[For the association Warning, May 19th, 2012: http://www.thewarning.info/spip.php?article342]
In recent months the world of the struggle against HIV/Aids is boiling, because one of the last taboos of prevention is falling: we may have here in a few times an alternative prevention targeted HIV negative peoples to reduce their potential risk of HIV infection. Indeed, following the encouraging results of iPrEx [1], an expert committee of the U.S. Food and Drug Administration (FDA) recently recommended the marketing of Truvada for prophylaxis [2], whereas the French ANRS has launched IPERGAY [3] for several months. But this new stage in the medicalization of sexuality dear to Michel Foucault remains controversial. However, the pharmaco-sexuality does not date from yesterday or the advent of treatment as prevention (TasP): birth control pills, morning-after pill, Trans hormonal-therapies, erection pills, post-HIV exposure prophylaxis (PEP)…
In France, the controversy between HIV organizations about PrEP appear in the media and social networks, from moral considerations disguised in ethical objections to classic behavioral speculations (as there was on the TasP or PEP) [4].
So, to clarify and defuse the situation, it should be noted some points:
– The biomedical prevention is a revolution in terms of sexual and mental health for serodifferent couples (especially those who want to have children) and poz sex workers (under pressure from their customers to have condomless sex), removing the risk and visceral fear of contamination. It is essential for fighting the demonization of people living with HIV/Aids (PLWHA) in our poz-phobic society: they are no longer considered as « viral bombs ».
– The biomedical prevention is a need expressed by all PLWHAs and peoples concerned by HIV [5].
– The biomedical prevention is an additional argument for the battle for universal access to treatment in poor countries and in prisons.
– The biomedical prevention is an important argument against the criminalization of HIV transmission, which beyond our respective countries, is increasing in Africa (since women are the first victims).
– The biomedical prevention must be done within the strict framework of informed consent and needs (therapeutic, psychological, sexual and social) of the concerned person(s). In no circumstances it may force the initiation of treatment to anyone, even if early treatment appears to have benefits, and although some mathematical models abound for the establishment of a general strategy of Test&Treat. Warning has long been positioned on the subject [6].
These reasons alone are sufficient to promote biomedical prevention [7] in a responsible manner and combined [8] to other tools in the fight against AIDS: condoms, HIV testing [9], Counseling, and struggles against serophobia and criminalization of sexual transmission of HIV. From this perspective, the recent opinion of the French National AIDS Council (CNS) on PrEP is remarkably balanced [10]. Particularly because it rightly emphasizes on the differential economic access to PrEP.
Then to push the economic limits of biomedical prevention, we should recall the principles of Denver, and all require lower rates of antiretroviral drugs or even threat if necessary to promote the purchase of generic antiretrovirals, more than ever. This benefits everyone, especially to poor countries that do not have the privilege to argue and remain the privileged terrain of our pharmaceutical companies in developing treatments which we are always the first winners! It is even perhaps time that the biomedical HIV prevention becomes a global public good and, as such, the drugs used are finally classified as essential medicines for priority health needs of people [11]: Yes to Truvada for 1$ per day in the North and 1$ per month in the South!
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Notes:
[1] Preexposure Chemoprophylaxis for HIV Prevention in Men Who Have Sex with Men: http://www.nejm.org/doi/full/10.1056/NEJMoa1011205#t=article.
[2] Recommendation which should probably be followed by FDA approval of marketing.
[4] In Quebec, health officials do not take into consideration at all PrEP. Belgium is even further behind, since only our association seems truly defending a holistic and free fight against HIV.
[5] PrEP acceptable to UK gay men, studies find: http://www.aidsmap.com/PrEP-acceptable-to-UK-gay-men-studies-find/page/2323923/.
[6] Ethics and health: eradicating the HIV epidemic by treating all HIV positive individuals, including those recently diagnosed, raises some important questions: http://blogs.poz.com/sean/archives/2010/10/parisian_activist_we_1.html.
[7] Particularly in the Canadian context where no federal recommendations has been issued about it. This can be understood as the Canadian Public Health – in its independence of judgment – still waiting for the southern big brother is positioned first. This has been done since the United States lined up a month ago on Swiss, German, French, British and UNAIDS recommendations, namely to systematically explain all poz peoples the benefits of effective treatment in terms of eliminating the risk of HIV sexual transmission: Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents: http://aidsinfo.nih.gov/guidelines/html/1/adult-and-adolescent-treatment-guidelines/10/initiating-antiretroviral-therapy-in-treatment-naive-patients.
[8] “Because each of us has a different life and sexuality all its own, it is to have at our disposal many tools as possible for our own prejudices that we should, at the right time! Combined prevention is to use one or more means of prevention according to our possibilities, our practices, our desires and those of our (or ours) partner(s). Able to talk about our sexuality and our health with our partner, our lovers, our friends, with medical professionals caring or activists can take stock of our practices and to get answers to our questions … So, to not be alone with our doubts, our questions, anxieties … let’s talk !”: www.aides.org/evenement/PREVS-et-vive-le-sexe-1166.
[9] And why not home testing: www.autotestvih.info.
[10] http://www.cns.sante.fr/IMG/pdf/Synthese_avis_PrEP_V7.pdf.
Folle Alliée 