This article by JD Davids previously appeared at TheBody.com, here.
This year, two cases have been reported of people getting HIV while adherent to pre-exposure prophylaxis (PrEP). The most recent was revealed this week at the HIV Research for Prevention conference in Chicago. In this same year, about 50,000 people in the U.S. (plus many, many more worldwide) will have acquired HIV while not taking PrEP.
Why do we focus so much on these rare cases of transmission among people who are adherent to PrEP? As someone who has followed PrEP developments for many years and is also a PrEP user, my heart is heavy hearing of this second case of HIV in a person who was PrEP adherent. Yet, given the most recent stats on HIV diagnoses in the United States, we know that nearly 200,000 non-PrEP-related cases of HIV transmission may have occurred in the U.S. alone in the four years since Truvada (tenofovir/FTC) was approved as an HIV prevention tool.
As always in the complicated course of the HIV pandemic, it's vital that we lead our efforts with science, public health and health justice, rather than being swayed from effective strategies by outliers that can trigger fear or exacerbate HIV stigma. In a world where people with HIV are jailed for consensual adult sex or even spitting, it can seem that HIV stigma has no bounds. And a specific cloud of fear has long existed around PrEP, even when it was still a theoretical concept, as if the idea of less-fettered sex is, in and of itself, dangerous.
The moderators of the popular PrEP Facts list on Facebook work assiduously to share information and temper judgment, but it's clear from the posts on that page that it's very hard for many people on PrEP to believe that we are, indeed, at incredibly low risk of HIV infection. The news of this new infection will recharge anxiety and fear among many who have found a level of unimagined comfort and reassurance from being on PrEP.
Howard Grossman, M.D., the HIV provider who reported on this transmission, reminds us that these two documented cases of HIV acquisition by people adherent to PrEP have come in a period when perhaps 100,000 people at risk of HIV have used this HIV prevention method. It's encouraging to see that this newly positive person is doing so well on treatment and has never had a detectable HIV viral load. That means he's on track for a healthy, long life and -- as with all people who have undetectable HIV viral loads on treatment -- has negligible risk of HIV transmission.
Visit TheBody.com to read the rest of this article, here.