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Who should take prophylactic HIV medications like Truvada?

Bottles of antiretroviral drug Truvada
Bottles of antiretroviral drug Truvada
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In an announcement last Friday, the World Health Organization recommended that all men who have sex with men take antiretroviral medication to prevent the contraction of HIV. Antiretrovirals, sold under the name Truvada, are used to treat HIV, but have also been shown to prevent the spread of the virus. Men who have sex with men are the most at-risk population when it comes to HIV -- they are 19 times more likely to contract the virus than heterosexual men.

The United States CDC recommended Pre-exposure prophylaxis, or PrEP, for people with HIV-positive partners and for certain populations of gay men in May. The WHO’s more sweeping advisory includes all men who have sex with men, and may carry more weight internationally. There is some concern about the WHO’s recommendations, including worry within the LGBT community that men will stop using condoms, and that the focus on PrEP might be misplaced at a time when community outreach and sex education is still vital to HIV prevention.

Other critics argue that it’s best to learn more about the long term impact and side effects of Truvada, and that condom use and other safe sex practices are the best bet. Proponents of the announcement say that it will legitimize PrEP and make it easier and cheaper for at-risk populations to prevent the spread of HIV.

What are the best ways to prevent the spread of HIV? Is prophylactic use of antiretrovirals a feasible option? How will the WHO recommendation impact HIV treatment and prevention in the U.S. and internationally?


Thomas Coates, Ph.D, Director of the UCLA Center for World Health, and is the Michael and Sue Steinberg Endowed Professor of Global AIDS Research within the Division of Infectious Diseases at UCLA

Perry Halkitis, Ph.D, Professor of Applied Psychology, Public Health and Medicine; Associate Dean of Academic Affairs Global Institute of Public Health at NYU