To the Editor:
I am writing in response to the full-page advertisement by AIDS Healthcare Foundation (AHF) which ran on the inside cover of last week's issue of Windy City Times dated March 9, 2011. The ad, with the headline "There is no magic pill," features an image of the HIV drug Truvada which is manufactured by Gilead Sciences, Inc. Both Truvada and Viread are being studied in pre-exposure prophylaxis (PrEP), as a possible means of lowering the risk of acquiring HIV. According to a fact sheet by the AIDS Vaccine Advocacy Coalition (AVAC), recent data from the iPrEx study presented at this month's Conference on Retroviruses and Opportunistic Infections (CROI) in Boston showed that daily use of Truvada in conjunction with safe sex counseling reduced the risk of HIV infection by 44 percent in gay men, other men who have sex with men (MSM), and transgender women who have sex with men (TSM). For those who took it regularly enough to have detectable levels of drug in their blood, the risk of HIV infection decreased by greater than 90 percent.
Gilead, while not the study sponsor, is providing drugs free of charge for use in these studies, and is expected to file with the U.S. Food and Drug Administration (FDA) for a labeling change for Truvada for use as PrEP. Other advocacy groups are forming their own response to the recent ad and to a planned letter by AHF to the FDA proposing that their review should not occur until more evidence is gathered. But I am writing now because I believe that the AHF ad campaign is misleading and is an unfair attack on Gilead.
This year marks 30 years since the first cases of AIDS were reported in the U.S., and yet in this country we still see 56,000 new HIV infections annually. As AHF pointed out in their ad, condoms are more effective than PrEP, and I think most of us would agree with that, at least when condoms are used, or even available or feasible. But many in the advocacy and scientific communities have also come to the realization that we are going to need every tool at our disposal to win this war. Just as in HIV treatment, in which we use combination therapy to keep the virus suppressed, we will require a combination of proven behavioral, biomedical, and structural interventions to eventually reach the tipping point in this epidemic.
Of course there is no magic pill. There has never been, and never will be, a one-size-fits-all method to prevent the spread of HIV. And for those populations who may be at higher risk, or who may not have the luxury of having all of the tools at their disposal (for example men or women whose partners are unwilling or unable to use a condom or other form of protection), if they could use a microbicide gel or even a pill to lessen their risk, why would we not want that?
Oral PrEP (if proven safe and effective); vaginal and rectal microbicides; condoms; risk-reduction and adherence counseling; treatment as preventionall of these and other methods must be allowed to be fully explored and studied. We owe it to ourselves, our partners, our families, our friends and to future generations. We cannot and must not allow politics or fear tactics to trump sciencewe are better than that. To do any less is a disservice to those whom we purport to serve.
Sincerely,
Jeff Berry
Editor, Positively Aware
Director of Publications,
Test Positive Aware Network