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.”