Antiretroviral prevention methods are not in competition, and policy makers and providers need to start to thinking about how antiretrovirals,pre-exposure prophylaxis and microbicides will be provided as part of a combination prevention package – and who will benefit most from each method, delegates heard at a satellite meeting on the opening day of the Sixth International AIDS Society Conference in Rome.
“You don’t want to have the family planning clinic here, the pills clinic here, the injections clinic here, and the microbicides clinic over here,“ said Dr Stephen Becker of the Bill and Melinda Gates Foundation.
Delegates were discussing the rapidly changing landscape of HIV prevention methods that use antiretroviral drugs.
“It’s very important not to pit prevention technologies against each other,” said Renée Ridzon of the Bill and Melinda Gates Foundation.
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I keep reading these insanely naive articles about PrEP with astonishment. Truvada is a drug that averages $11,000 a year. What makes anyone think that (a) Gilead is going to reduce the price to position is realistically as a prevention option, or that (b) insurance companies are suddenly going to start paying for preventive drug maintenance - something they have historically refused to do. And do the folks eagerly determined to push Truvada on sexually active people even read the warnings or list of potential side effects that come with the drug? The long term health risks are considerable. PrEp is hardly the miracle it's being touted to be. It's simply another way for Gilead (and any other pharmaceutical company that decides to go this route) to make more money off of fear and ignorance about HIV.
ReplyDeleteSomeone as sophisticated as you, anon, should know that some insurance companies are already covering PrEP. Glad you think you are so much smarter than thousands of scientists, advocates, trial participants, policy makers, and HIV prevention program implementers in countries all over the world who - based on tons of data - are optimistic about a new powerful tool in our prevention arsenal. This is a challenging intervention and no easy task to deploy smartly and strategically - for sure - but it's not insane. Insanity is doing the same thing over and over hoping for a different outcome, isn't it?
ReplyDeleteFYI, outside the U.S. in much of the world, Truvada costs about $100/yr. The high cost of Truvada in the U.S. is an enormous issue - and yes, must be addressed. The exorbitant costs Americans pay for all drugs is INSANE. One thing to remember - PrEP is NOT being seen as a lifelong intervention - most certainly it is time limited. People's prevention needs are not static - as their sex lives are not static - so the need for PrEP won't last anything close to a lifetime.... As with all drugs and medical interventions, ppl will need to do a risk/benefit analysis and determine for themselves whether the ratio works for them or not....
ReplyDeleteMr. Pickett, I am sure someone as sophisticated as you knows there are folks besides anonymous up there who have reasonable, legitimate concerns about PrEP as a prevention strategy. You are a high-profile prevention advocate for a major HIV/AIDS service organization, so it's rather shocking to see such a condescending response. It's clear you made up your mind a while back and have no patience for those who haven't jumped to the same conclusions already. I don't share all the same concerns as the original poster, but it's just way too early for people like you to be shutting down the debate.
ReplyDeleteI want to end this epidemic. We have a new tool that might help us turn the corner - in combination with a host of other prevention interventions as well as expanded access to testing, care, and treatment. Exciting, daunting stuff - and absolutely fraught.
ReplyDeleteAnon #2 - I would say that being caricatured as "insanely naive" is in fact an attempt to shut down the conversation. You, Anon #2 writing that I have "jumped to conclusions" tells me you think I haven't thought any of this through --- that's not a comment that really opens the dialogue, is it?
Is it dialogue you want?
"Jumping to conclusions" is hardly what I've done, and your assumption is condescending.
I have never used dismissive language to attack someone's genuine concerns. I have genuine concerns. So does every single PrEP advocate, PrEP scientist, and public health official considering PrEP.
There are lots of valid concerns, and significant challenges. For sure, let's talk about those. I am not aware of anyone who thinks this is a "miracle."
I just get a little snippy when those of us who are excited and energized about a powerful, effective new prevention tool, and are rolling up our sleeves to see how it may be deployed in the real world, outside of a clinical trial setting - are told that we are insanely naive and jumping to conclusions. Those are false assumptions and plain wrong.
I, as many, am committed to figuring out how to translate data showing PrEP works - among gay men in multiple countries, and now among heterosexual Africans in a number of countries on the continent - into smart, strategic interventions that have individual benefit and public health impact. It's a heavy lift.
I want to be part of changing the trajectory of this nasty epidemic - so let's have those discussions.