Advocating Pill, U.S. Signals Shift to Prevent AIDS

Federal health officials recommended that hundreds of thousands of Americans at risk for AIDS take a daily pill shown to prevent infection with the virus that causes it.

Comments: 207

  1. I think that this will give people a false sense of security and it could help to spread the disease. I don't think people will follow through with the HIV testing every 3 months and be responsible, many high risk people are not. I doubt that many people will continue to use a condom, I believe that they will feel the drug liberates them from that.

  2. I think that this will give people a false sense of security and it could help to spread the disease. I don't think people will follow through with the HIV testing every 3 months and be responsible, many high risk people are not. I doubt that many people will continue to use a condom, I believe that they will feel the drug liberates them from that.

  3. Very True! This drug costs $13,000 a year, taxpayers will foot the bill, are we asking the taxpayers to subsidize high-risk behavior by certain individuals ?? this looks more like successful lobbying by the drug company!

  4. Good move by the CDC. The public should be made aware of everything in the prevention toolkit, and this helps immensely. Its a personal choice by each person whether or not to take Truvada, and having the information out there is a good thing.

  5. Good move by the CDC. The public should be made aware of everything in the prevention toolkit, and this helps immensely. Its a personal choice by each person whether or not to take Truvada, and having the information out there is a good thing.

  6. "It would mean a 50-fold increase in the number of prescriptions for the drug, Truvada — to 500,000 a year from fewer than 10,000. The drug costs $13,000 a year."

    That's $6.5 billion a year. What is the cost of Truvada in other countries?

    "Generic versions are made in India, and it has become the backbone of AIDS treatment in poor countries." What is the cost of production and cost to the patient for the generic version?

    "While many antiretroviral drugs could in theory be used for PrEP, the only pill approved for that purpose by the Food and Drug Administration is Truvada, made by Gilead Sciences."

    Perhaps instead of hearing on Benghazi, Congress should hold hearing on drug costs and the cost of production. And the FDA should actively look for less expensive antiretroviral drugs to test.

  7. "It would mean a 50-fold increase in the number of prescriptions for the drug, Truvada — to 500,000 a year from fewer than 10,000. The drug costs $13,000 a year."

    That's $6.5 billion a year. What is the cost of Truvada in other countries?

    "Generic versions are made in India, and it has become the backbone of AIDS treatment in poor countries." What is the cost of production and cost to the patient for the generic version?

    "While many antiretroviral drugs could in theory be used for PrEP, the only pill approved for that purpose by the Food and Drug Administration is Truvada, made by Gilead Sciences."

    Perhaps instead of hearing on Benghazi, Congress should hold hearing on drug costs and the cost of production. And the FDA should actively look for less expensive antiretroviral drugs to test.

  8. Generic in India is a bit over $1 per pill.

  9. few million dollars in lobbying gets you million times more in returns!

  10. But I am curious, did the Indian company which makes the generic invent the drug? Do the research necessary to bring it to market safely? And what life saving and life altering drug does THAT company have in the pipeline? I am going to guess...none. The fact is, you are not just paying for the drug..you are paying for research for pipeline medications. I'll take it.

  11. Having any type of prophylaxis to a terrifying disease like AIDS is a positive step, but I think this specific treatment will have limited impact. A large share of the population for whom this drug is meant are those who have the least access to health care, are among the most likely to be uninsured, and cannot themselves afford a $13k prescription.

    Likewise, a good share of this population is more likely to be uninformed about their health status specifically and preventative health generally. The reduced transmission effect only holds true among individuals who take the pill every day. This may provide false comfort among those who don't understand the significance of missing even a single pill. Indeed, this regimen may make people more vulnerable to AIDS and other equally terrifying diseases by reducing emphasis on other preventative measures (i.e., if one treats this pill as a license to forgo condoms or share needles).

    It's a start, but not everyone will have access, and those who do should explicitly understand its limits and tread cautiously. If one makes a mistake and gets a disease like AIDS, that mistake cannot be undone.

  12. Having any type of prophylaxis to a terrifying disease like AIDS is a positive step, but I think this specific treatment will have limited impact. A large share of the population for whom this drug is meant are those who have the least access to health care, are among the most likely to be uninsured, and cannot themselves afford a $13k prescription.

    Likewise, a good share of this population is more likely to be uninformed about their health status specifically and preventative health generally. The reduced transmission effect only holds true among individuals who take the pill every day. This may provide false comfort among those who don't understand the significance of missing even a single pill. Indeed, this regimen may make people more vulnerable to AIDS and other equally terrifying diseases by reducing emphasis on other preventative measures (i.e., if one treats this pill as a license to forgo condoms or share needles).

    It's a start, but not everyone will have access, and those who do should explicitly understand its limits and tread cautiously. If one makes a mistake and gets a disease like AIDS, that mistake cannot be undone.

  13. I agree with many of your points but it is not accurate that the "reduced transmission effect only holds true among individuals who take the pill every day."

    The CDC guidelines released today report an estimated 99% reduction in HIV risk for 7 doses per week (full adherence), 96% for 4 doses per week, and even 76% for 2 doses per week."

  14. I have used it. Am HIV + and at time this pill was part of my "Cocktail".
    Help hold me on, but
    The most difficult drug to take: Bad Side Effects!
    I was very glad to go to newer drugs, less side effects. I guess Truvada contains something that is "PROVEN" to help avoid HIV - My suggestion to try First and check to see if you can tolerate it -
    you should not just stop abruptly! -
    And most: do not walk careless in the Jungle; to prevent getting infected we got, how sad, to behave in restricted ways.
    .. Hope it should go away in my Lifetime!
    Amen

  15. I have used it. Am HIV + and at time this pill was part of my "Cocktail".
    Help hold me on, but
    The most difficult drug to take: Bad Side Effects!
    I was very glad to go to newer drugs, less side effects. I guess Truvada contains something that is "PROVEN" to help avoid HIV - My suggestion to try First and check to see if you can tolerate it -
    you should not just stop abruptly! -
    And most: do not walk careless in the Jungle; to prevent getting infected we got, how sad, to behave in restricted ways.
    .. Hope it should go away in my Lifetime!
    Amen

  16. i must wonder if you are mistaken, i am on Truvada for six years now as part of my treatment. i note no side effects from it, and Truvada has long been considered a very-low-side-effects medication.

    less than 1 in 200 people show any signs of serious side effects, all of which are quickly reversible. i know of absolutely no HIV Medication Guides or activists who would ever call Truvada "the most difficult drug to take: Bad Side Effects!"

    are you sure you're not really referring to Sustiva or Atripla (the latter a 3-drug combo pill of Sustiva and Truvada) ?

  17. Yeah, Dr. Ben Carson reports that expenditures in the first few months in the ACA for HIV drugs are already 400% higher than in the general healthcare industry, and now these folks are going to have us all pay for their "Preventative" drugs too. Just great.

  18. That would be Dr. Ben Carson, the well known homophobe?

  19. Ben Carson? Yeah, right. Now there is a neutral source of information. (sarcasm).

  20. Yeah, Dr. Ben Carson reports that expenditures in the first few months in the ACA for HIV drugs are already 400% higher than in the general healthcare industry, and now these folks are going to have us all pay for their "Preventative" drugs too. Just great.

  21. That would be Dr. Ben Carson, the well known homophobe?

  22. Ben Carson? Yeah, right. Now there is a neutral source of information. (sarcasm).

  23. Just remember - if someone gets HIV - AIDS - we pay for the treatment and it spreading. Realizing that, Truvada is cheap. Also the price is a good deal dependent on Congressional (Republican driven) rules preventing the government negotiating a low price

  24. Anything that increases high-risk individuals' awareness of the risks they face will tend to change their behavior. For that purpose, sugar pills would work as well as expensive drugs.

    Therefore, "Truvada" would probably help whether or not HLTV-III (as named by Gallo in 1984) causes AIDS.

  25. Anything that increases high-risk individuals' awareness of the risks they face will tend to change their behavior. For that purpose, sugar pills would work as well as expensive drugs.

    Therefore, "Truvada" would probably help whether or not HLTV-III (as named by Gallo in 1984) causes AIDS.

  26. On that same basis, "Prayer" is even cheaper!

  27. There should be some mechanism for conditioning CDC endorsement on negotiating with Gilead Sciences lowering the price so their profits merely double instead of being multiplied fifty-fold. Perhaps $7 a pill instead of $35.

    I'm sure that in India the cost is well under $1. There is no reason to burden the entire healthcare system with obscene profits for merely combining two existing drugs and running clinical trials.

  28. There should be some mechanism for conditioning CDC endorsement on negotiating with Gilead Sciences lowering the price so their profits merely double instead of being multiplied fifty-fold. Perhaps $7 a pill instead of $35.

    I'm sure that in India the cost is well under $1. There is no reason to burden the entire healthcare system with obscene profits for merely combining two existing drugs and running clinical trials.

  29. I understand your point about combining two existing drugs, but in this case the two existing drugs are individually still under patent, so, for now, the total cost is the same whether you get them separately or combined in one pill.

  30. At what point do we start accepting responsibility for our actions? If you are engaging in high-risk sexual behavior and you aren't wearing a condom, I really don't have pity for you if you end up contracting HIV. This cocktail costs $13,000 a year and you can believe that people will not be paying out-of-pocket for this. We are effectively asking the taxpaying public to subsidize high-risk behavior by certain individuals who can't be bothered taking simple precautions to avoid disease.

  31. At what point do we start accepting responsibility for our actions? If you are engaging in high-risk sexual behavior and you aren't wearing a condom, I really don't have pity for you if you end up contracting HIV. This cocktail costs $13,000 a year and you can believe that people will not be paying out-of-pocket for this. We are effectively asking the taxpaying public to subsidize high-risk behavior by certain individuals who can't be bothered taking simple precautions to avoid disease.

  32. None of us are angels, I do have some pity.

    "Every saint has a past and every sinner a future." -Oscar Wilde

  33. Not just that, but--why would people voluntarily put themselves in such a position, i.e., of opting for the pill coupled with unprotected sex? Think of the possibility of unknown side effects or effects on the body from years of using the med, which we won't know statistically for some time into the future. People should opt for avoiding the practices and behavior that can lead to contracting the virus instead, IMO.

  34. "None of us are angels, I do have some pity."

    The difficulty is that if resources are limited then giving more to A means giving less to B. And if B is more deserving (or less costly to help) then it is not an ethical choice to help A. If you are paying from your own wallet, it is your business, but if you are paying taxpayer dollars, and are saying that someone should be denied a college education so someone else can have expensive treatment then you really have to refer to more than your personal pity.

    I think that a lot of Americans have not learned to accept that resources are limited but with global warming, the earth is about to tell us that "Yes they are limited".

    Bernard Shaw once said that America would be the first nation to drive to the poorhouse in an automobile. He could not have known how prescient he would be.

    We are spending money on expensive treatments for people who did not practice safe sex, and cutting food stamps. What CAN be said about us as a nation?

    CK's answer seems to be "It means we are compassionate."

  35. Isn't IV drug use a serious crime? Isn't knowingly spreading a deadly disease a serious crime? What next, at a grand a month each we hire limos for alcoholics so that they won't wreck their cars on weekend nights?

    An effective drug for some AIDS prevention is great, but charging an insurance pool $13K a year so a junkie can further put off quitting or seeking treatment, or so that gratuitous sexual entertainment is more carefree, seems like warped thinking and a free lunch the public should not bear.

  36. Isn't IV drug use a serious crime? Isn't knowingly spreading a deadly disease a serious crime? What next, at a grand a month each we hire limos for alcoholics so that they won't wreck their cars on weekend nights?

    An effective drug for some AIDS prevention is great, but charging an insurance pool $13K a year so a junkie can further put off quitting or seeking treatment, or so that gratuitous sexual entertainment is more carefree, seems like warped thinking and a free lunch the public should not bear.

  37. Actually, taxi rides home for alcoholics would save tens of thousands of lives, hundreds of thousands disabling injuries and billions of dollars EVERY YEAR!

  38. This is "pull yourself up by your boot straps," kind of thinking, nobody grows up with the intent of becoming a "junkie" and/or becoming infected by HIV, unless you want to live in a society where you allow your fellow citizen to die and suffer, because you're not willing to accept that they either have a disease or addiction over which they have no control, then I think you are being quite cruel, there needs to be safety net to rescue those whom have nobody else to rely on except the supposed goodness of their fellow man.

  39. Truvada...quo vadis? Insurance pays for the $13,000 bill each year and we get to chip in with higher premiums, just so that certain guys don't have to don a condom.

  40. Truvada...quo vadis? Insurance pays for the $13,000 bill each year and we get to chip in with higher premiums, just so that certain guys don't have to don a condom.

  41. I don't pretend to know what the best approach is, and from the article it appears that there isn't consensus even among health experts. Isn't it better that we should let a doctor decide after consulting with the patient rather than banning a preventive treatment outright? Or we can take your approach and ban the drug for prophylactic use and then pay for someone's lifetime of HIV drug cocktails.

  42. WE pay if AIDS much more if AIDS spreads. I pay for your breast and cervical cancer, your pay for my prostate and cardiac problems. That is how insurance, community, and compassion work.

  43. Insurance companies should pay if a person is in a relationship with someone with AIDS as condoms are not perfect and this is double indemnity. And obviously support its distribution for anyone with HIVAIDS but to support the distribution of a $13,000 a year drug because men don't like using condoms leaves me cold. If you don't want to use condoms pay for the drug yourself. I had BC, with radiation, and now live with ugly spider veins on that breast as a result of the radiation. Insurance won't cover the one-time fee of $500 to $1,000 to remove them, calling it cosmetic. That most insurance companies cover Truvade in lieu of condom use (as suggested in the article) says it's that male/female thing at work again--males sympathetic to other males and no understanding whatsoever of women's needs. Use condoms and send the money to Africa to help the tens of thousands of women who have AIDS.

  44. Insurance companies should pay if a person is in a relationship with someone with AIDS as condoms are not perfect and this is double indemnity. And obviously support its distribution for anyone with HIVAIDS but to support the distribution of a $13,000 a year drug because men don't like using condoms leaves me cold. If you don't want to use condoms pay for the drug yourself. I had BC, with radiation, and now live with ugly spider veins on that breast as a result of the radiation. Insurance won't cover the one-time fee of $500 to $1,000 to remove them, calling it cosmetic. That most insurance companies cover Truvade in lieu of condom use (as suggested in the article) says it's that male/female thing at work again--males sympathetic to other males and no understanding whatsoever of women's needs. Use condoms and send the money to Africa to help the tens of thousands of women who have AIDS.

  45. The iPrEX study, the basis for PrEP approval among MSM, found the average person did not become more risk taking after starting PrEP (ie. absent sexual risk compensation). Hence, the idea that people are using PrEP in lieu of condoms does not hold up to scrutiny, at least as of yet.

  46. While the prophylactic strategy appears sound, a major question when large numbers of people take a drug for long periods of time is the potential environmental effect. These drugs and their metabolites are excreted by humans into the environment, raising the question of whether there will be adverse effects on humans due to passive environmental exposure over time.

  47. While the prophylactic strategy appears sound, a major question when large numbers of people take a drug for long periods of time is the potential environmental effect. These drugs and their metabolites are excreted by humans into the environment, raising the question of whether there will be adverse effects on humans due to passive environmental exposure over time.

  48. Patients should approach any pill bearing these side effects and at this cost with very great care. And lest we forget, there are some strains of gonorrhea that have become resistant to every antibiotic.

    We really need HIV and gonorrhea vaccines. And every boy should be vaccinated against HPV before the age of sexual activity. Men (gay or straight) can contract this virus and they can spread it.

  49. HIV PrEP is not only the first bio-medical HIV transmission prevention, but it is also the first that gives full control to the receptive partner.

    Speaking Efficacy vs Adherence:
    PrEP's efficacy drops with the decrease of 'in-body drug levels' based on lessened adherence. These drug levels decrease over time and not momentarily from 100% to 0%.
    Condom efficacy however drops from 70% (Efficacy of Condoms at CROI 2013) to 0% when not being used - aka momentarily.
    If we were to compare PrEP vs Condom efficacy with equal adherence, based on a model of anal/vaginal sex once a day per week:
    7pills/week = 99%, 7condoms = 70%
    4pills/week = 96%, 4condoms = 40%
    2pills/week = 76%, 2condoms = 20%
    While the current pill form of PrEP is already a revolutionary bio-medical option, the studies continue with long-acting injectable options.

    Further, PrEP protects the whole body and not just the penis, vagina or anus. It does not protect against other STIs, but requires regular testing. Regular testing remains to be one of the most powerful prevention methods for all STIs - we can only treat an STI when we know it is there and with that treatment we brake the transmission chain.

    The cost effectiveness of PrEP is a much needed dialogue, and Gilead / producers of future PrEP approved ARV must be included in these conversations.
    While Michael Weinstein has rendered himself irrelevant as he continues to nourish stigma and discrimination with polemic, moralizing and misinformed statements.

  50. Why should taxpayers pick up the tab for a disease that can, for the most part, be avoided by behavioral changes?

  51. Hi Joe,

    I'm a microbiologist, and future clinician.

    There are a couple great reasons we should. To start, you're going to be paying the tab either way. When someone contracts HIV, and later AIDs, we don't just let them die. We pay for that person's treatment for the rest of his/her life, which can be quite a long time.

    The treatment not only includes the drugs mentioned in the article, it includes three more drugs which are equally expensive.

    What's more, if we pony up the money now there is a possibility of reaching 0 new cases/yr within our lifetimes. What many people don't know about HIV is that the chances of catching it during an individual encounter (even with high risk anal sex) are tiny. With the addition of two anti-virals found in truvada (assuming they are properly taken), the chances become infinitesimal.

    This means we might be able to eliminate HIV from our country within our lifetime (no new cases, and the old patients die gradually), while saving ourselves money that we would otherwise spend treating patients later.

  52. You could say that about a number of diseases, such as type 2 diabetes and several types of heart disease, not to mention illnesses caused by smoking.

  53. Do you ask the same question about heart disease, diabetes type II, hypertension liver transplants, renal dialysis and some other diseases that in many instances can be avoided?

  54. This is wonderful news and common sense, but it does bring to the forefront an often overlooked issue in the treatment and prevention of HIV and AIDS, the high cost of medications, not to mention side effects and in many instances having to take them for the rest of your life.

    I guess you can't blame for-profit pharmaceutical companies for developing drugs, that although extremely beneficial, will be required in perpetuity.

    However, why aren't the NIH and other government research branches around the world spending more resources on finding an HIV vaccine? I mean, seriously, what about places like Africa, where running water often is a luxury and entire populations are being decimated by AIDS? Do you really think that these governments will be able to afford $13,000 per year for drugs for a single patient?

  55. John, are you aware of Michael Weinstein's efforts to stop Vaccine Research in favor or providing more treatment?
    http://www.aidshealth.org/archives/news/hiv-vaccine-funding

    Oh and this one where new opened AHF centers are listed:
    (somehow they are all about testing and treatment and not at all about prevention)
    http://investing.businessweek.com/research/stocks/private/snapshot.asp?p...

    Funding for vaccine research has to be increased, but we must tackle this from every angle possible. ART is more expensive than prevention and with 50,000 new transmissions per year we are running out of time and money.

  56. I think vilifying the NIH, pharmaceutical companies, and other governmental agencies is ludicrous when you think about the fact that one can make a choice to just. use. condoms.

  57. You're absolutely right about the high cost of HIV meds. However, these medicines do not cost tens of thousands of dollars in Africa.

    The developed world gets their drugs from India, either in violation of developed world patents or under special license. Daily Truvada in South Africa would cost about $50/month or $600/year. Still expensive but not astronomical.

    Note that the Trans Pacific Partnership, a multi-nation trade agreement currently under negotiation, could potentially end the 'India pipeline' for pharmaceuticals to the developed world as Big Pharma lobbies hard for strict patent protections. This would be devastating.

  58. HIV is, literally, an evolution machine. Antiretrovirals of any nature constitute a selection pressure driving emergence of multiple-drug resistance and/or increased virulence. On the population level, at which epidemic dynamics are determined, treatment is not prevention. We are using up our emergency oxygen rather than escaping the stifling policy traps of marginalization that drive population-level patterns of susceptibility. More drugs = faster evolution of MDR-HIV. Then what?
    Rodrick Wallace, PhD
    Division of Epidemiology
    NYSPI at Columbia University

  59. You are misinformed.

    Transmission rates between HIV negative and HIV positive
    couples, where the positive partner was on treatment and had
    an undetectable viral load approach zero . That is one example of
    treatment as prevention.

    The second example is denying HIV introduced to individuals on
    PREP an opportunity to replicate and seed reservoirs that become
    impossible to eradicate. That is also treatment as prevention.

    With respect to selective pressure I suggest you reinform yourself
    on the number of mutations necessary for HIV to hurdle modern triple drug class
    therapy. It's possible of course. But more drugs means less iterations and therefore less possibility of mutations.

    By the way I also went to Columbia. My degree is in math.

  60. I would be interested in your thoughts on a vaccine, from the limited exposure I have to virology, I understand it is extremely difficult to develop an HIV subunit vaccine, primarily due to the shifting protein structure of the HIV surface layer, but maybe a new and novel approach could solve this problem and how do you think this might affect the epidemiology of HIV?

  61. I also went to Columbia, and, when greed dictates "science," as it seems to for people like Rodrick Wallace, well, that makes me question the value of the degree I got nearly 50 years ago. While he's right that HIV does create new immunities, and HIV treatment is rarely the-same-thing-for-the-rest-of-your life, there are already over 40 alternative treatments, tested, approved, and active in the field. Perhaps the real problem is the poor reporting in the Times.

  62. Many commenters here appear suspicious that PrEP users will treat PrEP as a license to increase their risk behavior (ie. use condoms less, having more sex partners). But despite its intuitiveness, consistently this has not held up to scrutiny. The iPrEX study, the basis for FDA approval of PrEP, reported that MSM (men who have sex with men) on average were no more risky after starting the regimen. Skeptics argued this was because self-report was used to measure risk change. In response, to counter the purported influence of social-desirability bias, the iPrEX group examined syphilis incidence among PrEP users, because PrEP does not protect against the STI and higher sexual risk-taking would manifest in increased syphilis diagnosis. But even then syphilis incidence held steady.

    There are many reasons to be concerned about PrEP or skeptical that it will live up to its promise, including limited insurance coverage among those in greatest need (eg. MSM of color, MSM aged 18-30) and reluctance to taking a daily drug that is non-essential to health. But sexual risk compensation is probably not one them, not only because of the absence of demonstrated risk compensation, but also because most PrEP providers enroll their patients in sexual risk reduction counseling when they check in for their mandatory HIV test every 3 months, in a policy strongly recommended by the CDC dating back to 2011.

  63. Commenters don't have to "appear suspicious". It has already been proven by numerous gay porn companies that have suddenly embraced PReP as an excuse to drop the condom use from their videos, which time and time again they vehemently opposed, calling barebackers killers. Of course, the namecalling is less now that they themselves are into it. Truvada is a licence to kill, and die.

  64. That's not exactly amateur commentary. Do you have any financial ties to Gilead? What is your relationship to the drug, its makers and its statistics?

  65. Is it possible there was no change in risk because men who choose to go on PReP were likely to not be using condoms in the first place?

    Considering cost, side effects and risk of other STDs (and the questions around drug-resistant strains of those STDs), I will stick with condoms. If I was in a relationship with an HIV-positive person, I would consider PReP. And I'm glad it's available to those people who don't use condoms, for whatever reason.

  66. I hope this doesn't lead to HIV resistance to Truvada by patients who only intermittently take their meds.

  67. The fact that the drug is available for healthcare providers to prescribe does not necessarily mean that it's available to the general public. Risk of exposure exists even with the safest of encounters. Unfortunately, in my personal experience as a well-insured healthcare consumer, doctors are unfamiliar and combined with the perceived increase in high risk behavior, are reluctant to prescribe this medication. Especially so for those who don't currently engage in high risk behaviors.

  68. HIV is an unusual infectious disease. Although communicable, although epidemic, it isn’t explosively infectious. Not only must contact be intimate but not every intimate contact results in infection. Use it. Anything that disrupts the one to one vectors upon which the spread of this disease depends pays exponential benefits.

    Wider use of a prophylactic meds in tandem with a continuing strategy of safe sex practices, including condoms, offers potential to so disrupt the epidemic as to isolate the disease and make outbreaks rare.

    Two underreported and probably underappreciated attributes of the epidemic among gay men are the initial high risk to young people on first becoming sexually active and a concurrent increased risk due to long term weariness that sets in years later among some men including those who, on coming out of safe monogamous relationships, are susceptible to complacency about safe practices. There’s always a new wave of young people becoming sexually active. Prior year education, however successful, has no impact. For this population it is a continuing fresh start. While more complicated, even obscure, so it is among fluid cohorts of older gay men whose circumstances change.

    Most gay men go through extended periods of un-risky or negligible risk behavior.

    Anyone whose behavior warrants this drug should get it. Protecting them is entirely worthy in itself while protecting countless other people.

  69. There never was any good reason to recommend it only for gay men. I suspect one reason for the shift is that the most of the current PrEP demonstration problems have been failures and CDC is hoping that casting a broader net will attract more users. PrEP's advocates have tended to look at it as a "magic bullet" without much consideration to practical aspects of implementation like financing and adherence. The pills are not without suide effects although these tend to be less frequent and impairing than older drugs, but they remain a problem for some people. Another consideration is that if someone forgets a dose here or there and doesn't notice the difference, it becomes easy to be non-adherent. Consistent adherence is essential to this drug having an effect and the circumstances under which ad hoc usage is protective have not been demonstrated. Someone saying to a new sex partner that they're on PrEP probably is not useful unless they can demonstrate consistent use (something unlikely to be discussed in the heat of an encounter). There continues to be a great deal of misinformation about antiretrovirals which inhibits people from exploring PrEP, but the implementation has been exceedingly naive about the actual willingness of people to use the drug in the way that is necessary for it to be effective and some key questions like ad hoc usage have not been answered.

  70. PEP (post exposure prophylaxis) is the same treatment for about a week as the PrEP treated here. Why doesn't the TIMES cover the whole story in one place???

  71. Given the choice under limited funds, it is clearly unethical to help a "decadent" medical victim before an "innocent" one. Anyone disagree?

    In this case the help proposed is a not insignificant $6,500,000,000.00 per year, out of the insurance pool. Unless funds are bottomless, more-innocent medical victims have to die, if money is directed as proposed here. I don't understand how we look askance at the obvious personal responsibility issue inherent in funding this medication over others.

  72. I disagree. You did not consider the cost of new infections that need to be treated for a lifetime.

  73. By all means, let's stop treating the "decadent." Why stop with people who want to supplement their condom use with a medication that will prevent them from contracting a life-changing virus? Let's also stop treating people who eat fatty foods, smokers, people who don't exercise, drunk and distracted drivers, teenagers who get injured in fights, pregnant women, impotent men, petty criminals, people suffering from the disease of addiction, people who risk cancer from not eating enough fiber or berries or eating charred meat, off-trail skiers, people who don't check for ticks, people who lie out in the sun too long, people who trip on the sidewalk while they're texting, and children who climb too high on the jungle gym when their mom told them not to. You'll be the only "innocent" person left. Enjoy.

  74. And, at $400,000 per case from diagnosis to death, think of the alternative costs in a broader spectrum. Particularly when somebody is smart enough to start a "Dallas Buyers Club" for PREVENTION!

  75. So Medicaid is paying 13000 a year to allow people to not wear condoms?

  76. Do you complain about Medicaid paying for people to smoke, eat junk food and drink?

  77. to DR-- Yes, i do.

  78. To Dr:

    Medicaid doesn't pay for primary care doctors to provide counseling on dieting and exercise or smoking cessation.

  79. This sems costly. Why not just use condoms and curb the risky behavior? HIV is a virus and can change, could there be a HIV form that develops immunity to Truvada? Not sure if this promotes risky behavior, but at risk groups need to still wrap it up. What risk are associated with using this drug?
    I was born in the mid 1980s. I believe my generation and the younger kids missed the whole HIV/AIDS epidemic. So many young people don't use condoms. A lot of people hardly ever get std test regularly. I'm sure someone that lived thru the epidemic, or seen love ones dying from it probably have no issues using condoms.

  80. Did you actually read the article? Obviously condoms are an ideal answer, but gay men are dropping them in droves--as you point out yourself. We need new options. As for the immunity, that's why testing is required every three months: if someone tests positive, he will be put on a triple cocktail to prevent resistant virus from thriving. As for the risks, as the article stated, they are relatively minimal, but not to be dismissed outright.

  81. It's not just Truvada, and the Truvada patent has been broken for nearly a decade with foreign generic alternatives.

  82. I was also born in the mid-80's, how fortunate you think our generation and those younger "missed" the epidemic. I was born to an HIV positive suburban nurse who had no idea she was infected. Thousands of children were born to infected women before anti-retrovirals were available to protect newborns. I've had the unfortunate experience to watch loved ones suffer and die from AIDS and HIV. Our generation certainly did not miss this epidemic, we are just rather talented at ignoring it.

  83. I'll take condoms over liver damage, thank you.

  84. “People are reacting out of fear,” Mr. Jacobs said. “Gay men who embraced the condom message and survived the trauma of 30 years ago have PTSD. This is a paradigm shift, and people don’t like change.”

    What an extremely insensitive and overly broad statement from someone claiming to be a therapist. We gay men who have survived 30+ years of this epidemic have done so in a variety of ways with a variety of outcomes. But generally, it has not robbed us of our ability to think for ourselves.

    It is not PTSD that leads some of us to the conclusion that this change of policy by the CDC is a huge victory for Big Pharma, but is fraught with risk for everyone else. It is our experience with over 30 years of unsatisfactory leadership from our policy makers and things like watching our friends die from AZT, another much heralded, but toxic, and ultimately inadequate "therapy" handed down by some of the very same people mentioned in today's article.

    I am deeply offended by Mr. Jacobs' statement. He owes an apology to a very large number of courageous gay men who quite legitimately disagree with him.

  85. You write as though the response to gayness has been universal. Unfortunately or fortunately, there are environmental factors in addition to situational factors at play when it comes to how sever the epidemic has been and how boys and men have weathered it.

  86. No disease has received funding in the last 30 years like HIV/AIDS. None. Alzheimer's is a far, far bigger killer and funding is hard to come by. Your comment makes it sound like America turned its back on the gay community and this horrible disease. Nothing could be further from the truth.

  87. self-identified enemies of Pre-Exposure Prophylaxis (PrEP, aka Safer Sex Pills) have as a group actually been quite strident in their declarations of personal trauma as the justification for their opposition.

    "Sex was filled the anxiety of death for me and all my friends, it must always be that way for you because i will not dishonor their memory!"

    i will be 42 years old shortly, and i have watched HIV warp the identities of gay men and others for far too long.

    PrEP is effective HIV Prevention, just as much for enrolling high-risk people into regular medical care as for this specific pill and its extremely effective protection benefit against HIV infection.

  88. Bravo to the CDC for throwing their weight behind this very necessary arsenal in the fight against HIV. The old tools clearly aren't working too well to stem the tide of HIV amongst gay men. We need to see if Truvada can help turn things around. Gay guys, talk to your doctors, tell them you're interested. If he or she gives you grief, find another doctor or just tell the clinician he or she had better prescribe it to you anyway.

  89. Why is it that when the high risk behavior is sex, people talk of personal responsibility, self control, and saving money but when the high risk behavior is poor diet and lack of exercise, people talk of Lipitor, Lopressor, and saving lives?

  90. This is a treatment "discovered" by nurses, first with AZT and then with other anti-virals as they emerged from research. And, by the way, why does the article NOT mention that there's also such a thing as "Post-Exposure Prophylaxis," which works AFTER exposure? Are they selling Truvada to prevent or only to treat? Since treatment lasts a lifetime, which is the bigger "market?"

  91. Generally speaking, it's not different, but there are exceptions. There's a larger percentage of people who have a genetic predisposition to high cholesterol then there are people who contract aids because a condom broke.

  92. Buy stock in Truvada fast! (Ha).

    Conservative Republicans take note: the US government strongly recommends this commercial product for the prevention of possible death. As a result, that commercial product will become far more popular and lucrative than all of its competitors. Will the government-created windfall profits the company will gain violate your small government philosophy?

    Note to potential HIV victims: it is very likely that this drug will lower your immunity to other diseases. God-playing scientists cannot trick Mother Nature. The human immune system is under assault from iatrogenic causes that are related to pharmaceuticals in humans and livestock. You’ve been warned.

  93. Gilead just sold $2.3 billion worth of Sovaldi, the company's new hepatitis C drug, in its first three months on the market, shattering the record for any new drugs entire first year on the market. Truvada as PrEP is a drop in the bucket by comparison and won't be affecting Gilead's already soared stock price any time soon.

  94. And the alternative to prevention is treatment which, at $400,000 per case, is a hellofalot more.

  95. The monthly cost of PrEP is a large multiple of condoms. The dollars spent on Truvada might better be spent on screening programs aimed at placing undiagnosed HIV positive individuals on medication.
    That said, gay men are not using condoms as they did 5 or 10 years ago so it is wise to offer alternatives.
    In the province where I live, Alberta, PrEP is available to those who satisfy an infectious disease specialist that it is necessary. My understanding is that prostitutes satisfy that requirement; other people, not as likely. The government covers 100% of the cost.

  96. Or the dollars might be spent on Brazilian or Indian generic alternatives, and a lot fewer dollars to save the $400,000 per case that an infection costs the health system. Oh, maybe that's why they haven't talked about it: Gilead has money to make, and the generic alternates are 10% of what they charge in the US.

  97. I have a question for all the commenters who are complaining that the taxpayer shouldn't pick up the tab for gay men's "irresponsible" behavior: Have you yourselves used a condom every single time you've had sex, with no exceptions? Have you ever had a condom break? Have you ever had unsafe sex -- even once? Because it only takes one sexual encounter to contract HIV, which is an awful lot more expensive to treat than Truvada. And even with treatment, HIV positive patients still face a higher risk of cancer and other health problems.
    I see a very ugly mean spiritedness behind the impulse to deny people medical treatments that would improve their lives -- masquerading as concern for the "taxpayer." How much would covering Truvada really cost each individual "taxpayer?" Fractions of a penny? This reminds me of the controversy surrounding birth control coverage mandated by the ACA. Some people screamed bloody murder because the "taxpayer" was being forced to subsidize women having condom-free sex. Then, as now, the putative concern was for the "taxpayer" who might have to pay a fraction of a cent more to help cover birth control. Yet I suspect the real reason for some people's opposition to coverage for birth control -- and Truvada -- is a hysterical fear that someone, somewhere, might be having more fun than they are.

  98. I can't imagine anything more "mean spirited" than encouraging others to engage in potentially deadly sexual behavior. How much "fun" is dying?

  99. On the contrary. More people having better sex may very well promote a happier society -- I'm all for that. But why should I be paying for it? Have I ever had unprotected sex? Sure, of course. On the other hand, most of that unprotected sex was not particularly high-risk. And even had I been unlucky, I wouldn't expect you to pay for my bad choices. Nor do I expect you subsidize the maximization of my future pleasure.

  100. I disagree with your contention that the "taxpayer" should be underwriting the cost of, what appears to be an effective anti-HIV drug. Expensive? Yes, at over $1000/month for the treatment, that is exorbitant. Had you argued that the USG could encourage the manufacture of a generic drug that has the same effect with substantially reduced cost, your argument would have been more convincing than stating it is 'mean-spirited' hysterical people thinking that some may be having more fun than they are.

  101. The cost for this drug amounts to 6.5 billion dollars per year. There is a an over the counter HIV test people can buy that costs $40. Screening those 500,000 would then cost 20 million and there are no side effects. How about we just give all the at risk people a free test kit and save 6.48 billion per year. Of course I'm assuming that those who know they are positive will change their behavior, take precautions and seek treatment.

  102. Unfortunately by the time the orquick (at home test) is able to give you a true result, which is at least 3 months after a potential exposure, most people have infected someone else. In regards to the cost of Truvada, one thing we may want to look as well is how much would be saved by preventing new infections, which are mainly happening in young men ages 18-24. These people generally don't have insurance (or haven't until recently) and as such became uninsurable after contracting HIV (although all that's changing). That means these young men become reliant on the state for their medical coverage for the rest of their lives, which with recent medical advancements means about another 50-70 years. On the other side most people end "high risk" behaviors at about 30 and would probably go off the drug after ten or fifteen years. In a perfect world everyone would use condoms 100% of the time, but clearly…

  103. I don't know where you are getting that absurd 6.5 billion number. The entire Ryan White budget isn't even near that! Please list your source of fact please.

  104. Scott,

    The article states that a one year course of treatment costs $13,000. It also states that the projected number of prescriptions would reach 500,000. Multiply 500,000 by $13,000 and you get $6.5 billion.

  105. "The guidelines tell doctors to consider the drug regimen, called PrEP, for pre-exposure prophylaxis, for gay men who have sex without condoms; heterosexuals with high-risk partners such as drug injectors or bisexuals; patients who regularly have sex with anyone they know is infected; and anyone who shares needles or injects drugs." Except for junkies who can't help themselves, why the heck are we supposed to pay for and encourage the continued hi-risk behaviour mentioned above. Guess what: It's not high-risk anymore if you take the "risk" out of it. There was only one person sited in the article who spoke with an ounce of wisdom - Michael Weinstein, president of the AIDS Healthcare Foundation. Truvada is a party drug. I'm sure he is well-hated throughout the pro-Truvada, gay-rights community. This is truly a travesty. People need to be responsible for their choices and actions. You have no right to take big risks and expect to have it "covered" and paid for by those who don't.

  106. So you argue that conditions for which persons have a element of control over should not be covered..

    So... Smokers who develop cancer: You support no coverage?
    People who seriously injure themselves in a car accident because they did not wear a seat belt: You support no coverage?
    An opportunistic pedestrian who J-walks and gets hit by a car: You support no coverage?

    Really? Are you that cold hearted and selfish that you would deny these people needed health treatment? Or is it really a morality issue and people having a type of sex you don't like..?

  107. "People need to be responsible for their choices and actions." Yes, people should indeed be responsible for their choices and actions. No argument there.

    The fact is most of us behave irresponsibly on occasion and I believe the costs of prevention as far as society is concerned are less than the costs of caring for the results of people who have acted irresponsibly.

  108. How about BP meds, heart disease treatments and other non-sexual diseases? Should we deny treatment to those who eat fatty food and are couch potatoes? Puritanism still rules in the US .

  109. Excited to see the NYT providing the extremely useful "Number Needed to Treat" visuals!

  110. The biggest issue here is that we are giving health people a drug! This can possibly create an even bigger issue down the road of drug resistant diseases. When will we learn!

  111. There is no risk free magic cure all pill-out there
    It is just not HIV but many contagious STDs
    Truvada or any drug can be rendered ineffective by resistant bugs. They just mutate fast. And we ain't be churning new chemotype drugs that fast.
    Average genesis of drug making takes a min. Of 6 years.
    Just love your buddy for the life!
    -Old Fashioned

  112. I started Truvada as Prep one month ago. I am gay. I am 54 years old. My husband of 7 years is HIV+ I have practiced safe sex and used condoms for nearly 30 years. THIRTY YEARS. This drug is a godsend. Why? Condoms slip off, they break. If you're straight - tell me how many times you've used condoms for oral sex? How often do you use condoms period?

    What no one will say and acknowledge -- where so many of the commenters here are on their morality/personal responsibility horse, which to my ears simply echoes the homophobic and anti-gay comments I have heard daily my entire life -- is the impact on intimacy. The desire for that type of closeness, intimacy is a huge and powerful force. It leads men to abandon safe sex, use of condoms, to slip up "just once", etc.

    I wonder how this breakthrough drug would be received if it was straight people who have been told to use condoms for all sex for the past 30 years??? I think we all know the answer to that one.

  113. I generally am very sympathetic to this comment, but I will add that the anti-sexuality masquerading as "personal responsibility" crowd has gone after heterosexual sex, too -- in a way that shifts the burden disproportionately onto women. I have been appalled to see access t birth control become a controversial issue once again -- I thought we had won that fight decades ago.

  114. Why should anyone but you pick up the tab for your private pleasures?

    Why is it anyone else's burden that you enjoy your sex life?

  115. Wizard Stew... "Why is it anyone else's burden that you enjoy your sex life?"

    Viagra?
    Vasectomy?

  116. As helpful as PrEP may be for preventing HIV infection, I still worry that it will send other STD rates through the roof, especially among those who use PrEP without condoms. The CDC gets it right in saying that PrEP should be paired with condom use, but in practice it seems that curbing new HIV infections means increasing the prevalence of syphilis, gonorrhea, chlamydia, etc.

    My main issue is that PrEP makes medication the precursor to behavior or, alternatively, makes behavior (i.e. safer sex) irrelevant. Understandably this is why it's hard to accept; how PrEP is actually used directly counters behavioral change public health models of preventing HIV, even if in theory they should provide double protection.

  117. "Other" std rates are already through the roof. This is why they have approved it.

  118. Perhaps the public health model in use, which has not had much success, does not work.

    Perhaps the conclusion drawn is not correct and that the new model, PrEP with or without condoms will work.

    Why push a model that has failed?

  119. 6.5 billion dollars per year is indeed a heft sum for the long-suffering US taxpayer.

    Nevertheless, this cloud does have several silver linings. First, it may reduce dramatically the incidence of, and the cost of treating, HIV/AIDS in the Land of the Free. Second, the resultant income stream to Gilead Sciences from the world's richest country will help greatly to subsidise the cost of protecting males in Sub-Saharan Africa who receive generic versions of the drugs developed by the like of Gilead. These last receive generic versions only because the drugs' developers don't pursue their patent rights in these very poor countries.

    Look at it this way. The USA is the world's richest and most privileged society in large part because of the free lands you stole from country's the First Peoples and the free labour provided by those you enslaved from sub-Saharan Africa. By effectively subsidising the cost of HIV/AIDS prophylaxis and treatment to the descendants of the relatives of those you enslaved, you are repaying to God a little bit of the historical crimes against his peoples that you committed.

  120. Many men with poor diets and risky behavior become impotent, and we provide them with tax payer Viagara, yet no one complains about that, but when it's about Gays and Drug users, then those behaviors are judged. Stop cherry picking the behavior - risky behavior is risky behavior.

  121. I complain about providing Viagra to impotent men at taxpayer expense. Why should I help pay for the impotent to achieve erections?

  122. Reply to New Yorker
    Really - no one complains about men having their Viagra covered?
    Ask a woman who works for a Catholic organization. Just a reminder - Catholic organizations don't want to pay for oral contraceptives, but, ummm, they pay for Viagra. So yes, there are some people who complain about Viagra getting paid for. Those complainers are called women.

  123. "Many men with poor diets and risky behavior become impotent"

    Is this made up to support your conclusion. Never heard of the combo causing impotency. Actually never herd of either one singly doing so. Most likely, although I not positive, starvation causes impotency. Does a poor diet cause starvation?

  124. This decision will lead to a substantial increase in health care insurance premiums, as the number of people at risk from AIDS. Is certainly larger than 500,000. We should expect that public health officials will eventually calculate that many millions of people in the US are at risk for HIV. These expenditures will also "crowd out" expenditures on other therapies. Given the magnitude of the potential financial, health care and political impacts of this decision, this decision should be reviewed and debated publicly before being finalized.

  125. It is far easier to cover a preventive drug regimen than it is to treat a lifetime of HIV. Truvada also will become generic in a few years, substantially lowering the drugs cost.

  126. I believe the CDC is taking the wrong approach. Treatment of HIV infection costs upward of $40,000 yearly. Many infected patients loose their jobs and health care insurance due to the Gay/AIDS stigma. Many others do not have health care coverage in the first place. Therefore, large numbers of people with HIV disease are not on treatment because they simply cannot afford the drugs and medical care. These people are highly infectious. The vast majority of HIV positive patients that are properly treated attain an undetectable viral load especially with early treatment and are not infectious. The United States needs to offer free government funded confidential testing and free medical care to all those who are positive. That would be very effective in ending the AIDS epidemic. People who do have insurance through their jobs risk loosing their jobs and health insurance if they seek HIV treatment or prophylaxis. These people should also be provided with free testing and treatment. Offering prophylactic Truvada without treating all HIV positive patients will encourage drug resistance and make the disease much more difficult to treat. In addition, encouraging widespread Truvada prophylaxis exposes large numbers of healthy people to a potentially very toxic drug. Although I am risking being labeled a communist, I do feel that it is important to mention that Communist China(a relatively poor country) offers government funded HIV testing and treatment. Why can't the United States?

  127. Why is the use of condoms, the front line in HIV protection, so panned in the community that is at risk? I'm all for these pills, even at a cost of $13,000 per year, but it amazes me that the decimation caused by this disease, particularly in the gay community, is so easily forgotten.

  128. I was 25 in 1980. I arrived in New York City at the age of 19 in 1974. I clearly remember when absolutely everyone around me started to die an absolutely horrific death. I stopped having sex with other people for 15 years. Because everyone I knew knew of someone who had become hiv+ from a broken condom. And I didn't want to die. In my experience no one under 40 knows what the onset of this disease was truly like. I think for them, since the 90's, it is simply a treatable disease like diabetes or COPD. Hopefully the up-coming television presentation of Larry Kramer's The Normal Heart will inform those who simply have no personal memory.

  129. As a gay man who survived San Francisco during the plague years I have to celebrate this news. Many of us had to watch our entire tribes die horrible deaths while being told there was nothing to be done. On the face of it this is an answered prayer.

    As a public health worker my optimism is far more cautious. The vast majority of new infections are among the young invincibles. The generation that came after treatments were developed and never witnessed the devastation this disease is capable of. Many of them take the attitude that as long as they didn't have sex with anyone over 30, 35 or 40 they are being safe. A ridiculous position but commonly held never the less.

    Now we are seeing the more, shall I say, 'garden variety' STDs reaching epidemic proportions. My fear is this protocol will exacerbate that. Yes this is a huge step forward but it is by no means a reason to think that condoms and safe sex practices are a thing of the past. To imply that is nothing but irresponsible.

    Yes, this should be made available and considered another weapon in the arsenal but only as an adjunct to condom use and safe sex practices and that point must not be lost in this discussion.

  130. Finally, the CDC is waking up. This is the 12th or 14th year of continued HIV infections at >50,000 per year. Truvada works. Why do the nay sayers say gay men, and others at risk in the US, including women, can't follow a drug regime where a much more complicated regime is being administered and followed in Africa?
    Truvada does not cause mutated forms of HIV. It prevents HIV from replicating.
    It is not the 'final solution' to HIV. It is what we have now. Other drugs and approaches are in the pipeline including a 3-month PrEP injection.
    STDs effect upon health pale in contrast to short and long term effects of being HIV+.
    HIV is a sexually transmitted disease and carries a lot of stigma in the US for treatment and once you contract it.
    Remember everyone lining up for polio sugar pills and later the vaccine?
    This is the first step to eventually eradicating this scourge that infects 50K citizens a year and kills 18,000. Reducing the HIV pool in the population is key to ending this. End infections, end HIV/AIDS related deaths here and in the world. HAS AHF just become irrelevant in the HIV prevention in the US because of their anti-PrEP stance?
    Whereas 95% of the men in the world don't use condoms, over 49% of gay men do, but it is not enough. Truvada fills in the gap.
    Finally let the CDC do their job!

  131. There are others besides gay men who can benefit from PrEP such as girls and women who do not have the power to negotiate for condom use in their sexual relationships. Insisting, even asking that a partner use a condom can put girls and women at risk for emotional and physical abuse as well as abandonment. Girls and women have been desperately waiting for an effective method of protecting themselves against HIV infection--this is an important. life-saving and personal rights-affirming alternative.

  132. You're letting emotion get to your logic. So this drug is personal rights affirming for abused women? Like someone who is abused would be able to get a prescription? And pay for it? Over a long term? Better to go for restraining orders and shelters instead of a costly pill that won't prevent a lot more immediate misery.

  133. What kind of world do you live in, Margo? There are women from all socio-economic levels, educational backgrounds, ethnicities and faith traditions who are in relationships in which they don't have equal power or are subjugated.

  134. If you're not feeling especially altruistic regarding using taxes to pay for these drugs, look at it another way: either we pay now or we pay later. If you think that denying these drugs to persons at risk will save money, wait until they're sick and receiving care on the taxpayer's dime. And doesn't compassion fit in here anywhere?

  135. Why can't compassion work both ways? If someone refuses to have compassion for their own bodies, why should my beliefs, and lifestyle, be taxed to support the lifestyles of others who disagree, or act amorally, or even immorally? Why cannot people be compassionate about those who wish to do what is right, and moral, who are principled? Why must compassion always be for those who are amoral, or act immorally?

  136. woody144 - People who are anti war have been asking that question for a long time.

    Take a look at what we're spending in medical costs to treat gun shot victims and then there are the illnesses caused by smoking, drinking, overeating etc.

    You'll just have to live with the fact that the rest of world isn't the saint that you are.

  137. woody144... obviously morality is subjective. You don't get to impose your own personal morality on others. After all, many people in this country believe homophobia to be immoral. And I would guess that you probably find this kind of morality to be quite subjective.

  138. Your title and first two paragraphs should discuss protection from HIV infection, not AIDS. At present, your writing makes this seem like a pill for people who have already contracted HIV, and therefore this would not be a huge breakthrough. This type of incendiary language (using the more severe term AIDS) also perpetuates improper use of the term.

  139. I just think gay guys should stop sleeping around and being promiscuous and treat sex and themselves with respect. Now with Truvada it will be hard to know whether someone is truly HIV negative or not, exposing the guys who are responsible and negative to their irresponsible behaviors. One way to bring new infections below 50,000 is to have newly infected guys pay for their own medicine. This would put an end quickly to their irresponsible behaviors.

  140. Straight people do lots of sleeping around too.

  141. "Straight people do lots of sleeping around too." Yes, they do. And they either use condoms or take their chances. They aren't asking the taxpayer to subsidize the ongoing distribution of a very expensive drug in order to make their risky behavior safer.

  142. There we go again with the argument that straight people sleep around too! How is that relevant to this, again? Of course Straight people do. But one can sleep around intelligently, protecting oneself with a condom. Also very few reach the levels of promiscuity of low self-esteem self-destructive gay men who need mental treatment just not Truvada...

  143. This proposal creates a conundrum for the Republican Party. On one hand because this program would be proactive, decrease the risk of AIDS in the gay community and result in an indirect benefit to the country as a whole they must, to appease the religious, right wing, lunatic fringe that forms the core of the modern Republican party, oppose this with all their might. However, this could provide a huge financial windfall to the drug industry that is one of the major donors to the party. Their solution to this will be business as usual. Fox news and Limbaugh will report their strong opposition to this program satisfying the party core while behind closed doors the drug industry will be assured that they will do nothing to stop this and lay the blame on President Obama. They still do not understand why Republicans like me do not vote for Republican candidates. Gotta love 'em.

  144. AIDS is 100% preventable if people who indulge in high-risk sexual behaviors use condoms, which are cheap and available everywhere. But because these people don't like to use condoms, we should provide them with a very expensive course of drugs, year after year? Why should I pay to subsidize the highly irresponsible behavior of others?

  145. Read this, he explains it better...

    Bret Cambridge - 10 hours ago - NYT Picks
    I have a question for all the commenters who are complaining that the taxpayer shouldn't pick up the tab for gay men's "irresponsible" behavior: Have you yourselves used a condom every single time you've had sex, with no exceptions? Have you ever had a condom break? Have you ever had unsafe sex -- even once? Because it only takes one sexual encounter to contract HIV, which is an awful lot more expensive to treat than Truvada. And even with treatment, HIV positive patients still face a higher risk of cancer and other health problems.
    I see a very ugly mean spiritedness behind the impulse to deny people medical treatments that would improve their lives -- masquerading as concern for the "taxpayer." How much would covering Truvada really cost each individual "taxpayer?" Fractions of a penny? This reminds me of the controversy surrounding birth control coverage mandated by the ACA. Some people screamed bloody murder because the "taxpayer" was being forced to subsidize women having condom-free sex. Then, as now, the putative concern was for the "taxpayer" who might have to pay a fraction of a cent more to help cover birth control. Yet I suspect the real reason for some people's opposition to coverage for birth control -- and Truvada -- is a hysterical fear that someone, somewhere, might be having more fun than they are.

  146. @LiveOn. He doesn't explain it better. It doesn't matter that my personal contribution to funding this program would be relatively small. The U.S. public debt is approximately 100% of GDP. The annual federal deficit adds about half a trillion dollars (not counting interest) to that debt every year. Public expenditures for health care are a big driver of this deficit/debt spiral. We cannot afford to fund every program that someone would like to see implemented. Here we have a problem that can be solved easily and cheaply by using condoms -- but no, the taxpayer is supposed to subsidize a $13,000 per annum course of drugs so that people who indulge in high risk behaviors can do so with an easy mind. That's simply crazy.

    Focusing just on gays for the moment -- I support equal rights for gays and lesbians, marriage equality, you name it. The idea of gay sex doesn't bother me in the slightest. What does bother me is the effrontery of people who think the public should subsidize risky sexual behavior, when there is in fact a cheap, safe alternative means of protection. Public monies should not be expended to enhance anybody's sex life.

  147. Shameful shameful shameful! If there were a depot formulation I might change my tune. Although reliable daily use shows protection against infection, non-daily sporadic use doesn't. We're setting ourselves up for widespread resistance against a really good drug. Meanwhile, gilead gets to multiply their customer base and their stockholders rejoice.

  148. The federal government, and many state Departments of Health, including NY and Florida, do offer free, confidential HIV and other STD testing. Get your facts straight.

  149. I don' want to debate efficacy, but still, in the graphs, how much do statins cost per annum? Could something other than cholesterol med be used for comparison? The point being that cholesterol meds can be needed for those who simply inherited their disease vs lifestyle risk.
    If there is any valid argument against wholesale prescription of this drug, it is that I'm not seeing a charge to strongly encourage a decrease in risky behavior. The risk includes a lot more than HIV and those affected can be in a long chain of un-aware and innocent sexual partners; people marginalized by the frivolity of t-shirt slogans.

  150. Not to mention the fact that most drug regimens where daily use is encouraged are seldom followed through by the majority of those taking them. Even vitamin regimens can become tedious, and be skipped.

  151. Drugs will never overcome poor choices and risky lifestyles. As a taxpayer and payer for insurance I should not have to contribute to the funding of this expensive treatment without the users choosing to change their lifestyle. I should not have to pay for an expensive drug just because someone doesn't want to use a condom while participating in high risk sex. Money does not grow on trees. No bottomless bucket that never runs out. I say the same for obesity and diabetes. If you will not choose to live healthy then I choose not to support/fund your lifestyle.

  152. Who have so much money to pay for such expensive prophylaxis of this disease? Or money we pay for credits, education, insurance is not enough? About 50 million Americans live below the poverty line, which the federal government defined in 2013. The biggest part of them are in risk. No doubt the pharmaceutical companies try to become richer. And our government protect them.

  153. Much of the response to the CDC's announcement is concerned with the behavior of gay men given more freedom to practice their sex lives as they wish. Setting aside unnecessary, uninvited moralizing, that is an uninformed tunnel view of the wide horizon of HIV infection in North America. In the US, HIV is now a heterosexual infection, passed from men to women and from women to men. I, a white, well-educated, upper middle-class, happily married wife and mother, am HIV negative. We recently discovered that my husband, a decent, loving father and husband, is HIV positive. Yes, it was a terrible shock and devastating challenge to the stability of our lives. During a period of crisis and depression several years ago, things happened, as they often do in real life. He contracted the virus. The virus didn't care that he's not gay, that he's not a drug user, nor any of the other assumptions we make about the kind of person the HIV virus prefers. It doesn't care, it's a virus. At the first meeting a support group for HIV- wives of HIV+ men, the other women told me over and over, "We're everywhere." Sero-discordant couples are everywhere. We are your neighbors, the parents of your children's friends, your sisters and brothers. No one regardless of sexuality or addiction should be denied life-saving protection. However, if we understand that the virus has no preferences, perhaps we could drop our prejudices. I've already called our doctor to request my prescription of Truvada.

  154. I do not know what to think about this, being half against and half in favor.

    At 61 and gay, I very clearly remember word getting even to America's heartland that gays were suddenly getting sick and quickly dying on the two coasts. As I slowly learned more about "the gay cancer" and the "gay pneumonia" that in time became known as GRID which in turn eventually became known as HIV/AIDS, it was clearly not a gay-specific disease but a sexually-transmitted viral infection. That so many at-risk people continue to ignore the evidence about condom use is, to me, disconcerting (other words come to mind but I hesitate to blame the victims).

    That said, though, having lost several good friends and one very dear and important one to AIDS, if this helps reduce new infections then the other half of me is glad the government is trying the new approach. I just hope it works.

  155. This is another miserable example of using medication as a substitute for behavioral modifications. Birth control pills are in the same camp as Truvada. Users take the pills thinking they are liberated, yet they can still contract other viruses and diseases from unprotected sex. Are people so desperate for sex that they won't go to a lab for a blood test or - heaven forbid! - use a condom? http://janispowers.com/2012/10/the-pill-ironic-reliance-on-a-non-feminis...

  156. I expect little support for my comment. What's wrong with condoms? They are cheap, effective and non toxic. $13,000 a year to take a serious druv to avoid the bother? Really, this is not good medicine or good social policy.

  157. What's wrong with condoms? 1) When sex will occur is often not predictable, thus condoms are often not immediately available when needed. 2) Condoms diminish male users' sexual pleasure. 3) Likely as a result of points 1 and 2, efforts to persuade people at high risk for HIV to use condoms every single time they have sex have met with very limited success despite billions spent.

  158. Aaron Walton - It's up to people to make sure condoms are available when they have sex. I'm no prude, I think sex is great, but like any adult activity it needs to be done responsibly. Condoms are inexpensive and easy to carry.

  159. Very mixed feelings about this as a solution for preventing AIDS transmission. I'm nearly 50, came out at age 18 (1983) just as AIDS was appearing in the public view. Just a little too young to have lost all my friends to AIDS, but somehow, by luck, self-preservation, and use of condoms (pretty much always after about 1990) I've remained clear of the virus. Even with every stereotypical gay male behavior you want to imagine (sex parties, bathhouses, etc).

    With age comes wisdom, I suppose, and today I am in a long term monogamous relationship which is condom-free. I consider myself lucky to have avoided the virus, and also not to be in a serodiscordant relationship, where this drug is an *ideal* solution.

    However, the gay men who most need this - young men hooking up online - men of color - poor - will never get it. It will be used (well, it's actually been used for years) by wealthy, white gay men to have all the sex they want and not worry about condoms. Perhaps my response here is more one of jealousy than anything else. I was a condom expert. Now they don't have to be. (Then again, multiple courses of antibiotics for other STDs is not good for you either)

  160. Thank you for acknowledging your jealousy. Every young gay man appreciates that!

  161. Won't the natural random mutations of the H.I. Virus eventually render Truvada useless?

  162. There sure is a whole lot of judging going on in some of these comments. Somehow, I suspect a lot of the people who are judging others' sex lives are the same ones who propose "abstinence only" sex education in our schools.

  163. And that's a bad thing because...?

  164. woody144 - It's bad because it doesn't work. Red states have a higher rate of teenage pregnancies.

  165. How much bribe did the CDC take to approve such an expensive drug? We should buy it from India.

  166. Michael Weinstein, president of the AIDS Healthcare Foundation, has called Truvada a “party drug” and argued that the drug regimen would encourage men to avoid condoms and thus increase the infection rate. He called the release of the guidelines “a shameful chapter in the history of the C.D.C.”

    Oh, I'm sorry, is it the CDC's responsibility to make sure everyone's using protection? Do people have no sense of personal accountability when it comes to their sex lives? I can't fathom how a scientific breakthrough is "shameful" just because of irresponsible people who think they're invincible.

  167. What has history (since the mid 1980s) shown? Increase in drugs is not correlated with a decrease in transmittal rate of HIV (it has held steady), on the contrary, there has been an increase in recent years. One tries to be nonjudgemental about diseases, but STDs are by and large, with a few exceptions, a life style disease. Now the healthy insureds are asked to foot the bill for others to engage in unsafe sex. $13,000 can treat 100,000 African girls and women with snail fever, but we as a country think that it should subsidize one Aemrican's annual party drug.

  168. We know that most people don't keep up drug regimens for disease like diabetes and hypertension, even when all you have to take is one pill a day. By extension most will stop taking their Truvada within a year too. Having stopped condoms long before, most will be back to having sex without any protection.

    While I applaud that this option now exists, I also know how it will end.

  169. How can we applaud the option that million of responsible individuals, straight and gay, are now supporting financially the crazy behaviors of self destructive low self esteem gay men? I have seen so many of those behaviors around me of guys living dangerously and being careless, it's mind boggling. How guys are still getting infected today with what we know about how to protect oneself against HIV is difficult to fathom. I stopped supporting all gay charities after watching so many HIV undetectable guys start being irresponsible again by practicing unsafe sex just after being given a new lease on life. What those guys need is mental treatment not Trvada

  170. PrEP should be made available to the entire adult population of southern Africa, only the drug used should be Kaletra, (lopinavir/ritonavir) not Truvada (tenofovir/emtracitabine). Truvada given by itself to people already infected with HIV--as would surely happen with mass treatment in Africa--would be guaranteed to fail and to generate widespread antiviral resistance, but single-drug treatment of HIV with protease inhibitors such as Kaletra has been shown to be reasonably effective and not associated with emerging resistance.

    The message would be, "Come in and get tested, and if you're already HIV positive, we'll give you the three-drug regimen that has proven most likely to save your life. But if either you test negative or you refuse testing, take a protease inhibitor. If you're not already infected, it will help keep it that way, and if you are infected it will be a whole lot better than nothing."

  171. So now we go from people taking personal responsibility for their behaviors and using inexpensive condoms to having insurance companies pay the drug companies $6.5 billion a year so people can feel free to do what they want? This makes me want to throw up.

  172. Interesting. "Most insurances cover this drug" presumably for mostly male users, while at the same time, most insurances will NOT cover contraceptive drugs for females. Why is the insurance industry allowed to discriminate against the female gender?

  173. Is it possible that the NYtimes still doesn't know the difference between HIV and AIDS after 30 years? PrEP prevents HIV infection not AIDS, the condition caused by HIV. A small mistake, but it is a glaring, disappointing one.

  174. The HIV virus is highly adaptive. The thought that you can take a pill to avoide a death sentence and continue to be irriresponcible is a farce. This cource will only satisfy the drug companies bleed the insurance companies and eventually create a Franknstein monster in the future.

  175. What we know of drugs is that none are 100% effective. Over time tolerances are created, and as with antibiotics, the same could be true of viral, or even retroviral drugs, that they create superbugs. That what society wants? What happens if that superbug becomes transmissible through the air, and is highly deadly? Mankind can mess with what it wants, but where morality comes into play, no one is sure of the consequences of long term use of any drug.

  176. "Michael Weinstein, president of the AIDS Healthcare Foundation, has called Truvada a “party drug” and argued that the drug regimen would encourage men to avoid condoms and thus increase the infection rate. He called the release of the guidelines “a shameful chapter in the history of the C.D.C.”

    This is the most selfish and irresponsible statement I have ever heard about Truvada. How many young people at their sexual prime must continue to cower and compromise in the face of a full and robust sex life, because Mr Weinstein and others of his ilk are bitter that they had to wear condoms through their 20s, 30s, and 40s when their sex drives were at their most acute.

    I concur with Damon L. Jacobs regarding his assertion that people react badly to paradigm shifts. This is certainly true of Mr Weinstein who should be rightly ashamed of himself for stigmatizing (mostly young) men who wish to protect themselves. Shame shame shame on YOU Michael Weinstein!

  177. I saw a 20-year-old at a bathhouse in New Orleans last month passing out Truvada at an orgy, because he knew there were HIV-positive people there he and his friends wanted to have sex with and no way were they doing that stupid condom thing. Doesn't get much more "party drug" than being passed out at a party, now does it?

  178. It is not a party drug when it saves people's life. Perhaps using Jean from Atlanta's specious argument, Lipitor is a party drug too because it lets people with high colesterol eat chocolate cake and bacon, and lobster bisque soup. Also, perhaps birth control pills are party drugs because they allow young unmarried women to have unprotected sex with multiple men without the fear of pregnancy. Perhaps nicotine patches are also party drugs.... Perhaps.

  179. Jean, your story seems fishy. This is an expensive drug that has to be taken every day. How would one (20 year old) person be able to afford large quantities of it and what would be the point of taking it once a few hours before sex?

  180. Great idea. After spending millions on public awareness and Aids prevention programs including a free condom bonanza, we are telling people to just take a pill?
    Whilst this is a boon yet again for big pharmaceutical companies and those amongst us with less morals by giving them an extra life vest, I just see a significant rise in STDs on the horizon.

  181. I have a good idea, how about CURE IT. Just like Test and Treat this wont work. A cure is so close. Why waste the funds. How much money was wasted on Test and Treat. Just like South Park episode where they said that they found a cure for AIDS- and what was it "MONEY" Throw as much money at it as possible.

    ACT UP needs to come back and take this over the finish line. WAKE UP people and stop wasting money. SILENCE= DEATH
    CURE= NO PROBLEM

  182. This is much more human and humane than anything else tried before in the fight against HIV/AIDS.

    Ignoring the judgment and policy prescriptions of social evangelical conservatives is in accord with American values and interests and human nature.

  183. Regarding the sidebar – “To Save a Life”

    The graphic displays the “effectiveness” of preventive drug treatments against heart attacks and against HIV. I would also suggest displaying the cost, since the cost of medical care is nearing a crisis stage.

    To prevent one heart attack, 250 patients would have to take statins for one year. Generic statins are available at $4 per month. The cost to prevent one heart attack is $12,000 ( 250 x 12 x $4 ).

    To prevent one case of HIV, 61 patients would have to take Truvada for one year. The cost to prevent one case of HIV is $793,000 ( 61 x $13,000 ).

    Both heart attacks and HIV can be severely reduced by patient behavior: exercise, diet and weight loss in the case of heart attacks and condom use in the case of HIV. The cost of medicines needs to be brought under control. Government research money could be used in exchange for lower prices.

    Drug company research is too often geared towards high profit solutions to problems that already have solutions. How much research money was spent on Viagra substitutes, so the patient doesn’t have to wait 15 minutes for a pill to take effect? How much was spent on research (and how much on advertising) for an assortment “low T” medicines, which all (coincidentally?) cost about $300 per month when testosterone injections have been available for decades and cost less than $30 per month?

  184. Another poisonous pill from big pharma that'll give you cancer or worse somewhere down the road. Educated yourself about HIV/AIDS and stop believing their lies. Watch 'House of Numbers' on youtube for starters.

  185. Ninety-nine percent effective isn't 100% percent effective. In other words, taking Truvada might protect you from contracting HIV -- but it might not. Then why take it? I don't get it.

  186. It seems worth noting that Gilead's stock price is currently heading back up toward the all-time high it hit earlier this year. Another reason to celebrate.

  187. "It would mean a 50-fold increase in the number of prescriptions for the drug, Truvada — to 500,000 a year from fewer than 10,000. The drug costs $13,000 a year, and most insurers already cover it."

    http://www.gilead.com/news/press-releases/2014/2/gilead-sciences-announc...
    These numbers seem wrong. Gilead reported in excess of 3B in product sales for Truvada in 2013, didn't they?

  188. embrace it for everyone, particularly women. tolerance has increased, but society has not yet accepted the reality of same-sex relationships. as long as there is fear, judgment, and rejection attached to coming out, there will be men who cross back and forth between intimacy with men and intimacy with women without informing either sex of their actions.

  189. Regarding comments about condoms breaking or not being used properly as an excuse for Truvada being used instead. First of all, Truvada provides no where close to 100% protection from AIDS either. Second, it has to be taken on a regular schedule to be effective so if you can't be expected to remember to use a condom, I wonder if you will remember to take a pill.
    I have no trouble paying for healthcare people need but when I see those who are mentally ill and have no ability to protect themselves from their illnesses wind up in jail because society can't afford to pay for proper care for them and children throughout this country being started on the road to multiple health problems because their families can't afford dental care,
    I do wonder why we can't expect those at high risk for AIDS to use condoms.

  190. You may want to educate yourself on the distinction between HIV and AIDS.

  191. I have to disagree with the folks that think it's just another big pharma drug that can cause cancer. True that education, prevention, and safe practices are some of the key components towards reducing HIV infections. However, realistically men sexually active individuals do not speak to their partners about their sexual activities. There are many who simply assume that their partner is "clean" just by visually inspecting them. And of course you have those that are not in monogamous relationships and do not make the safest decision "in the moment". So why not use a drug that can potentially help prevent HIV infection? But my issue is if sexually active individuals aren't making the effort to get tested, use condoms, and communicate with their partners, what makes us think they will actively pursue medication to reduce risk?

  192. I'm sorry for the inconvenience of safer sex; I like it no better than the next person. But to replace cheap, effective prophylaxis by condom, with a 13k/year pill is selfish, and wasteful of finite healthcare resources. The human resources and money absorbed by this profligate waste could be much more wisely allocated to prevention and treatment of diseases for which neither are available.

  193. $13,000 a year! And you would be given this because you are 'at risk' and don't like to practice safe sex? Anyone realize that we have MANY other diseases transmitted through un-safe sex, some of which are far more deadly than AIDS now is?

    Has the US government gone mad? Do we honestly, really honestly, think that people should not be responsible for themselves? 'Men don't like condoms?' How is it that this government believes that insurance companies should cover a medication (trust me, when the number goes from 10,000 to millions taking this rediculously expensive drug, they won't). Of course HHS will mandate it like free birth control of your choice.

    What kills me is that the only thing that can increase your premiums now is smoking because HHS just says so. But when it comes to having sex with multiple partners or sex and intervenous drug use, by all means, cover it all and don't make anyone responsible for their choices. Get fat, you'll be covered for life for all of the diseases you contract as a result, but don't worry, you're covered in full.

  194. Just to make to clear to people. Pharmaceutical companies in no shape or form want to find a cure/vaccine for HIV/AIDS. They want to treat you for life.They make countless millions/billions treating patience over their lifetime. Pharmaceutical companies could careless if you live or die all they care about is how much of there drugs they can feed you before you die.

    Bayer sold millions of dollars worth of an injectable blood-clotting medicine Factor VIII concentrate, intended for hemophiliacs to Asian, Latin American, and some European countries in the mid-1980s, although they knew that it was tainted with AIDS.

    This new drug comes at no surprise to me. Instead of spending the money on RD to find a cure they spent the money on another drug they can feed you over a lifetime.

    How many millions/billions will the pharmaceutical companies stand to lose if a cure was found. More than 1.1 million people in the United States are living with HIV infection. Do the math that's 1 million plus people that will have to take a cocktail of pills for the rest of there lives. Now ask yourself this. Do they really want to find a cure? Why cure a million people when u can treat then for life. It will always been more profitable to treat someone for HIV/AIDS then it is to cure then. So don't be shocked if a cure is never found.

  195. sounds like a conspiracy theory, and false. There is a ton of money to be made in a vaccine, just too hard to develop one yet. There is no wizard behind the curtain coordinating all the drug companies to shape their drug reseach in the manner you imply. What is so great about this drug is these men have a way for others to pay for it!

  196. Ok! I agree this pill is very good news from a health prevention stand point vav AIDS ... period. No arguments... No demonizing the guys who want to use it Please read my entire comment. It's complex and relevant to guys and girls.

    BUT on another point in the article about resistance to "reliance on condoms, which are effective but unpopular with many men,"
    As a woman, dealing with hetero males who've actually never offered to use a condom, I want to mention how angry I am about that stance which seems to be pretty much universal no matter sexual identity.

    That male frontal lobe inadequacy vav decision making in the face of risks is such a bane on this world... vav in this context... preganacy, and SIDs aand of course AIDS. Not to mention how selfish it is.

    I know I'm "ranting" but this rant is in order and I do see the issue of using condoms as more extensive a need than Truvuna, still I am glad Truvana is also available and I hope it's very successful vav stalling the spread of AIDS.

    To me, the best of all scenarios would be using condoms, except if pregnancy is the goal, AND Truvana if AIDS threat is anywhere in the picture.
    Guys be careful no matter who your partner is .

  197. that should just about break the bank for costs of this medication for the numbers that they are looking at. But no problem, all those in non risky relationships, can just pay for this risky behavior.

    But funny, we don't ask others to pay for the health risks of smokers, we tax the heck out of cigarettes. Guess the gay community is exempt from the same type of condemnation for risky behavior that causes costs to skyrocket.

  198. You do all realize that when they say insurance companies cover this, it means the cost is spread around to everyone who has medical insurance, right? Hobby Lobby boggles at birth control, but I haven't heard a word from them about this drug. If women are just supposed to control themselves so they won't need birth control, then why aren't these high risk people also just supposed to curb their desires and go without sex?

  199. I subscribe to the New York Times for its logical approach. What this article describes is illogical to an extreme. In economics, this would be described as rent-seeking behavior, at the sake of the population as a whole. You don't build a buffer around a drunk driver's car and then hand him the keys.

  200. While I am glad that this alternative to condoms has been deemed safe and effective by the CDC, I fear that any push for a vaccine or cure will be relegated to the back (very back) burner. Call me cynical, but for this extremely expensive medication there is now a captive body of guys that will be taking it for life. Will it ever go generic in this country? Will ANY HIV meds ever go generic in this country? (Mine currently retail at $2300 a month.) With all of that money coming in, is there any real incentive for Gilead or others to be at work on a one time, universal fix? What do you think?

  201. This is insane. While we're trying desperately to hold down insurance costs, we're paying people $13K annually so they can have unprotected sex.

    The real problem is that the US government could easily run a trial to prove abacavir and epivir are just as potent; and both are off patent. If the government wants to do this, they should fund an operation to provide off patent ARVs at minimal cost, that wouldn't need to be covered by insurance.

    This is just another example of Gilead gouging the public. The have a heavy presence on Capital Hill and it's showing as my wallet grows thinner.

  202. While this is good news for affluent, mainly white, gay men with good insurance, the real front in the war on HIV is in lower income young minority populations, not all of whom are gay but most of whom are going to have issues with the cost of this medication which will remain on patent as I understand it for some years to come. To use a military analogy, this isn't unlike using your best troops and tanks in your least challenging front of the war.

    To many in this population, regardless of their sexuality, the cost of what seems to be an effective means of battling this insidious disease might as well be $130,000 a year.

  203. Yes, this is primarily going to become a staple of affluent gay culture- pop a tab of Ecstasy, Viagra, and Truvada and then hit the party. Lower income and non-white gays will not have access to this unless they have Medicaid/Medicare.

    Interesting to see how many posts in the NYT Picks seem to be asserting that consistent condom use doesn't happen, is unrealistic, or even that using condoms is to "cower and compromise in the face of a full and robust sex life" (Illuminated from Los Angeles). This is actually not really new though- the practice of sharing HIV meds with others at sex parties to lower the risk of acquiring HIV has been around for years. Now it has simply moved from being a party drug to a legitimate prescribed regimen. The end result will be the same.

    Condoms prevent lots of other communicable (and some deadly) diseases such as Hepatitis B, Hepatitis C, syphilis, gonorrhea, chlamydia- the list goes on. As a healthcare profession with plenty of exposure and insight into gay culture in Manhattan & LA, I am 100% certain that many users will think taking PrEP antivirals is a hall pass to have unprotected sex, with an overall increase in sexually transmitted infections.

  204. This article, and the May 16 follow up, are good examples of what I would call dangerous, not just poor, science journalism that I plan to use in my university courses on science writing. While I believe Truvada and many other PrEP programs are worth trying in the general public, it should happen under conditions in which physicians and patients are adequately informed about the risks of drug resistance and drug-drug interactions, which are never, ever adequately addressed in clinical trials. By under-representing the importance of these issues, especially that of viral resistance (NOT doctor and patient resistance), these articles would lead one to believe there is no need for aggressive surveillance and planning for what to do if substantial resistance does arise. Ask anyone who has worked on infectious diseases for more than a semester will tell you that drug-resistance is not a matter of debate, it is a matter of fact. Will resistance be rare and mild or will it be frequent and life-threatening? As far as this article was concerned, it doesn’t matter. As far as Nature is concerned, the facts, not “expert opinion" or Gliead’s stock price, will tell us how foolish it is to ignore drug resistance. Let’s hope we’re not breeding another MRSA or VRE.

  205. ?? Who got paid off to recommend this???

  206. This is a God-send for sero-discordant heterosexual couples in which the man is HIV+ and the couple wants to have children. Before this, the only alternative that pretty much eliminated risk of transmission was expensive IVT/icsi procedures, even for women with no problem conceiving...

  207. With the potential for adverse side effects, a staggering cost ($13,000 annually), and the need for a daily pill regimen, Truvada is not likely to stem the tide of new HIV infections. A vaccine solution is still needed. Here is a recent story in HIV Plus where Robert McNally, CEO of GeoVax comments on the necessity of a vaccine: http://bit.ly/1oqhZgZ