Topics such as undetectable viral load, the use of pre-exposure prophylaxis (PrEP) and its relationship to decrease the chances of HIV transmission are moving away other HIV prevention strategies such as the consistent use of condoms. Theory promises much, but the practice can be completely different.
In the past year, the HIV response has seen a growing interest in the subject of treatment as prevention, that is to say, the use of antiretrovirals as a method of primary prevention. It is alarming to see the ease with which this new trend is moving years of hard work in raising awareness on the use of condoms. It is common to see headlines of news such as “The end of the era of condoms”, “Truvada, the substitute of condoms”, “Undetectable = no HIV transmission”.
The truth is that during the studies to determine the effectiveness of the PreP as a method of prevention, many patients in the study, did not achieve a good adherence to the treatment and did not take it steadily, despite having a strict medical supervision. This is something that should make it clear whether we want that this method has great impact.
The issue is more complex than it seems. If it is hard for people with HIV to take their daily pills, even if they need it, how constant can be an individual without HIV with their medication? When they don’t need it strictly.
Daniel Gauna, Coordinator of the Red Argentina de Adolescentes y Jóvenes Positivos (RAJAP), believes that “the indiscriminate launching to the market without information that accompanies and clarifies all the pros and cons of the use of PrEP cannot be allowed. People don’t know they must develop adherence, people have no idea of what adherence is. In addition, they are never told of the adverse effects produced by taking ARVS in health in the medium and long term”.
Another highlight on the PrEP is the funding. Recently, during the second Forum on the HIV continuum of care, held in Rio de Janeiro, Brazil, the uncertainty about available resources to respond to the epidemic raised, as the 90 – 90 – 90 HIV requires a big investment. In order to test 20% of people who are unaware of their HIV status at present, to begin early treatment regardless of the CD4 count, to provide treatment coverage to that 30% (or more) that needs to be reached in the region, we need many resources in each of our countries. Then, if we add PrEP to this, the budget the purchase of medicines will suddenly increase.
We find ourselves faced with the construction of a new discourse of new strategies to deal with the epidemic, many of which are not consolidated. It is not to be against or in favor of this evidence, because they are just that, evidence. The point is to consider the gaps to solve them and generate integrated, comprehensive, strategies that can effectively stop the epidemic.