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Not Just Rubbers for Lovers: HIV Prevention Beyond Latex

With the recent discussion of circumcision as the new "it" method of prevention, I thought it was important to give an update on methods of HIV prevention that are currently being developed that don't rely on the state interfering with our anatomy.


PEP stands for Post Exposure Prophylaxis. What this means, is that there is medicine (Truvada) that you can take after a potentially risky sexual encounter that may have exposed you to HIV. For example, barebacking, condom breaks, sexual assault, etc. PEP started out as something that was available to health professionals after something like a needle stick, but someone got the brilliant idea of sharing with non-health professionals too. The idea is kind of similar to Emergency Contraception in that by taking it soon after the risky sexual experience, you may be able to prevent infection. PEP should be available from your Dr., but is also available at places like Fenway Community Health and an emergency room like MGH. Before being prescribed PEP, the Dr. will give you a syphilis and an HIV test (both require blood being drawn). You take Truvada for about a month, and then consult back with your Dr. Truvada does have some side effects, like diarrhea, sleeplessness, etc. but it's different for everybody. As for price, it can be kind of expensive. Fortunately, you should be able to get it for little or no money through your insurance, or through HDAP. One thing you should be aware of, is that if you go through private insurance, your insurance company will know that you took PEP, which some people may be uncomfortable with. So, some people choose to go through HDAP even if you do have private insurance, but then that means the state government knows you took PEP, which may also make people uncomfortable. There has been some initial research on PEP, unfortunately, I don't have any numbers with me at the moment. It's definitely not 100% effective, so this is not something to rely on. But, at the moment, it's the only thing available to reduce risk after sex.


PrEP is kind of similar to PEP in that it requires taking antiretroviral medication. The biggest difference between PrEP and PEP is that little "r" between the first "P" and the "E." PrEP stands for Pre-Exposure Prophylaxis as opposed to Post. PrEP is even more in the initial stages of development than PEP. Some new studies have begun to look at PrEP as an effective means of prevention, but as far as I know, nothing has been concluded yet. But, this may be a good option to keep a look out for in the future. Some problems with PrEP, like PEP, are the side effects, the difficulty of taking pills daily, the expense, etc. Some people are worried that it may increase risk behavior because people will think they're immune. What do other people think? Is this a legitimate concern?


To start with, some marketing people need to come up with a sexier name for this. But that's not the point at the moment. Personally, I think microbicides are exciting no matter what you call them, but that might just be me. Microbicides are kind of like a lube that can be used before sex to serve as a sort of "chemical condom" (again, not very sexy) that could prevent HIV transmission, and maybe pregnancy. Like PrEP, this is still very much in the testing stages and is not yet available for public use. Microbicides can either be vaginal or rectal, meaning they can be used in the vagina, or up the butt by anyone engaging in anal sex. The idea is that it could potentially be empowering for receptive (bottom) sex partners so that they don't have to rely on the insertive (top) partners to put on condoms. The "female" condom came about for similar reasons about 20 years ago. Again, this is still in development, so nothing's available just yet, but keep your eyes peeled. Microbicides may be the new circumcision one day.


Don't get too excited... there's nothing concrete in this section just yet. But, it is something that is in the process of being developed. Mostly by large, generally evil, pharmaceutical companies. But, an HIV vaccine could potentially put an end to the epidemic. There are a number of concerns about the politics surrounding HIV vaccines. One, is that these large, generally evil, pharmaceuticals have little incentive to invest much in vaccine research because it could mean the end of making and selling and profiting off their HIV meds. There's also the concern that once a vaccine is found, people who are already HIV positive would become (even more) forgotten. But, these concerns aside for the moment, a vaccine would be incredible.

What can I do?

Get involved in research! So much of this stuff is so new that we really know very little about it. Places like Fenway, MGH, Brigham & Women's, etc. are all researching some, or all, of these things. All studies involve financial compensation and can help stop the epidemic!


Anonymous said...

"in the vagina by a woman, or up the butt by anyone engaging in anal sex."

I know you didn't mean it this way, but I think it is very important that we are very careful with language when talking about safer sex. Many FTMs (and genderqueer people as well) are unaware of the risks of front-hole/vaginal sex, and their health care providers often fail to tell them about the risks because they assume that FTMs do not have front-hole/vaginal sex.

I think it's really important that we are very clear with our language so that people are able to understand their risk better no matter what information they access. That's why I try to be very careful when educating about vaginal sex to not use language that assumes that only women have vaginas.

alex said...

duly noted and corrected. thank you!

Anonymous said...

Thanks, Alex!