Why PrEP is a milestone in preventing HIV

Protesters ask for PrEP to be available  in the UK (Photo: lewishamdreamer/Flickr)

Protesters ask for PrEP to be available in the UK (Photo: lewishamdreamer/Flickr)

When Raphael Landovitz was in medical school, he met a patient with a deadly infection due to complications from AIDS — who had no clue he was HIV positive. “He had clearly been HIV infected for a very long time, but had never been tested until he came in with this very severe brain infection,” Landovitz says at TEDxUCLA. When Landovitz asked the patient’s long-time doctor why he had never tested the patient for HIV, the doctor told him, “I don’t do AIDS.” The answer disturbed Landovitz, who began to question how many people were not getting proper HIV treatment due to lack of testing and treatment.

Landovitz, now a leading expert and clinical researcher in HIV treatment and prevention, wants to make sure no more health care providers “don’t do AIDS.” Anyone who has ever had unprotected sex, no matter their sexual orientation, race, gender, relationship status or other personal attributes, is at risk for the infection, he says, and the Center for Disease Control recommends that anyone between the ages of 13-65 should be tested for HIV at least once.

“HIV treatment has gotten so much better over the 30 years of the epidemic that people who are HIV infected, if they are in care and are treated and can take their medication, can lead a nearly normal-length life,” he says. “But there are still complications from HIV infection that make it something that you would rather avoid.”

Landovitz is an advocate for pre-exposure prophylaxis (or PrEP) a preventive intervention in which people at risk for HIV take anti-HIV medicines daily to lower their chances of getting infected — similar to how sexually-active women who want to avoid pregnancy take birth control pills whether or not they plan to have unprotected sex, he says.

“We are actually a part of an era of medicine where we’re changing from the past when people would only go to the doctor when they already had a disease or problem to get treated to this model where we try and prevent disease — a preventive revolution,” Landovitz says.

And PrEP is a huge milestone in the effort to prevent HIV infections, Landovitz says. “Clinical trial data shows us that if taken every day as prescribed, [PrEP] is more than 90% protective against getting HIV infection. We have a lot of experience with these medications … so we know its safety profile [and] there aren’t any show-stoppers that would make you say, ‘This isn’t safe; don’t do that,’” he says.

But PrEP has an image problem. Landovitz finds that many of the patients who would want to take PrEP don’t know about it, and many who do know about the drug are met with ignorance or even judgement from their health care providers. “I’ve heard some horror stories of patients who have heard about this — who’ve gone to doctors who have no idea what this is — and patients have to educate the doctors.” And even worse, he says, doctors are shaming patients who learn about PrEP on their own and ask for a prescription. “They’ll say, ‘You’re promiscuous if you want to go on this. Can’t you just use a condom?”‘

“There’s a lot to be learned about how we educate people about this really powerful and exciting new technology,” Landovitz says. “There is this technology with which someone who is HIV negative can use to protect themselves — it doesn’t rely on someone else’s using a condom or not or someone else’s behavior.”

To learn more, watch Landovitz’s whole talk below:

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