How Effective Are the Current Prevention Methods of HIV?

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Gay men using condoms was an enormous part of slowing the spread of the epidemic for years. But at most, we never got more than about half of Gay men to be using condoms regularly. With the introduction of effective treatment, that changed the consequence of HIV infection. It's been tougher and tougher getting people to be consistent with their condom use.

But also, the discovery that, when someone is on treatment successfully, and their viral load becomes undetectable, which means it cannot be detected in one's blood by the available technology. That makes a person essentially non infectious. There's not a single documented case of sexual transmission of HIV from someone who is known to be undetectable.

It's a possibility, but it's a hypothetical possibility because it hasn't been demonstrated. The risk is so remote. That then led people to start using treatment prophylactic. People who thought they might be at risk because of the behaviors they engage in or very intentionally if I am engaging in without condoms and that is also effective at preventing HIV.

Then, if somebody who is negative gets exposed, a condom breaks or they do something that they regret. We know that if they start treatment within a couple of days and take a 28 course of treatment, that they'll generally avoid getting infected. It's what health care workers have been doing for a long time.

They get a needle stick. They go immediately on anti retro viral medication for 28. This is called bio medical prevention. It's basically a pharmaceutical prevention to stop transmission of the virus. So the question becomes, it's great people have HIV, they're on treatment, they're not infecting, transmitting the virus to other people.

Certainly, people who've been exposed to treatment makes a lot of sense as an emergency intervention that I think we should be promoting much more. So, it's hardly being promoted at all right now, except for health care workers. But what is very contentious is whether to put people who don't have HIV but are deemed at risk of acquiring HIV on treatment prophylactically.

So, the first of all for someone who will not use condoms or cannot use condoms, sometimes people cannot use a condom, and some men cannot get an erection with a condom, or for passive partners whether women or men, it gives them a HIV prevention tool they can control, right.

So, they don't have to depend on their partner using a condom. Where it gets tricky is in my view is the extent to which this should be the center piece of our the prevention efforts. You know, I think it is something that should be available and people should know about it. But, I believe we should still be promoting the behavioral changes and then broader focus on healthy sexual decision making.

And the introduction of PREP, in addition to enormous cost which gets into question of resource allocation, it shifts the cost of HIV prevention away from public health departments, in on to pay us. It is a kind of looks like a quick fix, right. You just get everybody out there taking PrEP to stop the virus.

It's not going to happen that way. I personally think there is a risk that PrEP will, it's possibility that it could actually increase HIV transmission. Because the first of all it only prevents HIV, and for the indications for it, FTI prude indication is it use PrEP in combination with the condom.

The reality, and now people use it, no they're using PrEP instead of a condom. So, we're going to see an increase in sexually transmitted infection. We are already seeing a very significant increase in syphilis that I think may be due to instead of confidence in bio-medical prevention that's leading a lot of people to be engage in risky sexual practices.

Regardless of whether they are taking PrEP or not. There's is also concern about whether PrEP, risks ruining really effect anti-retroviral. Because of people taking it episodically, and then becoming infected and taking less than the therapeutic dose of it. And of course, the side effects in this anti- [retrovirals] or chemo therapy education is a very powerful and effective drugs, and some of the side effects we know for people who have HIV who are taking them, but we're learning more as you're on them for a longer and longer period of time.

You know, we don't know what it is means detect these for 20 years because no one's been on them or hadn't been around that long. And so, giving them to people who are HIV negative presumably for some extended period of time while they are sexually active, may post something down the road that we don't know about.