Updated 16 February 2016

When condoms aren't enough: To PrEP or not to PrEP?

Will taking pre-exposure prophylaxis, more commonly referred to as PrEP, condone risky sexual behaviour? What if people call me a “Truvada whore”? This is the story of a young South African wrestling with the idea of going on PrEP.

Growing up I often dreamt of running for president, so naturally my 17 year old self was absolutely captivated when my mom got me Edwin Cameron’s book titled Witness to AIDS.

The story journeyed into the duties of one of South Africa’s most distinguished judges, who also happened to be openly gay. Set largely in the 1990’s, the touching memoir focused on the adversities of contracting HIV at the time - stigma, unjust discrimination and the access to treatment which often meant the difference between living and dying.

Read: Warning over the isolated use of HIV drug Truvada

Reading this book as a teenager, together with losing my dad’s brother to the epidemic prompted me to vow to do my best to never contract the virus.

As young South Africans we’ve been raised in a condom-promoting culture so protecting myself was relatively easy. At least in the beginning.

For years I was uncompromising and used to insist on using condoms. My contemporaries largely attest to doing the same for the most part although many admit to slipping up occasionally.

The difficulty with condoms is that they’re not always readily available and are often used inconsistently. I can count on one hand the amount of people that claim to have never engaged in unprotected sex. There are many reasons for this, ranging from trust to the loss of sensation caused by latex.

Read: What it's like to be accidentally exposed to HIV

An incident in 2011 rendered me one of these people and I had to seek urgent medical intervention. This is when I first came across post-exposure prophylaxis (PEP).

“PEP is a short-term anti-retroviral treatment that reduces the likelihood of HIV infection after exposure” to the virus. It has to be taken within 72 hours. I had to take a pill once a day for 28 consecutive days.

The side-effects for me were brutal and included nausea, chronic fatigue and severe nightmares. I soldiered on and saw the treatment through however, because I knew that contracting HIV also had its fair share of side-effects.

Read: HIV: What is pre-exposure prophylaxis?

A year or so later I heard of Truvada which was a pre-exposure prophylaxis (PrEP). Much like PEP, this preventive drug acts like a vaccine against HIV if taken daily. In 2012 it was approved by the stringent FDA in the US. For the first time since the outbreak of HIV almost two decades prior, there finally seemed to be a way to not only contain the virus but also stop its spread. Many did not see it like this unfortunately.

Preferring prevention to cure, I did extensive research on the drug and learnt that it was thought to be 99% effective at blocking HIV infection if taken exactly as prescribed.

Unlike the PEP that I had taken, the side effects were said to be minimal, although a small proportion of people could suffer from minor ones such as nausea which generally disappears after several weeks. More serious adverse effects are associated with kidney function, but susceptibility can be detected by ones doctor prior to prescribing Truvada.

PrEP does not protect against STI’s

My plan was not to substitute condoms but rather to complement them because PrEP does not protect against STI’s. In the event that a condom could not be used for any reason or that it broke, I would be able to rest assured that my likelihood of being infected with HIV was minimised due to this second layer of protection.

I presented this case to my friends and family and to my surprise, none of them were in favour of taking the drug - citing possible side effects of the new drug or the limitations that PrEP had with regards to other STI’s.

Read: More proof that PrEP works

I suspected that a lot of the hesitation was because they were worried that PrEP would condone and open the doors to risky sexual behaviour. I later learnt that there were groups in the US that campaigned against the use of PrEP for those exact reasons and users of the drug were labelled “Truvada whores”.

This probably explains why the uptake of the drug has been poor in both the gay community and the developing world.

According to the iPrEX study using Truvada as PrEP, there was no evidence that taking Truvada increased unsafe sex.

Here’s the blunt truth: people are still having sex without condoms or are using them inconsistently. This is enough for HIV to be transmitted. If this wasn’t the case then we would not be having new HIV infections.

I like to think of PrEP like birth control – which doesn't prevent women from contracting STI's and HIV but it does prevent them from falling pregnant. Sure PrEP won't reduce the risk of contracting STI's but it sure will reduce that of HIV. Is it not in the best interests of everyone for people to be less likely to contract this virus and in turn unable to transmit it? I cannot see how not.

*Siya Mnyandais a politics and philosophy graduate from the University of Cape Town. He is extremely passionate about the South African political landscape and is an active commentator on racial relations, governance and social justice issues. He currently works for a multinational technology company in the private sector.

Also read:

Revealed: Same-sex secrets of South Africa's male students

South Africa licenses anti-retrovirals to prevent HIV

Why more people at risk of HIV should be taking Truvada

Gautengers, watch out for these 3 STIs

Truvada protects against HIV, but you can still get other STIs

Gay men may not have to take daily HIV prevention pill

Men on new HIV preventative drug ditching condoms


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