Did reading about the case of Steven Spencer make you nervous?

Spencer is a 27-year-old man who lives in Sydney. In recent weeks,  it’s been reported that Spencer became the seventh person globally to contract HIV while taking PrEP.

A lot of the headlines surrounding the disclosure of this diagnosis focused on it being an example of PrEP ‘failure’ – an example of PrEP not providing the protection that it is supposed to give. PrEP is a pre-exposure medication that is designed to prevent people from acquiring HIV.

Steven Spencer tested positive for HIV in December 2018. He was well-informed about how to use PrEP – he’d been taking it for five years. Spencer had been using the ‘on-demand’ method of taking PrEP. This is a method that has been endorsed and recommended by health experts – it means that you don’t have to take PrEP every day, you just need to take it before and after your sexual encounters where you feel that there’s a risk of transmission of the virus.

Does the case of Steven Spencer means that we should be re-thinking our embrace of PrEP as one of the key tools for the prevention of HIV transmission?

What is PrEP?

PrEP stands for pre-exposure prophylaxis. It was in 2012 that the World Health Organisation endorsed the use of antiretroviral medication – which is used to treat someone who has HIV – as a pre-exposure prophylaxis to prevent people from acquiring the virus.

In simple terms, PrEP is medication that acts as a preventative to HIV.

Truvada was the brand that was first available for use as PrEP, but there are now generic versions of the medication also available.

How effective is PrEP?

The CDC – Centers for Disease Control and Prevention in the US – advises that PrEP reduces the risk of acquiring HIV from a sexual encounter by more than 90%.

A major research project – the iPrEx Study – found that PrEP was up to 99% effective.

The San Francisco AIDS Foundation and the San Francisco Department of Public Health advise that PrEP provides 92%-99% reduction in HIV risk.

“Out of all of the hundreds of thousands of PrEP users we have only a handful of reports of the drug failing…” confirms Matthew Hodson of NAM Aidsmap.

If we compare the effectiveness of PrEP versus condoms, research indicates that condoms are somewhere between 70%-92% effective in preventing the transmission of HIV – if they are used correctly and do not break. However,  researchers have also found that condom use errors – breakage, slippage, or incomplete use – occur in up to 40% of sexual encounters.

“The reason that any instance of someone acquiring HIV while on PrEP is big news is because it’s so rare…” explains Matthew Hodson. “When someone who uses condoms acquires HIV it doesn’t make the news – it happens too often to be newsworthy.”

How do I get PrEP?

The availability of PrEP will vary depending on where you are. Some countries have made PrEP available free-of-charge to people at risk of acquiring HIV, in other countries it is only available if you purchase it privately.

As a first step, speak with your doctor of sexual health service. They will be able to advise whether PrEP is available on prescription. If it’s not available through your health service, there are options available to purchase online.

“Worldwide, more than 400,000 people have started taking the pill via official channels, almost two-thirds of them in the United States…” explains Matthew Hodson. “It’s estimated that about the same number may have accessed PrEP via unofficial channels, particularly in China and Russia but also in the UK.”

Don’t forget about U=U

U=U stands for Undetectable = Untransmittable. What this means is that if someone has HIV but their medication has reduced their viral load to ‘undetectable’ levels, then they can’t transmit the virus to anyone else.

This is sometimes referred to as Treatment-as-Prevention, or TasP.

Combination Prevention Strategies

A number of cities around the world are reporting declining HIV transmission rates – cities such as London, Sydney, New York, and San Francisco. The best success in tackling HIV appear to be coming from combination prevention strategies.

‘This turnaround shows what can be achieved by utilising everything we’ve got in the fight against HIV…” says Ian Green, Chief Executive at UK health charity Terrence Higgins Trust, talking about good results being achieved in London. “That includes the widespread availability of condoms, a range of ways and places to test for HIV, early diagnosis and access to treatment, and increasing availability of the HIV prevention pill PrEP.”