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article imageThere is a way of almost completely eliminating the risk of HIV

By Karen Graham     Dec 1, 2015 in Health
Today is World AIDS Day and there is no better day to talk about the prevention of HIV than now. While the number of HIV infections has dropped 35 percent since 2000, and AIDS-related deaths have dropped 40 percent, these statistics could be even lower.
CTV News is reporting that in a study published in the New England Journal of Medicine on World AIDS Day Tuesday, it was reported that using the anti-retroviral medication, Truvada, before and after having sex proved to be 86 percent effective in reducing the odds of contracting HIV.
We already know that the use of Truvada on a daily basis by people at high risk of contracting the AIDS virus, primarily those men who have sex with men, has proven to be nearly 99 percent effective, even when a dose was accidentally missed. But taking a pill every day seemed to present a challenge to many people.
“Everybody that was taking the pill as prescribed, they were protected,” said Dr. Cécile Tremblay, professor in the department of microbiology, infectious diseases and immunology at the Université de Montréal who led the Canadian arm of the study, according to the Globe and Mail.
A study of the "as needed" strategy
It is the use of an "as needed" strategy that prompted the new study. Researchers focused on 400 gay men and transgender women, high-risk individuals who had unprotected sex with two or more partners within a six-month period. The participants were broken down into two groups — a placebo group and a Truvada group.
According to the study, "Participants were told to take two pills before sex, a third pill 24 hours after having sex, and a fourth pill 24 hours after that. When sexual intercourse happened more often, participants were told to take one pill per day and then the two post-exposure pills."
The "as needed" strategy seemed to work. Participants who took the antiretroviral drug Truvada before and after sex were 86 percent less likely to contract the virus, compared to those in the placebo group. "Using anti-retroviral therapy reduces the amount of virus in that person as much as possible so they cannot transmit (HIV)," Robert Hogg of the BC Centre for Excellence in HIV/AIDS told CTV News on Tuesday.
World AIDS Day statistics
According to the World Health Organization (WHO), almost 16 million people, 11 million of them in Africa, are on anti-retroviral medication today, up from 700,000 in 2000. The bad news? Less than half of those infected with HIV/AIDS are getting any treatment, reports the Chicago Tribune.
Financial barriers are particularly daunting. Funding globally for fighting HIV was $21.7 billion this year. However, funding needs to increase by 50 percent to meet UN goals to eradicate HIV/AIDS by 2030. “The progress we’ve made against HIV/AIDS is so powerful that it’s easy to get lulled into a false sense of security about the size of the fight in front of us,” Erin Hohlfelder, ONE director of global health policy, said in a statement, according to U.S. News and World Report.
Another financial burden addressed in the study was the cost of treatment using Truvada. The medication currently runs about $1,400 per month, taking one pill every day. Gilead, the manufacturer of Truvada allows people to apply for a discount card that knocks off about $400 per prescription, and if someone has really good medical insurance, they can get by without paying anything.
However, in Canada, Truvada can be prescribed as a treatment for HIV and AIDS, but not as a prophylactic. While doctors can prescribe Truvada in an "off-label" capacity, using it as a preventative medication, many insurance companies will not approve it, although Dr. Tremblay says it’s different in Quebec because coverage is extended to off-label drugs.
Truvada will help in preventing the spread of HIV/AIDS, especially in people who engage in unprotected sex, but Truvada does nothing in protecting against other STDs, like gonorrhea, syphilis, or chlamydia infections. These "notifiable sexually transmittable diseases" have increased at an alarming rate in the U.S. and the UK.
But most notable is the increase in STDs in bisexual and gay men, a high-risk group. This was interesting because the rise in STDs means that these men were not using condoms. This points to more "risky behavior" among many in the high-risk group, thinking taking an anti-retroviral protects them from everything.
This study, "On-Demand Preexposure Prophylaxis in Men at High Risk for HIV-1 Infection," was published in the New England Journal of Medicine on Tuesday, December 1, 2015.
More about Truvada, prophylaxis, un plan, before and after pill, Condoms
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