This week the results of the PROUD study were presented at the Conference on Retroviruses and Opportunistic Infections in Seattle. This is an important UK based study which looks at how men who have sex with men who are HIV negative can take Truvada, a drug used to treat HIV , to prevent getting the virus through sex, this is also known as Pre Exposure Pofilaxis (PrEP). The Proud study showed that Truvada could offer an 86% protection to HIV.
Truvada, has been taken by HIV positive people for over 10 years to treat HIV, and it is relatively safe. However, it must not be forgotten that it has potentially harmful effects, especially on the kidneys and bones. People who take it need to be strictly monitored.
Truvada has been already recognised to work in preventing HIV for a while, and it has been approved for HIV prevention in the US for over 2 years, but still it is not approved in Europe. The PROUD study is important for us in the UK, because on top of proving the efficacy of Truvada as PrEP, it also offers an excellent model of provision of prevention for men who have sex with men within the NHS. People in the study not only received the pill, but also had psychological support and chances to discuss and reflect on their sex lives. An interesting result of the study was that participants did not increase their risk taking behavior because they were on Truvada. Probably that was helped by all the support they received.
A lot can be said and, has been said, about PrEP; it has generated a flurry of activism and demands (and also controversy) for fast availability on the NHS. Access to Prep for gay men at high risk of acquiring HIV has become the number one activism priority.
I have supported my fellow activists in the LGBT community demonstrating in front of the Department of Health (see picture above) for fast access to PrEP. I have done this in the spirit of solidarity, as I want to support what many gay men feel it’s better for themselves. I believe that it has been proven that PreP, if provided properly, could save many lives. I know that PrEP research has been community driven, and this is also important.
However can PrEP just be provided to men who have sex with men in the UK? What about others? What about other vulnerable populations, such as black women and migrants? What about trans women? All the data we have here in the UK is about men who have sex with men, and this worries me.
I have so many questions in my head. Firstly and foremost I am extremely nervous about HIV prevention becoming totally centred on ARV’s. What about all the other issues? What about choice? Can we really treat ourselves out of this epidemic?
For now I would just like to share some questions I have regarding women’s access to PrEP that keep popping into my head. What are yours?
- Do women in the UK want PrEP? In what circumstances? And, how would they like to use it?
- How would PrEP be included in holistic sexual and reproductive health services for women alongside condoms/femidoms, contraception etc.?
- Can PrEP be provided with opportunities to enhance women’s agency and increase our skills in sexual negotiation so that we can have safe and pleasurable sex and experience fulfilling intimacy (hopefully!)
- How would be PrEP provided to women in our health structures? Would it be provided in family planning clinics? By GPs? Who will pay for it?
- How will healthcare providers be trained in providing PreP to women? How will they be trained to deal with HIV stigma and gender based violence?
- If women are vulnerable to HIV as a consequence of violence and abuse, is PreP the answer ? Maybe it could be, in the short term, while women are supported to end the abuse.
- How can PrEP provision be fully integrated to services that support women to exit abusive relationships?
- How are we going to ensure that provision of PrEP for women provides pathways to other key services for women: including mental health services, drug and alcohol services, access to refuges and safe housing (for those exiting abusive relationships) etc. ?
This blog represents my personal views and opinions, not those of the organizations and networks I am associated with.