Truvada: medicine, not a moral statement

The US Centers for Disease Control and Prevention (CDC) recently recommended Truvada, a daily HIV prevention pill for people at substantial risk of contracting HIV. The World Health Organization just put its considerable weight behind the same recommendation. Truvada is a form of PrEP, pre-exposure prophylaxis, that could significantly reduce HIV infection rates. It is also used for PEP—post-exposure prophylaxis for those who might have been exposed to HIV, the virus that causes AIDS. About 35 million people were infected at the end of 2012.

Truvada is a combination of two AIDS medications for use in conjunction with safer sex practices. Used properly, it is more than 90% effective.

PrEP is an option for certain HIV-negative people who have sex without a condom, and injecting drug users. While the CDC guidelines don’t specifically spell them out, let’s not forget some very important demographics: sex workers, and women who have sex with men who refuse to use condoms. It’s not easily available, but it has life-saving potential.

Reaction has been mixed in the US. While some advocates have welcomed this new option in the arsenal of prevention, others, such as Michael Weinstein of the AIDS Healthcare Foundation, are passionately against it. Weinstein has called it a “party drug”. Others have expressed a fear of irresponsible sexual behaviour, or, eeeek! people having more sex.

So what if people have more sex? Wait, wait, all you who are poised to rant in the comments section. Just think for a minute before you throw stones—or condoms. Before you judge, consider this: Have you always been responsible sexually? Does this make you a bad person? Also, if you have always been conscientious, toed the line, remained a virgin, got married, and stuck to your partner, could it be possible that you’re just a tiny bit jealous?

If you choose to be celibate or monogamous, that’s a fine choice. But if you choose to have lots of sex with lots of people or with one person who is infected, that too is a valid choice, and you don’t deserve to die for it. I was a college student when AIDS became official (that was when white people started dying of it) and it is hard to describe the terror and panic this caused. Talk about a buzz-kill—there we were in college, discovering the world, each other, and ourselves, and suddenly we were told that experimentation could be the end of us. Now I am an adult with children in my life, all on the threshold of their own ages of discovery. Do I want to legislate what they do and whom they do it with? Of course I do! I’m as much of a control freak as the next parent/aunt/friend. But I can’t, and given that reality, I want them informed and protected.

The late film director, activist and poet Derek Jarman wrote: “Understand that sexuality is as wide as the sea. Understand that your morality is not law. Understand that we are you. Understand that if we decide to have sex whether safe, safer, or unsafe, it is our decision and you have no rights in our lovemaking.”

The Truvada debate is reminiscent of the early days of the birth control pill, when people fussed about how it would encourage rampant sexual behaviour. If it did, well, the world continued turning. News flash: People have been having unprotected sex since the beginning of time, and they will continue to do so (allow me to point out that most of us are the results of unprotected sex). Why not offer protection when possible?

HIV/AIDS activist Julia Greenberg says: “I get annoyed by the polarizing nature of this debate. PrEP is not the only answer, but it is effective, and needs to be one of the options. We know condoms work but we also know that some people hate to use them or there are power issues that make consistently using them impossible.”

Truvada isn’t an easy choice or a magic cure that will end AIDS. It’s expensive, it can have really uncomfortable side effects, and it’s still new, with unknown long-term effects. It’s a commitment: You have to remember to take it diligently. It’s definitely not for everyone.

Siddharth Dube is a public health specialist. He took Truvada as post-exposure prophylaxis for a month when he mistakenly used an expired condom that broke. The drug caused diarrhoea, fatigue and nausea. He says: “Truvada, like anything else that can prevent people from getting a terrible lifelong disease, is a blessing. But I hope that most people will be able to rely on using condoms rather than popping such a strong pill. It shouldn’t be the first HIV-prevention choice for most people.”

That’s a sensible point of view: Truvada as an option when others fail. The US government surveyed men who have sex with men in New York City, and reported that more than 50% had had at least one non-condom encounter within the last year. These are not people who went out and hurt anyone. They had consensual sex. But, in this very strange culture, there is more support for them to buy a gun to keep themselves safe than there is to get medication to keep themselves safe while doing something personal, private, and harmful to nobody.

If you travel to Cameroon or Paraguay, it’s smart to get a yellow fever shot. If you race your sports car on a track, it’s smart to wear a flame-retardant Nomex suit. If you drink sugar-cane juice in the monsoon, it’s smart to be inoculated for hepatitis. If you’re having sex or injecting drugs in a world with a lethal virus, it’s smart to take steps to prevent it from killing you or someone you love.

Sohaila Abdulali is a New York-based writer. She writes a fortnightly column on women in the 21st century.

Also Read | Sohaila’s previous Lounge columns