Op-ed: Why is PrEP not being discussed in Nashville

Call it being naïve or maybe just too ambitiously involved in real HIV-prevention discussions since I was diagnosed as HIV-positive on January 24, 2012, but I simply do not understand why PrEP (pre-exposure prophylaxis) is not being discussed more in this city.  [emtricitabine/tenofovir disoproxil fumarate (Truvada®) fixed dose combination for pre-exposure prophylaxis (PrEP) to reduce the risk for HIV infection.]

For those of you that are not aware yet of PrEP, it “involves taking daily medication that helps to prevent the transmission of an HIV infection. It also includes other risk-reducing techniques, such as treatment for drug addicts or education about safe sex practices.” (source: Healthline)

With new HIV infections hovering around the 50,000 mark, according to the most recent CDC data, and according to statistics provided from Nashville CARES, there are over 5,200 individuals living with HIV/AIDS in Greater Nashville, the discussion of PrEP is more than timely.  The time is now!

But there is this new stigma associated with HIV-negative folks that are considered at the highest risk of HIV-infection (gay men who have anal sex) to begin such a preventative method--PrEP. WHY? Is it because that many are worried about the costs associated with the prevention method?  Most insurance plans just require a co-pay.  Is it because these drugs are from pharmaceutical companies and some feel they are a big money-hungry establishment?  These are the drugs that are keeping some of our friends and family living with HIV alive!  It is no longer just a last option. It’s insane to not, at the least, allow and foster a discussion of all the methods that are available, in my opinion.  And the fact of the matter remains that PrEP is the ONLY FDA tested and FDA approved prevention method for men that have anal sex with men.  Condoms are still an important and necessary tool, of course.  But there are no condoms that have the FDA stamp of approval on them for anal sex. 

On my blog, I have an Open Letter on PrEP from HIV influencers that has over 50 signatures from high profile advocates in the country, including local Nashville CARES CEO Joseph Interrante and Street Works’ Robbie Maris, agreeing that the time is now for our community and others to support a healthy and much needed opportunity to discuss, between a patient and their physician, if the use of PrEP is advantageous. 

I do not believe that PrEP is an option for everyone.  However, I do believe that we, as a community, should foster these discussions between individuals and their doctors sooner than later—and allow those informed decision makers the right to weigh the options. 

Many of you may be confused by the different voices in the debate on the practicality, safety, adherence requirements and benefits of this prevention tool. While not minimizing any of these concerns, we believe that individuals should be empowered to make informed decisions about their use of PrEP as a, FDA-approved prevention strategy. Moreover, I do not believe it is necessarily a matter of choosing between PrEP or condom use/other forms of behavior change. PrEP can and should be viewed as an addition to, not a substitution for, our current arsenal of prevention strategies. These may or may not be used in combination depending upon the individual situation. I do also recognize the importance of safer sex counseling and regular HIV and STI testing, provided by authorized organizations and methods.

Let’s get off our asses, community, and recognize that the time is now for all of us to stand up, again, agree that discussions about this modern tool is necessary, effective, needed.  Please discuss PrEP with your physicians.


The Future of HIV Prevention: Truvada® PrEP


(Disclosure:  Josh Robbins is a consultant of O&AN, however this editorial doesn’t necessarily reflect the views or opinions of Out & About Nashville. This content was provided as part of an on-going relationship with his HIV BLOG http://imstilljosh.com.)



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