Health professionals have been surprised to find that a proven H.I.V. prevention method has been slow to catch on with the groups that are most at risk. Many health experts hoped that the medication, named Truvada, would be embraced by H.I.V.-negative gay men as well as others with a heightened risk of infection. However, in the eighteen months that the medication has been on the market, few men have requested prescriptions.
Truvada is a combination of two antiviral drugs that have been used to treat H.I.V. since 2004. The controversial new form of H.I.V. prevention, a daily pill, has been shown in studies to be highly effective in protecting people from becoming infected with the virus. Michael Rubio, a 28-year-old gay man, said he began taking the pill after four friends became H.I.V. positive through unprotected sex within the course of a year. Mr. Rubio said, “With my inner circle so affected in the last year, it was a no-brainer to consider this for my life right now.”
Truvada was hailed as a way to reduce new infections among high-risk groups like young gay men, people in relationships with H.I.V.-positive partners, and prostitutes. Surprisingly, the idea that healthy gay men should take a medication to prevent infection has been met with hostility or indifference in some quarters. Dr. Lisa Capaldini, a primary care doctor who treats gay men, said, “It’s gotten tons of attention at H.I.V. meetings as a new tool for prevention, and I consider it an important option for the right person. And yet there’s been very little interest among my patients. There’s a fascinating disconnect.”
50,000 new H.I.V. infections occur annually in the United States, with more than half of them attributed to sexual transmission between men. A disproportionate number of the cases are found among African-Americans and other minorities. Public health officials have promoted condom use during every sexual encounter as the only effective method, short of abstinence, for preventing H.I.V. transmission for the last three decades. When the Food and Drug Administration approved the new treatment method, they also called for prescriptions to be accompanied by counseling, frequent H.I.V. testing, and the continued promotion of safer sex.