By Greg Millet
Biomedical strategies such as pre-exposure prophylaxis (PrEP) and ARV treatment as prevention are essential to bringing an end to the HIV epidemic. After all, through them, HIV-negative people can avoid HIV infection by taking medication.
Yet despite their effectiveness, the prophylactic usage of ARVs in the U.S. has been slow. “I think the challenge that we have both in the United States and globally is how are we going to get access for this particular type of medication for those communities that need it the most,” says Gregorio Millett, vice president and director of public policy for amfAR. Among those communities most in need of ARVs are Black gay men and the Black community in general, Millett says.
Unfortunately, there are fewer resources today to advance PrEP and other forms of prevention. A study released in July by the HIV Vaccines and Microbicides Resource Tracking Working Group found that investment in HIV-prevention research fell by $50 million in 2013 largely because of declining investments by the U.S. and Europe. As a result, the rollout of new HIV-prevention options could slow down even more, the working group says.
Money isn’t the only thing keeping ARVs from being used prophylactically. Here are six myths that are also contributing to the lag.
Myth 1: PrEP should be used for prevention only after all eligible AIDS patients are on treatment. Some believe that we shouldn’t redirect HIV/AIDS medications to people without HIV until all people with HIV are treated. But there is a flaw in that thinking, says South African scientist Salim Abdool Karim, M.D., Ph.D., a professor at Columbia University’s Mailma School of Public Health and director of the Center for the AIDS Programme of Research in South Africa, or CAPRISA.
For every person who begins treatment, two more people be-come infected, so while we’re saving lives, we have to “use all tools to prevent those two people from acquiring HIV,” says Dr. Karim.
Myth 2: It is not safe to give ARVs to healthy people. This myth plays on the fear that, be-cause of their adverse effects, the treatments will do more harm than good. While that may have been true in the early days of HIV/AIDS medications, it’s no longer true today, Dr. Karim says. In fact, most of the drugs used today have excellent safety profiles and have been taken effectively by hundreds of thousands of patients.
Myth 3: Asymptomatic people will not adhere to ARVs for prevention or treatment. Some feel that PrEP is a waste of time because people who aren’t HIV positive won’t have the sense of urgency to take their medications. But Dr. Karim disagrees, saying that HIV-positive and HIV-negative partners have strong motivations for taking PrEP drugs.
HIV/AIDS professionals must also educate the community and work with it to break the barriers to adherence, says Seema Sahay, Ph.D., a scientist with the National AIDS Re-search Institute in Pune, Maharashtra, India. “We can find solutions and talk to [com-munity members], and then adherence will be enhanced,” she says.
Myth 4: Drug resistance from PrEP will undermine future AIDS treatment. Some fear that if people who don’t have HIV take PrEP, they will build up a resistance to HIV drugs in the future. But according to studies, the bulk of resistance occurs when ARVs are used for treatment, not prevention. Besides, Dr. Karim says, “If you use PrEP, you don’t get infected, so you don’t have [to worry about] resistance.”
Myth 5: PrEP will increase HIV risk by lowering condom use. If people have a biomedical means of prevention, they’ll engage in unsafe sex practices and use fewer condoms over time, some say. Yet studies show that this isn’t true, Dr. Karim says.
Education will also play a role in making sure people are aware that condom usage is still important. For example, clinicians must do a better job explaining the need, says Edwina Wright, M.D., Ph.D., an associate professor with the Burnet Institute, based in Melbourne, Australia. They must balance the duty of caring for patients with providing care to partners and the broader community, which can be done through PrEP, she says.
Myth 6: We do not know how PrEP works and need more education efforts before the roll-out. While it’s true that more must be done to educate people about PrEP, “through implementation we learn,” Dr. Karim says.
If not, “we’re still going to have hundreds of thousands of infections among African Americans and specifically among young Black gay men who are dispossessed, who don’t have access to care and really have no place to go,” Millett says. “And that’s problematic.”