Truvada as Prep: Can the End of AIDS be in Sight?

Truvada-and-toast

HIV/AIDS may soon be wiped out. Imagine those dreamy, utopian words being uttered in 1984? The past’s distant fantasy could now plausibly become reality, thanks to a wonder drug that comes in a blue pill, called ‘Truvada.’ Truvada, while a story of miracles, is also one of obstacles and controversies. Our story on the topic, shot in New York City and Berlin, aired on 3sat/Nano on December 1, 2015, and can be seen here.

Thanks to previous advances, AIDS is no longer an automatic death sentence and has ceased to pervade the collective psyche and popular culture. But young people and people of color still get infected at alarming numbers. But Truvada can be the big game changer. Developed originally by Pharma-giant Gilead Sciences as part of a post-infection AIDS therapy, it was later discovered that Truvada also works as Pre-Exposure Prophylaxis’ – commonly referred to by its acronym ‘PREP.’ Indeed, if taken 7 days a week, Truvada is 99% effective in preventing HIV transmission, according to a major clinical trial.

Miracle blue pill?

Miracle blue pill?

Truvada has become an integral part of AIDS-prevention strategies in a number of major U.S. Cities, particularly San Francisco and New York, but at the time of filming knowledge of PREP was sparse in the general public, and not even a household word by many of those most acutely at risk.

Dr. Howard Grossman, a prominent Manhattan physician, regularly prescribes Truvada and reports that not a single patient on the drug has contracted HIV. For the first time, he believes that HIV/AIDS can be wiped eradicated, given Truvada and effective AIDS treatments.

AIDS-activist Damon Jacobs is Dr. Grossman’s patient. Damon shares his Truvada ritual for the camera, taking his daily “blue pill” with his breakfast cereal and toast. Truvada is empowering for Damon because he is no longer dependent on his partners wearing a condom to keep safe. Damon started and administers a Facebook group informing people about Truvada. His mission is to get the word out. His shirt says it all: ‘Prep Warrior.’

Surprisingly, Damon finds Prep to be a tough sell in the gay community.

Surprisingly, Damon finds Prep to be a tough sell in the gay community.

Damon tells us that most gay men don’t wear condoms; he doesn’t lecture them that they should. He believes that people can decide for themselves if PREP is protection enough. This viewpoint is controversial, with accusations flying that Truvada is being used as a party drug. Others in the gay community refuse to take the drug because they believe that doing so would show a lack of solidarity with those already infected.

Dr. Howard Grossman and ‘Prep Warrior’ Damon Jacobs

HIV/AIDS is particularly still a health crisis in low income communities such as the Bronx. We visited ‘BOOM Health’ in the Bronx which provides Truvada to the community and also engages in community outreach to get the word out about PREP, filming a group of young volunteers candidly discussing PREP. There is a particular stigma in minority communities about discussing sexuality, let alone particular treatments.

The kids at Boom Health in the Bronx candidly discuss Prep and sex without condoms.

Returning to Berlin, we learned of an entirely different set of obstacles for Prep in Germany. Gilead has not even applied to the EU for Truvada to be used prophylactically. Just why is not clear.

Truvada is neither well known nor readily available in Germany.

Truvada is neither well known nor readily available in Germany.

As a consequence, one can get Prep in Germany only one of two ways – either to be part of a clinical trial, or to pay an economically prohibitive 860 euros a month. This is frustrating to Berlin physician Heiko Jessen, who has to break the news to many young patients in their 20’s that they are HIV-positive.

Berlin physician and Prep advocate Heiko Jessen breaking the news to a patient that the drug costs a fortune.

Will Truvada/Prep be the final word in stamping out HIV/AIDS, or will controversy and cost limit a panacea’s potential?