Critics of PrEP, the daily pill that stops people getting HIV, say that gay men just need to change their behaviour, not take a preventative medicine. Here is why that alone is not the answer
Suzi Price; Friday 20 May 2016
When the Pill was introduced, there was an immediate backlash, as people felt it would encourage promiscuity. We managed to overcome that stigma, and over 50 years later we are on the cusp of something similarly revolutionary in regards to HIV.
PrEP, a daily pill that stops people getting HIV, could soon be provided on the NHS. For gay men, the demographic most at risk, there is the very real possibility that they too will be able to have sex without life-changing consequences.
Yet like the Pill, PrEP is not without its critics – we are seeing many of the same arguments, often made by heterosexuals with a low HIV risk, being rolled out to deny gay men PrEP.
It’s important to remember that it’s not just gay men who get HIV, but often the main arguments against it are based on judgements about their behaviour.
1. “Just stop sleeping around”
Shaming anyone’s sex life isn’t an effective way to prevent HIV and whilst it stands to reason that the less people you sleep with the less chance you have of getting HIV. It’s not that simple.
For gay men the odds are stacked against them from the off. One in 20 gay men in the UK has HIV. This compares to 1 in 1,000 straight people.
If you are a sexually active gay man, you have a high chance of sleeping with someone with HIV. If he is one of the 14 per cent of gay and bisexual men who aren’t aware that they have HIV, there is a real risk you will acquire it from them.
People who have diagnosed HIV and are on effective treatment are essentially non-infectious.
2. “Use condoms”
People say that giving gay men PrEP will mean they are less likely to use condoms. The UK-based PROUD PrEP trial, which was designed to understand how PrEP would be used in the real world,showed that this wasn’t the case.
Condoms used perfectly are 98 per cent effective, but this isn’t a realistic scenario. They can break or come off – this brings overall effectiveness to 85 per cent. This is without factoring in the times people are just too drunk or turned-on and decide to chance it.
Let’s face it: people do make bad decisions in the heat of the moment.
Clearly condoms have been, and will continue to be, vital to the fight against HIV. Scientists have concluded that if gay men had given up on condom use entirely between the years 2000 – 2010, we would have had 400 per cent more new infections. With around 2,500 gay and bisexual men acquiring HIV a year though, condoms have clearly not managed to crush the epidemic single-handedly.
3. “Just pick a partner and stick with them”
In reality, more men get HIV from their boyfriend or regular partner than from casual sex – promoting monogamy isn’t a catch all solution.
Clearly, what we have been doing hasn’t stopped HIV or even slowed it down amongst gay men (each year a record number get diagnosed with HIV).
But we have something that works – PrEP.
PrEP is at least as effective as condoms in preventing transmission. In the three major studies on PrEP, there were no instances of someone who was taking PrEP, in the correct manner, acquiring HIV.
By all means if condoms work for you, keep doing what you’re doing – but if that was enough, we would have stopped HIV in its tracks a long time ago.
We need to keep the options open for everyone, and level the playing field for populations facing an unfair burden of HIV, meaning they can have the privileges that so many of us take for granted – the chance to have sex without fear.