ZEITGUIDE “HEALTH” IMAGE BY KRISTOFER PORTER

If you had a high risk of getting cancer or Alzheimer’s, and there was a drug that you could take every day to reduce your chances by over 90%, would you take it?

Well, that’s the conversation happening right now about HIV, a disease that still infects about 50,000 new Americans each year.

Just two weeks ago, the U.S. Centers for Disease Control and Prevention issued guidelines for the preventative use of the HIV drug Truvada. It’s called PrEP, short for pre-exposure prophylaxis. Taken daily, PrEP decreases the risk of HIV infection by 92%. They recommend it for the 500,000 Americans at high risk for contracting HIV: those with infected partners, who share needles, or have non-monogamous sex without condoms.

It’s difficult to truly fathom that after so much safe-sex education, swaths of the population didn’t get the message. According to The Atlantic, only 60 percent of teenagers claim to use condoms. Another study published in the Journal of Sexual Medicine found that more than 90 percent of men over 50 didn’t use a condom when they last had sex with a date or casual acquaintance.

The CDC believes PrEP—which costs $13,000 a year per person and may be covered by insurance—could slow the spread of HIV, but not everyone is so sure.

Sean Strub, the founder of POZ Magazine and executive director of the Sero Project, which fights the stigmatization and criminalization of HIV is doubtful: ”Just because some people take PrEP it doesn’t necessarily mean we will reduce HIV transmission within the community,” he told us. “Obviously, not everyone at potential risk of infection is going to take it. If the compensating effect means many fewer people at risk will use condoms does that offset any gain from the relatively few who are on PrEP?”

The Los Angeles-based AIDS Healthcare Foundation outright objected to the CDC recommendation, worrying that fewer people will use condoms, which can prevent other sexually transmitted diseases, and that people won’t take the drug as directed. “This is a position I fear the CDC will come to regret,” president Michael Weinstein said in a statement.

Always a man of strong opinions, The Normal Heart (just released on HBO) playwright and activist Larry Kramer told The New York Times, “Anybody who voluntarily takes an antiviral every day has got to have rocks in their heads,” he said, given the side effects of drugs he’s been on. “There’s something to me cowardly about taking Truvada instead of using a condom. You’re taking a drug that is poison to you, and it has lessened your energy to fight, to get involved, to do anything.”

The known side effects, including bone demineralization and kidney issues, have even some doctors skeptical about writing unnecessary prescriptions. Our friend, Dr. Daniel Bowers who is a nationally recognized specialist for HIV/AIDS treatment, says PrEP should be offered to those who won’t use condoms and have addictive tendencies. It’s a form of harm reduction. “If patients can’t make the positive step of practicing safe sex, then it’s a great plan B. Take it every day, come in every two months for testing.”

There are other sides to the conversation as well: In a New York Times op-ed, Donald McNeil Jr. suggests that PrEp could produce a “new” sexual revolution, as the birth control pills did in the 60’s.

And then there’s the fact that the $6.5 billion that could be spent annually on prevention for the 500,000 high-risk Americans, could also be used towards the treatment of the 23.5 million in Sub-Saharan Africa living with HIV.

This conversation will definitely continue to unfold…

Keep Learning,

Brad Grossman

Creator, ZEITGUIDE
Founder, Grossman & Partners

These ZEITGUIDE Newsletters continue the narratives we explore in ZEITGUIDE 2014 and delve into the leading-edge issues we are exploring for our clients who want to stay on top of our constantly changing culture. If you are receiving our newsletter, that means you have been supporters of Grossman & Partners or purchasers of the ZEITGUIDE since its inception.

Follow this link to the article by Emma Jacobs about Grossman & Partners,  “Cultural Attache´ to Executives” in today’s Financial Times.