Daily Pill—Taken Without Fail (No Screwing Up)—Reduces HIV Infection Rates By 90%

NYT:

In a development that could change the battle against AIDS, researchers have found that taking a daily antiretroviral pill greatly lowers the chances of getting infected with the virus. In the study, published Tuesday by the New England Journal of Medicine, researchers found that the hundreds of gay men randomly assigned to take the drugs were 44 percent less likely to get infected than the equal number assigned to take a placebo. But when only the men whose blood tests showed they had taken their pill faithfully every day were considered, the pill was more than 90 percent effective, said Dr. Anthony S. Fauci, head of the division of the National Institutes of Health, which paid for the study along with the Bill and Melinda Gates Foundation. “That’s huge,” Dr. Fauci said. “That says it all for me.”

First: thanks, Bill; thanks, Melinda. Moving on:

Also, the antiretroviral pill—Truvada, a combination of two drugs, tenofovir and emtricitabine—is available by prescription in many countries right now.... The protection, known as “pre-exposure prophylaxis” or “PreP,” is also the first new form available to men, especially men who cannot use condoms because they sell sex, are in danger of prison rape, are under pressure from partners or lose their inhibitions when drunk or high.

This pill—is "the pill" taken?—will be popular among gay men who want to have unprotected sex with their partners because it feels better, because condoms are the wrong sort of pain the ass, because fucking without condoms is more intimate. And it may change the mental calculus around negotiated safety for gay men in stable relationships. (Gay men in LTRs may decide to go condom-free a little sooner: a high level of trust used to be required before a couple could go condom-free. But if men can go on an effective pill when they first stop using condoms with a new partners—one that lessens their risk if their trust was misplaced—they're likelier to stop using condoms sooner.) But I doubt that the pill, if it becomes available, will stem the tide of HIV infections in the gay community. The men most in need of the drug—the significant chunk of gay men out there who aren't using condoms with random and/or anonymous partners—those guys just don't give a shit. They don't give a shit about themselves, about their partners, about contracting HIV or other STIs, about their health, about the health of their community. These guys are unlikely to take a pill "faithfully."

And the pill? It has significant side effects—what is going to happen to someone who takes the pill for decades? And the pill costs $14,000 a year—who's going to pay? There are currently long and growing waiting lists for drugs that mean the difference between life and death for people who have full-blown AIDS. And if guys taking the pill come to see themselves as invincible and/or immune, what are the odds that some—many?—will take more risks, expose themselves to HIV more often, and by so doing wipe out whatever protections the pill provides?

Color me skeptical, but I'm not sure it's practical to suggest that all gay men everywhere be placed on an expensive drug regimen all of our adult lives—along with "other high-risk groups," like "sex workers... drug users and uninfected people married to infected people."

UPDATE: Andrew is a lot more upbeat: "massive breakthrough," "best news in a long time." I remain skeptical. Yes, this is big news. But who are the gay men most likely to use this drug? Health-conscious gay men with access to health care who self-select to take the drug. In other words, gay men—negative and positive—who are already protecting themselves and/or their partners. And this made me roll my eyes...

This could have real implications especially in those subcultures where using condoms is rare, where the closet or the DL make any candid discussion of HIV before sex taboo.

Asking your doctor to write you a prescription for a drug that makes it possible for you to have tons of unprotected gay buttsex will require the mother of all candid discussions.

Closeted guys and guys on the DL—and "DL" is just another way of saying "closeted"—are unlikely to regard the gay pill as any less taboo than a candid discussion about HIV or a condom. Closeted guys avoid those discussions and refuse to use condoms because having them or using them implicates them as gay. How will getting and taking the gay pill be any less of a taboo?