Health & Medicine

The WHO has simple advice for sexually active gay men: Take your antiretrovirals!

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Credit: Carlo Allegri/Reuters

Men hug as they take part in the annual Gay Pride Parade on Christopher Street in the Manhattan borough of New York June 29, 2014.

The World Health Organization has recommended that all sexually active gay men take antiretrovirals, even if they are not HIV-positive.

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(This story is based on a radio interview. Listen to the full interview.)

The treatment is known as "pre exposure prophylaxis," or PreEP. The WHO says taking these medications every day — along with using condoms — is estimated to cut the incidence of HIV among gay men more than 20 percent. 

Dr. Gottfried Hirnschall, the Geneva-based director of the WHO's HIV department, says the recommendation was prompted by some disturbing health trends:

"What we have seen in the last couple of years is an incredibly strong increase in new infections in gay men," he says. "We've seen this in major cities all over the world, and we've seen this in the US, in Europe, in Asia, in places in Africa like Mombasa. So in response to that we are really trying to see what could be in the arsenal of preventive interventions that could be made available to men who have sex with men."

Hirnschall says studies show using anti-retroviral drugs, also part of the treatment of HIV-positive people, has a strong prevention effect. "So what we are recommending is that gay men consider this is an option — in case they do not want to or can't take other options, specifically condoms," he adds. "So it's by no means an order. WHO makes recommendations, and these recommendations are just to add as an additional option in the context of a broader range of interventions that, of course, has to include condoms."

Hirnschall says the daily preEP pills are very effective. They've been described as more than 99 percent effective at preventing HIV — and in many US states the treatment's covered by insurance. But he points out "these pre-exposure prophylaxis pills ... need to be taken every day, [which] is true for every other prevention dimension, including condoms. If you use them, they're very effective. If you don't user them, if you don't take the pills every day, obviously they won't help. So the challenge will be to translate what we have seen in studies as a highly efficacious intervention into really effective interventions in reality, in the field." 

The preEP pills do have their share of critics. The AIDS Healthcare Foundation lobbied the FDA to reject Truvada (a brand of preEP) arguing that gay men might stop using condoms, or might forget to take one pill, and quickly risk becoming infected.

"Obviously not everyone likes [pre-exposure prophylaxis], obviously not everyone wants to do it. Certain people think this is an intervention they would consider, and some people are already doing it, so we're seeing a broad range of opinions here," Hirnschall says. "Clearly this means we need to do a lot more outreach, more sharing of information. And clearly it's a choice, an individual choice that usually should be made with a provider so that also certain measures can be put into place so these people are helped to adhere to these drugs, and that these people are seeing this very often as an interim measure. We don't expect that a gay man takes this for the rest of his life. Life changes, there may be times when somebody takes this and then stops taking it because the risk may change."

Put theory aside for a moment and take a look at reality,Hirnschall says. "Why is it that in Bangkok we are seeing incredibly high rates of new infections? Is it that condoms are not available or that they don't want to use condoms? I think it’s a combination of things — and the more options we can make available safely, the greater the likelihood will be that we can deal with this surge of new infections."

Four Facts from WHO: 

1) HIV infects cells of the immune system

Infection results in the progressive deterioration of the immune system, breaking down the body's ability to fend off some infections and other diseases. AIDS refers to the most advanced stages of HIV infection, defined by the occurrence of any of more than 20 opportunistic infections or related cancers.

2) 35.3 million people live with HIV worldwide

More than 35.3 million people are currently living with HIV, and 2.1 million of these are adolescents (10-19 years). All adolescents are vulnerable to HIV due to the physical and emotional transitions, and potentially heightened risk-taking behavior, inherent to this period of life. The vast majority of people living with HIV are in low- and middle-income countries. An estimated 2.3 million people were newly infected with the virus in 2012.

3) Combination antiretroviral therapy (ART) prevents the HIV virus from multiplying in the body

If the reproduction of the HIV virus stops, then the body's immune cells are able to live longer and provide the body with protection from infections. If the HIV positive partner in a couple is on ART, the likelihood of sexual transmission to the HIV-negative partner decreases dramatically.

4) There are several ways to prevent HIV transmission

  • Practice safe sexual behaviors such as using condoms;
  • Get tested and treated for sexually transmitted infections, including HIV;
  • Avoid injecting drugs, or if you do, always use new and disposable needles and syringes;
  • Ensure that any blood or blood products that you might need are tested for HIV.

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