As effective as condoms

HIV-AIDS organizations are urging European health authorities to approve and subsidize the use of HIV prevention drug Truvada as infections slowly rise across the continent.

In the US, Pre-Exposure Prophylaxis (PrEP) is already offered to gay and bisexual men and sex workers. But in Europe, it is only available through two medical studies - one in Britain called PROUD and another in France named IPERGAY.

Last month, scientists - satisfied that the pill does help prevent participants from contracting HIV, stopped part of both trials to prevent any unnecessary exposure to the virus. But European health officials still appear hesitant to widely prescribe the costly drug.

Rising HIV rates

In several major European cities, HIV incidence among men who have sex with men (MSM) continues to climb. In London, one in eight gay men is now living with HIV. Around a quarter of all those who have the virus don't know they have it and are at high risk of passing it on to sexual partners.

With advances in treatment, condom use among gay and bisexual men has fallen over the past decade. HIV is no longer seen as a terminal illness, so increasing numbers of men are prepared to "risk it."

One participant in the UK PROUD study - Chris (not his real name) - told DW that being on PrEP has reduced his anxiety about contracting HIV.

"There are a few regular partners who I know, and now maybe I decide that the risk is that low - because I'm on PREP - that I can enjoy with my regular partners a more natural way of sex," said Chris, adding that he still used condoms with casual partners.

More 'barebacking'?

PrEP is controversial. Some gay rights' groups say Truvada is nothing more than a party drug which will lead to more 'barebacking' or condomless sex and ultimately increase HIV incidence.

But the UK and French studies show that is unlikely, with condom use remaining more or less steady during the trials. Although the full results won't be known until February, indications from the French IPERGAY trial suggest the medicine's efficacy surpassed 80 percent and was even higher in those who took the drug regularly.

In Britain, 50 percent of the participants of the trial were put on Truvada immediately, while the other half had to wait a year. France conducted a placebo-controlled trial to test if the drug would still work if used around sexual encounters, rather than every day.

Participants in both studies were already engaging in bareback sex before the trial and all were told to use condoms as well as the drug.

Dr. Laurent Cotte - one of the principle IPERGAY investigators - says they were quick to shut down the placebo arm of the trial when the drug's success became apparent both in France and the UK.

"The trial was surveyed regularly by an independent committee who saw the results unblinded. There was an anticipated meeting of the committee, and for this meeting, the results highly demonstrated efficacy."

Health officials hesitant

Dr. Cotte says the placebo-controled trial was critical to prove to French health authorities that HIV incidence could be reduced.

"Without these results, it is sure that there would not have been any kind of [health authority] approval. With these results, it opens the way for an approval. The next question will be some kind of reimbursement for the treatment, and at this point, that's not sure."

The French IPERGAY study tested the efficacy of the drug Truvada around sexual relations rather than every day use. It is hoped that the idea of a "gay morning before and morning after pill" could work out cheaper.

But many European health authorities still need convincing that they should foot the one-thousand-euro-per-month bill ($1,250) for daily PrEP. But with an all time high number of new HIV diagnoses among UK gay men last year, Gus Cairns from Britain's PROUD study warns they need to act sooner than later.

"Condoms work fine if you use them. But a bare majority at most and in most places a minority of gay men are 100 percent consistent condom users, even by their own account. So we're obliged to find other answers that can be used - ideally alongside condoms," he said.

Adherence had been an issue in previous global studies of Truvada, one of a combination of two drugs also given to HIV positive people. Participants in both European trials were better at taking the drug according to a schedule.

Gay men respond well

"Obviously if you're HIV positive, you have a huge incentive to take this drug. If you don't, you'll eventually end up sick and die. But taking it as prevention doesn't have the same incentive - it's not as scary. But what PROUD and IPERGAY showed is that if you give PrEP to the right group – to a group of gay men who are at sufficiently high risk and sufficiently motivated – then it will work," Cairns told DW.

Chris, who's been on Truvada for 18 months and doesn't have a boyfriend, can't imagine life without the drug.

"The only time I would stop the Truvada treatment was if I find a boyfriend who I would 100 percent trust. I've got used to an extra protection, and even if I use it sometimes, I just feel more safe, more secure," he said.

For now, every participant in both studies has been offered PrEP for at least the next year.

But some question whether it's okay to offer high-risk individuals such an effective harm reduction tool and then, at some point in the future, just take it away.