are political and scientific motives for not forcibly pushing these yet. But as we fill in the knowledge gaps, the right way to use this modality will be the same as birth control and condoms and other preventive measures - emphasis on the risk of improper use while encouragement on proper application.
Continue reading "HIV Pre-exposure Prophylaxis and the Underground Economy" »