AIDS/HIV | Truvada

Why Are Gay Men Resisting PrEP?


Despite the proven effectiveness of taking a daily Truvada regimen as a form of pre-exposure prophylaxis, or PrEP, there is a slow uptake of the drug in the gay community, and even a hostile resistance from some segments. The reasons for this seem to come from multiple fronts:

  • Some gay men are met with negative reactions from others, including their own healthcare providers as well as other members of the gay community who throw around the term "Truvada whore" as a form of slut-shaming
  • A general lack of awareness of what the drug does, or even that it exists as a preventative measure
  • The rare but serious side effects of kidney damage and bone density loss
  • The cost, which can top $1000 per month without medical insurance

In the meantime, HIV infections are on the rise in the U.S. with approximately 50,000 new infections annually and over 57% of gay men reporting having unprotected sex, quite likely as a result of "condom fatigue." Incidentally, during trial studies there was no noticeable difference in the level of risky activity engaged in between men who believed they were on Truvada vs. those who believed they were on the placebo.

Plus, there is a generational shift in attitudes as younger gay men are coming to know HIV as a manageable disease, having not experienced the utter devastation it wreaked in the 80s and 90s.

Still, doctors remain hopeful and the drug regimen itself is likely to undergo drastic changes in the coming years, including changing the administration method to something like gels or injectibles as well as a less-frequent dosing. Said Dr. Mayer of Fenway Health. “It’s going to take time. It’s really early days.”

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  1. Why should anyone have to take a prescription medication unless it's absolutely necessary? Whatever happened to safe sex?

    Posted by: Jack M | Jan 2, 2014 9:01:29 AM

  2. Who believes someone would resist taking this for fear of being called a "Travuda Whore" rather than the most obvious explanation (welcome to the real world) that insurance companies and Medicaid are NOT going to gladly cover it unless pre-authorization is required (a partner with HIV, for example) and that "being tired of condoms" isn't going to get you free medication at the expense of your insurance company or the public.

    Posted by: MIke | Jan 2, 2014 9:11:35 AM

  3. Until there is a cure there is always a risk.

    Posted by: Shugo Chara Egg! | Jan 2, 2014 9:16:16 AM

  4. "I'm on the pill"

    How many daddy's have heard that one?

    Yes you are a Truvada whore if you are taking PrEP explicitly so you can run around have unprotected sex with complete strangers

    Posted by: qj201 | Jan 2, 2014 9:16:29 AM

  5. $1000 a month without health insurance...that's a big deal to a lot of people!

    Posted by: John | Jan 2, 2014 9:18:32 AM

  6. As an HIV educator, I've asked why Truvada has not come into wide use. A great many people would LIKE to get it, for a variety of reasons, but very few can get it because of the cost. The cost must come way down, and be covered as a prescription by insurance plans, before people will be able to use it.

    Posted by: Gregory In Seattle | Jan 2, 2014 9:19:08 AM

  7. My insurance (blue cross) covers Truvada for PrEP, my monthly cost is only $15. I've had no side effects. I practice safe sex, but condoms aren't 100% safe, can break, or there could be other problems, and so I feel like having this extra level of protection is worth it.

    Posted by: J | Jan 2, 2014 9:23:15 AM

  8. how about
    instead of expensive drugs
    people wear condoms

    Posted by: bill | Jan 2, 2014 9:56:22 AM

  9. I think it's highly disrespectful to the countless gay men who fought and who died in the 1980s and 1990s to even just have a pill that would SAVE THEIR LIVES. Why isn't their a cure yet? HIV researchers have failed at their job. They should all be fired and never receive another drop of federal research money. They should not be hailed as hero but as failures. PREP is a cop out by the researchers who failed to come up with an effective vaccine and/or cure.

    Posted by: Joe | Jan 2, 2014 10:01:09 AM

  10. Well according to my "Insurance Plan" the "Pill" is $ 1187.00 a month!!!! anyone else??

    Posted by: aj | Jan 2, 2014 10:05:38 AM

  11. Maybe because truvada does NOT protect from syphilis, ghonorrea, herpes, HPV and such other amenities? So it still might be quite better wrap oneself up before casual sex?

    Posted by: mEis | Jan 2, 2014 10:08:59 AM

  12. I think it mainly comes down to the cost, but here's another reason why I think PreP is not for me or many others. Why take a daily pill which you may forget to take from time to time when you aren't necessarily sexually active on a daily basis and even if you are, you may not always be having penetrative sex. I'd rather use a condom for the times I need them, which as others said protect me from other STIs, than have to take a damn pill, with serious side effects, every day.

    Posted by: Graphicjack | Jan 2, 2014 10:21:44 AM

  13. I think the comments here are pretty indicative of why people don't use it, which is that people are judged for not wanting to use condoms.

    Posted by: abe | Jan 2, 2014 10:25:59 AM

  14. Some of us aren't taking it because when we mentioned it to our doctor, they looked horrified and gave a safe sex speech and talked about the "danger" of taking a pill daily... and said they woudn't prescribe it

    Posted by: Anonymous | Jan 2, 2014 10:29:03 AM

  15. Um, I dunno? Condoms are cheaper? Um, who knows what a drug will do to your liver and kidneys after having taken it for more than 10 years? I'm not sick so why would I take a drug, anyway? The drug manufacturer is not rich enough? It's just more profitable to keep people on the precipice of catastrophic illness, than to find a cure, actually? Etc., etc., etc.

    Posted by: Sean Maloney | Jan 2, 2014 10:30:55 AM

  16. I also checked my insurance cost. The drug is in the formulary, and no pre-authorization is required. The cost would be $400 / year. The insurance companies would rather pay for Truvada than incur the cost of an AIDS patient. I think it is great that this option is available. I can't imagine anyone using the term Truvada whore or whore for that matter, and if they did that would just reflect back on them as being an ignorant fool with sexual hangups. Regarding the comment about the doctor looking horrified... time to get another doctor for obvious reasons. That is highly unprofessional behavior. Doctors are suppose to heal, not to judge. For the comments about people without health insurance... according to the law now, you're suppose to get it. Logon to and sign up. Oy vey!

    Posted by: Gerry | Jan 2, 2014 11:01:58 AM

  17. All drugs have side-effects. Why would you be insinuating that we all should be taking this? How about always wearing a condom (a lot of the young ones are into some sort of bareback craze), not doing drugs that kill your common sense, and not having to sleep with a different guy every week? Much more sensible options but no, let’s pop a pill for horniness.

    Posted by: MD | Jan 2, 2014 11:02:15 AM

  18. Outside of being in a relationship with someone you know is HIV+ and also know doesn't have any one of a multitude of other STDs, using this pill does NOT eliminate the need for using a condom.

    Posted by: anon | Jan 2, 2014 11:03:29 AM

  19. My doctor actually brought the topic up. I have given it a lot of thought and have decided to decline. While my health insurance will cover it with a small co-pay, I have always practiced safe sex and know myself well enough to realize that it might cause me to let my guard down. (Truvada whore?)

    Of course if I had a positive partner, I would probably go this route.

    I also asked the doctor a question that he didn't have an answer for...and that was, "If I use Truvada for a number of years, will this affect the options for future treadment should I seroconvert?"

    Posted by: florida | Jan 2, 2014 11:13:42 AM

  20. And the side effects from using a condom every time are...

    I think I'd choose the option without side effects, thank you.

    But I have no problem if others in different situations choose to go this route.

    Posted by: KevinVT | Jan 2, 2014 11:24:01 AM

  21. "Plus, there is a generational shift in attitudes as younger gay men are coming to know HIV as a manageable disease, having not experienced the utter devastation it wreaked in the 80s and 90s."

    Then we've failed to educate them properly.

    This is the same sort of attitude which existed before the epidemic.

    Got an STD? Just run over to the clinic to get a shot or a prescription.

    Just another time bomb ticking away.

    But, hey, everyone has the right to choose how they live.

    Candidly at this point if another epidemic broke out, I'd probably sit this one out. Men can make their own choices and engage in whatever activity they like.

    But if a new HIV/AIDS appears, my basic attitude would be "clean up your own mess".

    I would probably turn my back. Already gave at the office.

    That would be my choice.

    And people are crazy to think that risky sexual activity won't lead to more trouble. It is just a matter of time.

    Posted by: JoshG | Jan 2, 2014 11:46:38 AM

  22. Within the gay community itself, this risky and unnecessary drug is mostly being pushed by the bareback brigade--among them so-called HIV prevention activists--the majority of whom couldn't even keep themselves negative. Take a wild guess why that might be the case.

    Posted by: Douglas | Jan 2, 2014 12:50:33 PM

  23. Is it really that hard for them to figure out why gay people aren't rushing to get Truvada? Are they that dense?

    No way and I mean, no way am I ever going to fork over $1000 a month for a drug when I don't need it. I rarely engage in anal sex and when I do it's always with a condom.

    To each there own, but I'm still relatively young. The thought of popping a pill everyday for the rest of my life while potentially doing damage to vital organs is not quite appealing. I'm sure the pharmaceutical companies will do just fine without my $1000 a month.

    Posted by: NY2.0 | Jan 2, 2014 12:58:50 PM

  24. Enough with this BS! I've never heard the term "truvada whore". It's completely made up to drum up sympathy for PrEP proponents and discredit opposition. Then there's this constant narrative of the ole geezers who just don't get it when people bring up valid concerns. Like 90% of people aren't adherent, doesn't protect against other STIs, can cause a drug resistant strain of HIV, that the FDA approval was the result of collusion with Gilead..

    Posted by: andy | Jan 2, 2014 1:02:22 PM

  25. The comments do a better job of explaining the obvious reasons why gay men would resist such a drug than the post does. For some people, taking an expensive drug with unknown long-term side effects may make sense, depending on their personal risk levels and comfort zones, but for many of us, there are better ways to stay safe than popping an unnecessary pill. The better question would be: Why would someone choose to take this?

    Posted by: Ernie | Jan 2, 2014 1:12:26 PM

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