When Milwaukeean Josh Beck, 34, posts a profile on gay dating sites, he gets a lot of questions about his HIV status: “negative plus PrEP.”
PrEP is an acronym for “pre-exposure prophylaxis,” which means taking anti-retroviral medication to protect against acquiring HIV infection. PrEP is a growing strategy in combating HIV. It puts protection in place when at-risk people don’t use condoms or don’t know the true HIV status of their partners.
A number of online meeting sites for gay and bisexual men have begun adding the “negative plus PrEP” option to their apps, but the vast majority of primary care physicians in Wisconsin seem to know nothing about it.
Although most HIV-positive people are honest about their status, a large number of them don’t know theirs. As many as 60 percent of infected young gay and bisexual men are unaware of their status, according to a 2012 study.
Gay men cruising online and elsewhere might believe they’re negative based on their latest HIV test results. But they could have become infected since their last test without knowing it. Or they might have contracted the virus so soon before their last test that their bodies didn’t have enough time to develop the HIV antibodies that produce a positive test result.
Given these unknowns, a “negative plus PrEP” status is reassuring to prospective sex partners. “People seem much more comfortable because I’m on it,” Beck says.
Beck learned about PrEP from an ad he saw in The Advocate and asked his doctor about it. Although his doctor had never heard of it, he looked into the treatment on Beck’s behalf and provided a referral.
Now Beck takes one Truvada pill per day, which research shows can provide him up to 97 percent protection from contracting HIV — if he takes the pill with food at the same time every day without fail. Failure to comply with the dosing guidelines lowers PrEP’s effectiveness significantly.
Truvada is a combination of two anti-retroviral drugs that are also used together to treat active HIV infections. Beck’s insurance covers the cost, which is much less than treating an HIV infection.
PrEP has been around for many years, and the U.S. Centers for Disease Control and Infection recommends it for some sexually active gay and bisexual men who are negative, as well as for some negative men whose partners are sexually active. But very few of the people who need it are aware of PrEP, according to a September 2104 survey by The Kaiser Family Foundation. The survey found that only 26 percent of gay and bisexual men knew there’s a treatment that can prevent HIV infection.
Dr. Andrew Petroll is trying to build awareness of PrEP among his peers in Wisconsin. Petroll is an infectious disease specialist with the Froedtert and Medical College of Wisconsin health network and an associate professor of psychiatry/behavioral medicine at the college’s Center for AIDS Intervention Research.
Even as he’s working to increase awareness of PrEP in Wisconsin, Petroll is conducting a survey to determine the level of PrEP awareness among physicians in the cities with the 10 highest populations of people living with HIV.
The lack of awareness concerning PrEP in Wisconsin is troublesome, because the strategy has had great impact elsewhere. In San Francisco, where both HIV-testing and PrEP are promoted aggressively, the HIV-infection rate has been coming down for the past three years, Petroll says.
He currently has about 40 Wisconsin patients on PrEP, including Beck.
“We’re seeing signs of an increase in demand for this (in Wisconsin),” Petroll says. “But people who are really interested in finding it are having a hard time getting it.”
Lack of awareness among physicians isn’t the only barrier to receiving PrEP. Some patients face discrimination from doctors when they ask about it, Petroll says. And doctors who are unfamiliar with PrEP are inclined to dismiss it due to dubious concerns.
Beck has heard many of those concerns, both from his primary care physician and from people online. “My doctor was concerned that, like with a lot of antibiotics, my system could build up a resistance to it,” Beck said.
That fear isn’t real, and it’s probably based on the way that HIV mutates into drug resistant strains, forcing infected patients to switch medications from time to time. But without HIV present in the body to mutate, the development of resistance is not a concern for HIV-negative people taking PrEP.
The major concern is side effects. The awful side effects associated with highly active anti-retroviral therapy are legendary. Truvada, however, was chosen for prevention not only because it works and is simple to take, but also because it has the fewest side effects in the anti-HIV drug arsenal, Petroll says.
There’s a 1-2 percent chance of kidney dysfunction for which Petroll monitors patients on a regular basis.
Beck says that he’s experienced virtually no side effects and there have been no indications of side effects in his routine blood work. He said people are more surprised by that than any other aspect of the treatment.
Like nearly everything else to do with HIV/AIDS, there’s also a political dimension to PrEP. Some activists believe it’s a cop-out, a shirking of personal responsibility.
Gay actor Zachary Quinto set off a firestorm on the subject when he criticized PrEP during an interview with Out magazine.
“We need to be really vigilant and open about the fact that these drugs are not to be taken to increase our ability to have recreational sex,” he said. “There’s an incredible underlying irresponsibility to that way of thinking … and we don’t yet know enough about this vein of medication to see where it’ll take us down the line.”
Petroll and Beck say the benefits far outweigh such concerns.
“It puts you in control if you’re not sure that your partner is always taking his meds or telling the truth about his status,” Petroll says.
When people are looking to have uncommitted relationships or one-night stands, it offers peace of mind if their condom slips or they’re too inebriated to use a condom, he adds.
Beck says he plans to remain on PrEP until he enters a committed relationship, and he’ll continue to educate people about it when he has the chance.
“I’m glad people ask me about it,” he says. “Every doctor I’ve talked to sees my medication list and whenever they’ve asked about (Truvada), they’ve thought it’s really cool that I’m being proactive. I’ve gotten nothing but support from people. I think the message is really starting to get out there.”
To contact Dr. Andrew Petroll, visit froedtert.com and search the website’s “Find A Doctor” database.