HIV/AIDS groups are jointly praising new recommendations from the Centers for Disease Control encouraging gay and bisexual men to take medication designed to block them from contracting HIV.
In a joint statement on Thursday, 68 groups announced their “strong support” for the CDC guidance promoting use of oral pre-exposure prophylaxis, also known as PrEP for those vulnerable to HIV infection — including gay and bisexual men not in monogamous relationships who have had sex without a condom.
“PrEP has the potential to help many individuals in the U.S. and around the world protect themselves from HIV,” the statement says. “Failure to strategically, effectively and responsibly implement this scientifically sound strategy as part of comprehensive prevention and treatment programs in our fight against HIV would be a true catastrophe.”
Among the signatories to the statement are amfAR, the AIDS Institute, the National Minority AIDS Council and the New York City-based Gay Men’s Health Crisis.
On Wednesday, the CDC issued new recommendations on PrEP, saying health care providers should consider advising use of the drug for uninfected patients who are at substantial risk of infection, including men who have sex with men.
According to both the HIV/AIDS groups and CDC, PrEP can reduce the risk of HIV infection by more than 90 percent when taken daily as directed, although inconsistent use results in much lower levels of protection.
CDC Director Tom Frieden said in a statement PrEP can be an effective tool to stop contraction of HIV when used with other prevention methods.
“HIV infection is preventable, yet every year we see some 50,000 new HIV infections in the United States,” Freiden said. “PrEP, used along with other prevention strategies, has the potential to help at-risk individuals protect themselves and reduce new HIV infections in the United States.”
The recommendations from the CDC come two years after the U.S. Food & Drug Administration approved the oral drug Truvada for HIV prevention. The agency reviewed data from multiple, multinational clinical trials of PrEP use among individuals with different risks for HIV infection.
Donnica Smalls, a CDC spokesperson, said the guidelines are meant to replace interim guidance CDC has issued through the years as trial results showing efficacy have become available and are the first formal recommendations offering comprehensive information about PrEP.
But not every AIDS group is happy with the CDC recommendations. Michael Weinstein, president of the AIDS Healthcare Foundation, which has already taken hits for objecting to the FDA’s approval of PrEP, issued a statement saying the CDC recommendations are “ill-advised.”
“This is a position I fear the CDC will come to regret,” Weinstein said. “By recommending widespread use of PrEP for HIV prevention despite research studies amply chronicling the inability to take it as directed, and showing a limited preventive effect at best, the CDC has abandoned a science-driven, public health approach to disease prevention — a move that will likely have catastrophic consequences in the fight against AIDS in this country.”
Weinstein said the recommendations will lead individuals to engage in sex without condoms, which could make them vulnerable to other sexually transmitted diseases, such as syphilis, which has shown to be on the rise and with new infections mostly among men-who-have-sex-with-men.
“The CDC would be better advised to put its weight behind HIV testing and linkage to treatment for the estimated 20 percent of the 1.3 million people living with HIV in this country today who have never been tested for the disease,” Weinstein said.
According to the AIDS Healthcare Foundation, only about 10,000 individuals have been prescribed once-daily Truvada as PrEP to reduce the risk of HIV transmission. It’s also an expensive drug; it costs $13,000 a year, although many insurers already cover it, according to the New York Times. Moreover, Gilead, the manufacturer of Truvada, doesn’t advertise the drug as a prophylactic, although it does advertise the medication for HIV treatment.
But the 68 groups that jointly praised the CDC recommendations also criticized Weinstein, saying his assertion that PrEP will lead the way to sex without condoms isn’t based on sound science.
“In fact, initial studies suggest the opposite, and Weinstein’s assertion underestimates the capacity of informed individuals to make decisions about their health and sex lives,” the groups said. “We all must do more to reinvigorate the approach to correct and consistent condom use and underscore that PrEP and condoms are complimentary interventions to the prevention of all STDs, including HIV.”
The groups say Weinstein fails to realize condoms aren’t consistently or correctly used “for a host of reasons” and PrEP now provides “an additional option that also provides significant protection against HIV.”
The Boston-based LGBT and HIV/AIDS organization known as Fenway Health issued its own statement praising the CDC for the guidance, saying it was involved with PrEP research since the first safety studies were conducted in the United States more than five years ago, and was one of two iPrex study sites in the country.
“As rates of HIV infection continue to increase in gay and bisexual men, we need to make sure we are using all of the tools available to us to combat that increase. PrEP is a proven and important new tool that should be part of those efforts,” Boswell said. “The CDC guidelines are helpful, since they clearly suggest that PrEP should be part of a comprehensive national prevention strategy.”