The WHO Wants All Gay Men to Take HIV Prevention Medication
Condoms aren't enough: For the first time, the agency is recommending that
all men who have sex with men use prophylactic treatment.
 Cari Romm <http://www.theatlantic.com/cari-romm/> Jul 11 2014, 5:34 PM ET
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   A man suffering from HIV/AIDS receives treatment in Siliguri, India.
(Rupak De Chowdhuri/Reuters)


Condoms alone aren’t cutting it, the World Health Organization declared
today, urging all men who have sex with men—regardless of HIV status—to
begin using antiretroviral drugs as a means of protection against the
disease.


Worldwide, a man's risk of HIV infection is 19 times greater if he has sex
with other men than if he doesn't. Taken regularly, the recommended
pre-exposure prophylaxis, or PrEP—a single daily pill containing two
separate medications—is up to 92 percent effective
<http://aids.gov/hiv-aids-basics/prevention/reduce-your-risk/pre-exposure-prophylaxis/>
in protecting its users from HIV. In an update to its HIV prevention
guidelines
<http://apps.who.int/iris/bitstream/10665/128048/1/9789241507431_eng.pdf?ua=1&ua=1>,
the WHO estimated that the widespread use of PrEP among gay and bisexual
men could prevent as many as one million new HIV infections over the next
decade.


It’s a number worth celebrating, in theory, but how attainable is it? In
the same guidelines released earlier today, the agency also noted that its
recommendation may be easier said than fulfilled:


“Implementation may prove challenging, however, where access to services
and provision of alternative prevention tools are limited or lacking.
Issues of criminalization, stigma and discrimination, and violence should
be considered during implementation, especially where same-sex behavior is
illegal.”


And as the BBC <http://www.bbc.com/news/world-25927595> reported in
February, homosexuality is a capital crime in five countries and punishable
with imprisonment in 70 more, leaving a sizeable chunk of the world’s
high-risk population unlikely or unable to follow the WHO’s wishes.


In the U.S., PReP has already seen its fair share of controversy. The WHO’s
announcement comes on the heels of a similar policy
<http://www.cdc.gov/hiv/prevention/research/prep/> from the Centers for
Disease Control and Prevention, which recommended in May that health
workers offer PrEP, marketed in the U.S. under the brand name Truvada
<http://www.fda.gov/downloads/drugs/drugsafety/ucm312307.pdf>, to people at
high risk of infection, including gay and bisexual men, injection drug
users, and women who sleep with men of unknown HIV status. Long used by
HIV-positive patients to stave off AIDS, Truvada sparked a bitter debate
after it was approved as a prophylaxis in 2012. While some hailed its
preventive properties, others—including many in the LGBT community—argued
that it would quickly become a risky replacement for condom use.


"If something comes along that's better than condoms, I'm all for it, but
Truvada is not that," Michael Weinstein, president of the AIDS Healthcare
Foundation told the Associated Press
<http://www.usatoday.com/story/news/nation/2014/04/06/gay-men-divided-over-use-of-hiv-prevention-drug/7390879/>
in April. "Let's be honest: It's a party drug.”


Of course, the WHO isn't advocating PrEP as a replacement for condoms, only
as a supplementary measure. But the treatment may be the key to leveling
the prevention playing field, the WHO maintains
<http://www.who.int/mediacentre/news/releases/2014/key-populations-to-hiv/en/>,
arguing that “preventive efforts are still lagging too far behind” for
certain high-risk segments of the population. Overall, the number of
HIV-related casualties is going down—thanks in large part to the
antiretroviral medicines used by 13 million people worldwide—but they’re
going down much more slowly for some groups than for others, a gap this new
policy aims to close.




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