Truvada and PrEP: The HIV Controversy

Truvada: It works, but doctors don't want to prescribe it.Have you ever heard of the HIV preventative drug Truvada? Many people haven’t. The reasons why may surprise you and are are the heart of a growing controversy in the medical field.

First things first: If you haven’t heard of Truvada, let’s fill you in. It is a combination of the drugs emtricitabine and tenofovir disoproxil fumarate. Studies have shown that when taken correctly, Truvada has cut the risk of contracting HIV for homosexual men by 90%. It’s also shown effective for women as well as transgendered men and women, but the studies on these groups have been smaller. Most people report no side effects, but the most common is (in approximately 10% of patients) gastrointestinal discomfort for the first few weeks.

Sounds great, right? Well, here are the details. The annual retail cost of taking Truvada is $13,000. Furthermore, the drug is only considered effective when it is taken every single day. This creates issues of affordability for many. However, there is another roadblock to regular distribution of this drug: an issue of morality.

The drug Truvada, as part of pre-exposure prophylaxis (PrEP), has for the most part been considered acceptable in certain cases, such as monogamous couples in which one person was HIV-positive. However, for those who may not wish to remain monogamous there has been a stigma assigned to those who wish to take the drug.

There is a growing movement to combat this stigma. Dr. Susan Buchbinder, director of HIV research for the San Francisco Department of Public Health states of Truvada, “It’s a really remarkable tool that we need to finally roll out so people can actually use it.”

Whether or not medical professionals have an aversion to prescribing the drug based on their moral beliefs, there is also the issue of the complexity of prescribing Truvada. Those who take the drug must submit to an initial HIV test, then have follow-ups every three months thereafter. Follow-up testing is required to make sure there are no other STIs and to check for signs of organ-damaging drug toxicity.

Clearly, there are many hurdles, both economical and social, to regular distribution of this seemingly life-saving drug. But the debate is clear: Should your physician’s attitudes and beliefs affect their recommendations to you as a patient? Would you like your doctor to tell you that you “shouldn’t” take a drug because he or she wouldn’t agree with your lifestyle if you took it?

A controversy, to be sure. What do you think? Share your thoughts with us below.

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