In this installment of the popular Ask the Doc series, Dr. Howard Scheiner looks again at PrEP with Truvada, the pros and cons of the regimen, and other risks that come with unprotected sex, like anogenital warts, anal cancer, HPV, STDs and Hepatitis C. Learn how safer sex and regular testing can help keep you healthier.
Q: Dear Doc, I just read a quote from Larry Kramer, in The New York Times, referring to PrEP. He said that “Anybody who voluntarily takes an anti-viral every day has got to have rocks in their heads.” What do you think about that?
A: For those of you who may not know Larry Kramer, watch the recently released HBO film of his play, “The Normal Heart.” As a co-founder of both GMHC and ACT UP, clearly the lens through which he views HIV/AIDS is unique. His perspective is shaped by his own illness and personal struggles and his fight to give voice and visibility to the anguish and suffering of a once ignored and shunned generation, along with his fight for accelerated approval of AIDS drugs.
It seems from my reading that he views PrEP medication as a “poison” to the body. And while this or any medication may have side effects or long-term consequences, for those who choose to decrease the risk of transmission with this approach, it can be a useful tool. PrEP can be stopped at any time, should one come to agree with him or find this tool is no longer necessary or if side effects occur; HIV once acquired cannot be stopped so easily.
It should be noted that Truvada was approved as PrEP to be used as part of a comprehensive prevention strategy that includes safer-sex practices with condom use. In my experience, this is not always the situation in the real world, where PrEP is used as the only strategy. Of course, regular testing for other sexually transmitted diseases — some of which facilitate HIV
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Larry Kramer is a great writer and a great guy. I admire him enormously. But he’s also a product of an earlier era when the AIDS epidemic was decimating his friends and there was no effective way reduce risk other than condoms.
It’s a new day and there are more options. Which are most appropriate for a particular individual is a choice to be made between patient and physician. It’s not a matter of politics as some would make it.