Last week, amid much fanfare, an FDA Advisory Committee unanimously recommended that Gilead Sciences, the maker of Truvada, a drug previously used to treat AIDS, be permitted to market it to prevent HIV infection. Findings from a handful of clinical trials, including one involving discordant couples where one person is negative and the other positive, showed promising results. The outcomes were best when used properly (HIV negative partner adhered to a drug regime and the couple used condoms). The results of the clinical trial involving women was not so promising.
While the advent of medical-based prevention is a reason for great hope in reducing the number of new infections each year, medicine alone has never been a panacea in the HIV pandemic. What we’ve learned in 30 years of the epidemic is that while actual HIV transmission may be pretty straightforward, the social and psychosocial “back story” is not.
A significant body of evidence now shows that the “structural drivers” of the epidemic – things that cause people to engage in high-risk behaviors such as unprotected sex or syringe sharing – are as deep and complex as it gets. Poverty, homelessness, trauma, lack of access to healthcare, racism, homophobia, domestic violence, gender disparities, criminalization of HIV transmission and drug use are just a few. Many of these also prevent individuals from adhering to medication whether it’s antibiotics or insulin. HIV prevention is as complex as the things that make it necessary. Can we really just throw a pill at it?
While hopefully Truvada will be useful in the toolbox of HIV prevention, we cannot make the mistake that Magic Johnson did a decade ago when he announced he was cured. We cannot afford for young people to again hear that a drug will cure AIDS or prevent it. We cannot dumb down HIV prevention when so much is still at stake.