PrEP Transcript
00.00.13-00.00.18
Title:
THE HIV VACCINE
KRO
October 2014
00.00.23-00.00.36
[Kenneth Almanza]
So we’re here at Hollywood, Hollywood California, we’re here at, er, Temple Night Club. It’s a gay Latino… it’s a vaquero, we call it a vaquero here in Los Angeles, and it’s for gay cowboys and admirers. Basically, so we’re doing HIV testing tonight.
00.00.38-00.00.55
So this is our mobile testing unit, this is basically where we do our HIV tests. And pretty much we treat it like a laboratory, okay. Um, so far we have about a dozen people who are tested, as you can see they all have a unique ID code that we have for our privacy, and we all have negative results tonight, which is a good thing.
00.00.56-00.01.08
[Narrator]
Kenneth Almanza is an HIV counselor in Los Angeles.
He has sex with men and takes PrEP, brand name Truvada.
The pill can prevent HIV infection.
He keeps an online video journal.
00.01.09-00.01.24
[Almanza]
These pills are something that are available for HIV negative men, and once you take this pill daily, after about a week or so, you can have protection in your body, erm, up to 99% against HIV.
00.01.24-00.01.31
[Almanza]
Now that I know I have PrEP, it just gives me that sense of comfort,in any situation that I’m in sexually.
00.01.24-00.01.30
Title:
KENNETH ALMANZA
HIV Counseler/PrEP user
00.01.31-00.01.41
[Narrator]
Not everyone is happy with the new pill.
Like Michael Weinstein, president of the AIDS Healthcare Foundation in Los Angeles,
the largest foundation in this field in America.
00.01.42-00.01.54
[Michael Weinstein]
First law of medicine is do no harm, and I believe that this intervention will do harm.
[Interviewer]
Why?
[Weinstein]
Because people will think they’re protected when they’re not, they won’t use condoms, and, er, then infection rates will go up.
00.01.44-00.01.50
Title:
MICHAEL WEINSTEIN
AIDS Healthcre Foundation
00.01.56-00.02.02
[Narrator]
PrEP is also taken by women.
It allows them to safely get pregnant by a man with HIV.
00.02.01-00.02.01
[Man]
I see you!
00.02.03-00.02.07
[Poppy Morgan]
She would not be here without PrEP. There’s no way we could have had her without PrEP.
00.02.14-00.02.22
[Robert Grant]
These are the laboratories of the Gladstone Institute, San Francisco, California, and we’re mainly focused here on HIV infection.
00.02.22-00.02.31
[Narrator]
Professor Robert Grant is a researcher.
His team found that PrEP, short for Pro-Exposure Prophylaxis ...
can prevent HIV infection.
00.02.32-00.02.59
[Grant]
The pill has two medications that get inside of the cell, and it prevents that cell from, er, from replicating the virus. So the virus can get into the cell, but it does not spread from that cell because, er, it is blocked by those, er, medications inside of the cell. So they should take the pill daily for seven days before they should feel protected, and we ask that they take it for at least 28 days after their last, er, sexual exposure.
00.02.33-00.02.40
Title:
Prof ROBERT GRANT
Researcher
00.02.59-00.03.25
[Narrator]
A miracle pill. More than 30 years after the discovery of HIV ... which has caused millions of AIDS deaths worldwide. The America government approved PrEP and Truvada two years ago and the pill has already prevented HIV patients from developing AIDS. It is now also available for healthy people ...to protect against HIV. The pill is popular among gay men. But how protective really is PrEP?
00.03.26-00.03.54
[Grant]
If we look at everyone who received the drug, whether or not they used it, er, we saw that the risk of HIV reduced 44%. And so, erm, but we also know that half of the people who received the pills did not take them, did not take them really at all, and those people were not protected. The half of people who take the pills, every day, er, did not get infected. We saw no infections among people taking Truvada every day.
00.03.55-00.04.13
[Weinstein]
The gold standard for data, is effectiveness, and what they call intent to treat, which is to take the whole group. Don’t cherry pick the group and take the people who are most likely to adhere, and base it on that and exclude all the others, because we have to approximate a real world situation.
00.04.13-00.04.25
[Interviewer]
How safe is it? Up till 100%?
[Grant]
Well, in our most recent analysis, we saw no-one become infected with HIV, so that means 100% effectiveness.
00.04.25-00.04.31
[Weinstein]
Gay men are being use as guinea pigs. This is a mass experiment, okay. And, you know, who’s gonna be responsible if it ends badly?
00.04.32-00.04.55
[Grant]
There’s no way that we can guarantee that people will never become infected when taking PrEP, erm, but we know that the, er, protective effect is more than 96% among, er, those who take it daily, and it could be much more than 96%. In fact we see to date, no one becoming infected if they take PrEP daily.
[Interviewer]
But if they don’t?
[Grant]
If they don’t, there’s no protection at all.
00.05.07-00.05.11
[Howard Grossman]
Alright, let’s just check your blood pressure.
00.05.13-00.05.19
[Narrator]
Howard Grossman is a doctor in New York.
His patients are mostly gay men. He provides PrEP.
00.05.19-00.05.38
[Grossman]
Last fall, I probably had 4, 5 people on PrEP, who had come and asked me about it early on. Erm, now I think we were up to almost 80 people. And every single day somebody walks in here and asks me about PrEP. At least one person, if not two or three or four.
00.05.39-00.05.44
[Narrator]
Grossman even takes PrEP himself.
With condom use, he suffers from erectile dysfunction.
00.05.45-00.06.27
[Grossman]
I started taking PrEP in July. I had had two episodes where I had had unprotected sex. I can’t guarantee my behaviour. Here I am, somebody who has been involved with HIV for thirty years, I know, I know from the inside what it’s like. I’ve lost most of my good friends, erm, over this time. I went through the most horrible parts of the epidemic with patients, you know, hand in hand, erm, and if, if, I couldn’t guarantee my behaviour, who could? So I thought, you know what, this makes sense.
00.05.20-00.05.26
Title:
HOWARD GROSSMAN
Doctor/PrEP User
00.06.29-00.06.36
[Narrator]
The effect of the pill remains in the body for some time.
But for maximum protection, the pill should be swallowed daily.
00.06.37-00.06.54
[Grossman]
I’m a diabetic, less of a diabetic now because I’ve lost a lot of weight in the last couple of years, erm, but I take an injection every day, erm, I take, you know, fish oils every day, I take probiotics every day. Erm, it’s not, it wasn’t hard to add another pill.
00.06.55-00.07.01
[Almanza]
It’s been about four months, one, two, three, four.
00.07.01-00.07.05
[Narrator]
Kenneth Almanza also has hardly any problems after four months.
00.07.06-00.07.14
[Almanza]
I’ve only missed maybe two doses, erm, because I was… I spent the night somewhere else. But other than that it’s been very easy.
00.07.15-00.07.25
[Weinstein]
So the question is, will the people who won’t consistently use a condom because they’re undisciplined take medication every single day?
[Interviewer]
What do you think?
[Weinstein]
No.
00.07.26-00.07.32
[Narrator]
There are negative things to consider about PrEP.
Resistance may occur.
As well as side effects.
00.07.33-00.07.50
[Grant]
One in ten PrEP users have naseua or some abdominal cramping, but typically it only lasted a week or two, and resolved. We also found that it is necessary to monitor, the, er, kidney function with blood tests every three months, but doing that people were able to stay safe.
00.07.51-00.08.10
[Grossman]
I haven’t felt anything. You know some people have complained of a little upset stomach or nausea the first couple of days, Truthfully I think a lot of that’s in their heads. Erm, my experience with people on tenofovir and tribidibine, the two drugs that are in Truvada, is that it’s very very well tolerated.
00.08.11-00.08.45
[Weinstein]
Well, we give this medication to people who have a deadly virus, okay. And the side effects have to be balanced with the fact that HIV untreated will kill you, okay, so therefore it’s a good trade off. But if you’re talking about giving this to 22 year old’s, okay, erm, we know that it is associated with bone loss and kidney disease. Not in every person, but in a significant minority of people. And also, again in the real world, are the young people who go on this, are they gonna go every three months to get a kidney test? Er, are they gonna go and get a bone density test? No.
00.08.46-00.09.29
[Almanza]
Among HIV positive men, and women, there was a lot of reportable side effects, but there wasn’t any data that supported what would happen in a HIV negative individual. So I kinda thought to myself, well, do I really wanna put myself in that situation? What if something comes down the line saying that PrEP was very adverse for the liver, or something you know. I still kinda have those thoughts, they still kinda run through my head. But so far I haven’t read any reportable side effects that have been serious, erm, and I guess I’m willing to serve as a guinea pig for my community, because if I take it and something god forbid happens along the way, at least other negative men will be able to know that and make a more informed decision.
00.09.29-00.09.30
[Narrator]
There's more.
00.09.30-00.09.48
[Grossman]
Now that you’re here for your three month test, Wayne’s gonna do a swab, a throat swab, for gonorrhoea and chlamydia. Er, then you’ll give us some urine and we’ll also do a swab for anal gonorrhoea and chlamydia. Erm, if you’re at any risk for that.
00.09.48-00.10.01
[Grant]
People do need to understand that PrEP prevents HIV, but it does not syphilis, gonorrhoea, chlamydia, or pregnancy, so there’s other reasons to use condoms even if people are using PrEP to prevent HIV infection.
00.10.02-00.10.11
[Narrator]
PrEP may protect against HIV, If properly taken.
However, there are also disadvantages.
Why not just rely on condoms?
00.10.11-00.10.30
[Almanza]
What may be easy for you or someone else, is not easy for me. It’s a psychological thing, it’s an emotional thing, it’s a physical thing. In the heat of the moment, in any situation, even if a condom’s there, I know the majority of people aren’t gonna use it, and I know that because I’m a councillor and I’ve tested thousands of people over the past four years.
00.10.30-00.10.39
[Weinstein]
We know that condoms are the best way to prevent HIV. And we need to tell people the truth: that is the best way to prevent HIV and other STDs.
00.10.40-00.10.46
[GROSSMAN]
We shouldn’t just give that message that if you’re on PrEP you can stop using condoms in every situation. I’m not sure we know enough yet to say that.
00.10.48-00.10.57
[Grant]
PrEP can be a backup - to condom use – or it can be a way of preventing HIV among those who are not using condoms for whatever reason.
00.10.58-00.11.08
[Grossman]
What we need to do is focus our condom message on the unknown partner – that unknown hook up, that unknown hook up; the person where you really don’t know their situation.
00.11.08-00.11.24
[Weinstein]
When it went before the FDA for approval, everyone was saying “it will be used with condoms.” And I said “Bologny!” Bullshit, you know? It’s not going to be used… If people are… why would they take this medication if they intended to use condoms? It doesn’t make sense.
00.11.25-00.11.37
[Almanza]
As far as these little guys… You know I haven’t been using them. Um, I was very sporadic even before I started PrEP, but I knew I didn’t really like condoms… Um, so they’re going out of business.
00.11.41-00.12.01
[Narrator]
Each year, America counts 50,000 new HIV cases. The medical ethics discussion has focused on PrEP use by gay men: almost half of the users are female. One of them was Poppy Morgan. Her husband has HIV. The two wanted a child together. PrEP, or Truvada, offered a solution.
00.12.01-00.12.20
[Poppy Morgan]
There was a time when we were both taking Truvada - he was taking it for treatment, I was taking it for prevention - it felt very strange to take the same medication, um. It’s a, you know, strong medication so it felt - it just felt strange, but um... I never felt any side effects, you know I didn’t feel anything.
00.12.21-00.12.25
[Narrator]
Stress strikes, when the two have sex without a condom for the first time.
00.12.25-00.12.50
[Morgan]
There were times I would get so worried that, that you know, I’d contracted the virus – even though I know the science said it’s a very low chance. There was always the ‘what if’, yeah, always. Made my husband very nervous, he was very nervous all the time. He was afraid he had infected me… yeah, he was always afraid of that, every time, erm, so it was a lot of stress to deal with in our relationship, you know.
00.12.50-00.12.57
[Narrator]
After a year and a half and over 500 PrEP pills, Poppy got pregnant.
In 2013, Daisy was born.
00.12.58-00.1-00.13.24
[Morgan]
Our baby was born in April… erm, and yeah, I was negative, she was negative. When we used to look at her, we would both cry, because of the miracle that she was. Erm, you know like I said, she would not be here without PrEP, there’s no way we could have had her without PrEP, erm, so that’s the only reason she’s here.
00.13.25-00.13.26
[Morgan]
Yummy!
00.13.27-00.13.51
[Morgan]
I don’t think I would wanna stay on PrEP, we can use condoms, that’s okay. I don’t know though. I have to think… you know, I think about it all the time, should I or shouldn’t I? But, um, I just think it’s… at this point, I think it’s too risky, the side effects and exposing my body to such strong medication might not be the best healthy choice.
00.13.59-00.14.01
[Almanza]
Are you doing ok?
[Man]
Yeah, yeah, yeah.
[Almanza]
Okay.
00.14.05-00.14.13
[Almanza]
So, today, er, your result is HIV negative. If it’s hard for you to wear condoms, I would consider maybe using PrEP.
00.14.14-00.14.24
[Narrator]
PrEP costs about 1000 euros per month.
In America, the costs are often covered by insurance.
After an additional examination, Kenneth’s insurance fully covers the medication.
00.14.24-00.14.37
[Almanza]
This PrEP study’s only gonna last two years. So after that I have to figure out, am I gonna continue PrEP, and what insurance provider am I gonna have at that moment-
[Interviewer]
Can you afford it?
[Almanza]
I couldn’t afford it, no. No, I couldn’t afford it otherwise.
00.14.37-00.15.04
[Grant]
Public insurance companies as well as private insurance companies do pay for PrEP, and they pay for PrEP because they’d much rather pay for a few months of PrEP than lifelong HIV treatment, and um, and that’s an important point to make. By preventing an HIV infection, er, with a few months of PrEP use, we can prevent the need for lifelong HIV treatment, which is more expensive, and more toxic than, than PrEP.
00.15.05-00.15.29
[Narrator]
The World Health Organization is pro PrEP, but
In most European countries it is not yet registered.
The drug's manufacturer Gilead has not yet submitted the PrEP to the EU for approval
It's waiting for further European research.
GGD Amsterdam wants to start a pilot project with PrEP in 2015,
for men having sex with other men.
Professor Grant believes that Europe has to take quick steps.
00.15.29-00.16.06
[Grant]
It can save lives, it will save lives, and so I would encourage the European Medical Authority to review the available data, and to, er, to make decisions as quickly as possible. One thing that I would add, is that, erm, these, er government institutions typically do not act unless there’s demand. And so, er, people in the Netherlands, if they want PrEP, should let their elected officials know that and say you know, why are we allowing HIV to continue to spread in our, in our country? Why aren’t we doing everything we know how to do to, er, stop the spread of HIV?
00.16.06-00.16.37
[Weinstein]
At the end of the day, we’re gonna have the result of this grand experiment in about two years. We’re gonna have the people on PrEP, who sero-convert, we’re gonna have the people who develop drug-resistance, we’re gonna have, er, you know, increasing rates which we already have, for syphilis, gonorrhoea, chlamydia, okay. And so we’ll see how this experiment works, so you know, we’re not going to wage a huge campaign, um, but we’ve been through this before and we’re confident that the results will bare out what we are saying, and if we’re wrong we’ll be happy to admit it.
00.00.13-00.00.18
Title:
THE HIV VACCINE
KRO
October 2014
00.00.23-00.00.36
[Kenneth Almanza]
So we’re here at Hollywood, Hollywood California, we’re here at, er, Temple Night Club. It’s a gay Latino… it’s a vaquero, we call it a vaquero here in Los Angeles, and it’s for gay cowboys and admirers. Basically, so we’re doing HIV testing tonight.
00.00.38-00.00.55
So this is our mobile testing unit, this is basically where we do our HIV tests. And pretty much we treat it like a laboratory, okay. Um, so far we have about a dozen people who are tested, as you can see they all have a unique ID code that we have for our privacy, and we all have negative results tonight, which is a good thing.
00.00.56-00.01.08
[Narrator]
Kenneth Almanza is an HIV counselor in Los Angeles.
He has sex with men and takes PrEP, brand name Truvada.
The pill can prevent HIV infection.
He keeps an online video journal.
00.01.09-00.01.24
[Almanza]
These pills are something that are available for HIV negative men, and once you take this pill daily, after about a week or so, you can have protection in your body, erm, up to 99% against HIV.
00.01.24-00.01.31
[Almanza]
Now that I know I have PrEP, it just gives me that sense of comfort,in any situation that I’m in sexually.
00.01.24-00.01.30
Title:
KENNETH ALMANZA
HIV Counseler/PrEP user
00.01.31-00.01.41
[Narrator]
Not everyone is happy with the new pill.
Like Michael Weinstein, president of the AIDS Healthcare Foundation in Los Angeles,
the largest foundation in this field in America.
00.01.42-00.01.54
[Michael Weinstein]
First law of medicine is do no harm, and I believe that this intervention will do harm.
[Interviewer]
Why?
[Weinstein]
Because people will think they’re protected when they’re not, they won’t use condoms, and, er, then infection rates will go up.
00.01.44-00.01.50
Title:
MICHAEL WEINSTEIN
AIDS Healthcre Foundation
00.01.56-00.02.02
[Narrator]
PrEP is also taken by women.
It allows them to safely get pregnant by a man with HIV.
00.02.01-00.02.01
[Man]
I see you!
00.02.03-00.02.07
[Poppy Morgan]
She would not be here without PrEP. There’s no way we could have had her without PrEP.
00.02.14-00.02.22
[Robert Grant]
These are the laboratories of the Gladstone Institute, San Francisco, California, and we’re mainly focused here on HIV infection.
00.02.22-00.02.31
[Narrator]
Professor Robert Grant is a researcher.
His team found that PrEP, short for Pro-Exposure Prophylaxis ...
can prevent HIV infection.
00.02.32-00.02.59
[Grant]
The pill has two medications that get inside of the cell, and it prevents that cell from, er, from replicating the virus. So the virus can get into the cell, but it does not spread from that cell because, er, it is blocked by those, er, medications inside of the cell. So they should take the pill daily for seven days before they should feel protected, and we ask that they take it for at least 28 days after their last, er, sexual exposure.
00.02.33-00.02.40
Title:
Prof ROBERT GRANT
Researcher
00.02.59-00.03.25
[Narrator]
A miracle pill. More than 30 years after the discovery of HIV ... which has caused millions of AIDS deaths worldwide. The America government approved PrEP and Truvada two years ago and the pill has already prevented HIV patients from developing AIDS. It is now also available for healthy people ...to protect against HIV. The pill is popular among gay men. But how protective really is PrEP?
00.03.26-00.03.54
[Grant]
If we look at everyone who received the drug, whether or not they used it, er, we saw that the risk of HIV reduced 44%. And so, erm, but we also know that half of the people who received the pills did not take them, did not take them really at all, and those people were not protected. The half of people who take the pills, every day, er, did not get infected. We saw no infections among people taking Truvada every day.
00.03.55-00.04.13
[Weinstein]
The gold standard for data, is effectiveness, and what they call intent to treat, which is to take the whole group. Don’t cherry pick the group and take the people who are most likely to adhere, and base it on that and exclude all the others, because we have to approximate a real world situation.
00.04.13-00.04.25
[Interviewer]
How safe is it? Up till 100%?
[Grant]
Well, in our most recent analysis, we saw no-one become infected with HIV, so that means 100% effectiveness.
00.04.25-00.04.31
[Weinstein]
Gay men are being use as guinea pigs. This is a mass experiment, okay. And, you know, who’s gonna be responsible if it ends badly?
00.04.32-00.04.55
[Grant]
There’s no way that we can guarantee that people will never become infected when taking PrEP, erm, but we know that the, er, protective effect is more than 96% among, er, those who take it daily, and it could be much more than 96%. In fact we see to date, no one becoming infected if they take PrEP daily.
[Interviewer]
But if they don’t?
[Grant]
If they don’t, there’s no protection at all.
00.05.07-00.05.11
[Howard Grossman]
Alright, let’s just check your blood pressure.
00.05.13-00.05.19
[Narrator]
Howard Grossman is a doctor in New York.
His patients are mostly gay men. He provides PrEP.
00.05.19-00.05.38
[Grossman]
Last fall, I probably had 4, 5 people on PrEP, who had come and asked me about it early on. Erm, now I think we were up to almost 80 people. And every single day somebody walks in here and asks me about PrEP. At least one person, if not two or three or four.
00.05.39-00.05.44
[Narrator]
Grossman even takes PrEP himself.
With condom use, he suffers from erectile dysfunction.
00.05.45-00.06.27
[Grossman]
I started taking PrEP in July. I had had two episodes where I had had unprotected sex. I can’t guarantee my behaviour. Here I am, somebody who has been involved with HIV for thirty years, I know, I know from the inside what it’s like. I’ve lost most of my good friends, erm, over this time. I went through the most horrible parts of the epidemic with patients, you know, hand in hand, erm, and if, if, I couldn’t guarantee my behaviour, who could? So I thought, you know what, this makes sense.
00.05.20-00.05.26
Title:
HOWARD GROSSMAN
Doctor/PrEP User
00.06.29-00.06.36
[Narrator]
The effect of the pill remains in the body for some time.
But for maximum protection, the pill should be swallowed daily.
00.06.37-00.06.54
[Grossman]
I’m a diabetic, less of a diabetic now because I’ve lost a lot of weight in the last couple of years, erm, but I take an injection every day, erm, I take, you know, fish oils every day, I take probiotics every day. Erm, it’s not, it wasn’t hard to add another pill.
00.06.55-00.07.01
[Almanza]
It’s been about four months, one, two, three, four.
00.07.01-00.07.05
[Narrator]
Kenneth Almanza also has hardly any problems after four months.
00.07.06-00.07.14
[Almanza]
I’ve only missed maybe two doses, erm, because I was… I spent the night somewhere else. But other than that it’s been very easy.
00.07.15-00.07.25
[Weinstein]
So the question is, will the people who won’t consistently use a condom because they’re undisciplined take medication every single day?
[Interviewer]
What do you think?
[Weinstein]
No.
00.07.26-00.07.32
[Narrator]
There are negative things to consider about PrEP.
Resistance may occur.
As well as side effects.
00.07.33-00.07.50
[Grant]
One in ten PrEP users have naseua or some abdominal cramping, but typically it only lasted a week or two, and resolved. We also found that it is necessary to monitor, the, er, kidney function with blood tests every three months, but doing that people were able to stay safe.
00.07.51-00.08.10
[Grossman]
I haven’t felt anything. You know some people have complained of a little upset stomach or nausea the first couple of days, Truthfully I think a lot of that’s in their heads. Erm, my experience with people on tenofovir and tribidibine, the two drugs that are in Truvada, is that it’s very very well tolerated.
00.08.11-00.08.45
[Weinstein]
Well, we give this medication to people who have a deadly virus, okay. And the side effects have to be balanced with the fact that HIV untreated will kill you, okay, so therefore it’s a good trade off. But if you’re talking about giving this to 22 year old’s, okay, erm, we know that it is associated with bone loss and kidney disease. Not in every person, but in a significant minority of people. And also, again in the real world, are the young people who go on this, are they gonna go every three months to get a kidney test? Er, are they gonna go and get a bone density test? No.
00.08.46-00.09.29
[Almanza]
Among HIV positive men, and women, there was a lot of reportable side effects, but there wasn’t any data that supported what would happen in a HIV negative individual. So I kinda thought to myself, well, do I really wanna put myself in that situation? What if something comes down the line saying that PrEP was very adverse for the liver, or something you know. I still kinda have those thoughts, they still kinda run through my head. But so far I haven’t read any reportable side effects that have been serious, erm, and I guess I’m willing to serve as a guinea pig for my community, because if I take it and something god forbid happens along the way, at least other negative men will be able to know that and make a more informed decision.
00.09.29-00.09.30
[Narrator]
There's more.
00.09.30-00.09.48
[Grossman]
Now that you’re here for your three month test, Wayne’s gonna do a swab, a throat swab, for gonorrhoea and chlamydia. Er, then you’ll give us some urine and we’ll also do a swab for anal gonorrhoea and chlamydia. Erm, if you’re at any risk for that.
00.09.48-00.10.01
[Grant]
People do need to understand that PrEP prevents HIV, but it does not syphilis, gonorrhoea, chlamydia, or pregnancy, so there’s other reasons to use condoms even if people are using PrEP to prevent HIV infection.
00.10.02-00.10.11
[Narrator]
PrEP may protect against HIV, If properly taken.
However, there are also disadvantages.
Why not just rely on condoms?
00.10.11-00.10.30
[Almanza]
What may be easy for you or someone else, is not easy for me. It’s a psychological thing, it’s an emotional thing, it’s a physical thing. In the heat of the moment, in any situation, even if a condom’s there, I know the majority of people aren’t gonna use it, and I know that because I’m a councillor and I’ve tested thousands of people over the past four years.
00.10.30-00.10.39
[Weinstein]
We know that condoms are the best way to prevent HIV. And we need to tell people the truth: that is the best way to prevent HIV and other STDs.
00.10.40-00.10.46
[GROSSMAN]
We shouldn’t just give that message that if you’re on PrEP you can stop using condoms in every situation. I’m not sure we know enough yet to say that.
00.10.48-00.10.57
[Grant]
PrEP can be a backup - to condom use – or it can be a way of preventing HIV among those who are not using condoms for whatever reason.
00.10.58-00.11.08
[Grossman]
What we need to do is focus our condom message on the unknown partner – that unknown hook up, that unknown hook up; the person where you really don’t know their situation.
00.11.08-00.11.24
[Weinstein]
When it went before the FDA for approval, everyone was saying “it will be used with condoms.” And I said “Bologny!” Bullshit, you know? It’s not going to be used… If people are… why would they take this medication if they intended to use condoms? It doesn’t make sense.
00.11.25-00.11.37
[Almanza]
As far as these little guys… You know I haven’t been using them. Um, I was very sporadic even before I started PrEP, but I knew I didn’t really like condoms… Um, so they’re going out of business.
00.11.41-00.12.01
[Narrator]
Each year, America counts 50,000 new HIV cases. The medical ethics discussion has focused on PrEP use by gay men: almost half of the users are female. One of them was Poppy Morgan. Her husband has HIV. The two wanted a child together. PrEP, or Truvada, offered a solution.
00.12.01-00.12.20
[Poppy Morgan]
There was a time when we were both taking Truvada - he was taking it for treatment, I was taking it for prevention - it felt very strange to take the same medication, um. It’s a, you know, strong medication so it felt - it just felt strange, but um... I never felt any side effects, you know I didn’t feel anything.
00.12.21-00.12.25
[Narrator]
Stress strikes, when the two have sex without a condom for the first time.
00.12.25-00.12.50
[Morgan]
There were times I would get so worried that, that you know, I’d contracted the virus – even though I know the science said it’s a very low chance. There was always the ‘what if’, yeah, always. Made my husband very nervous, he was very nervous all the time. He was afraid he had infected me… yeah, he was always afraid of that, every time, erm, so it was a lot of stress to deal with in our relationship, you know.
00.12.50-00.12.57
[Narrator]
After a year and a half and over 500 PrEP pills, Poppy got pregnant.
In 2013, Daisy was born.
00.12.58-00.1-00.13.24
[Morgan]
Our baby was born in April… erm, and yeah, I was negative, she was negative. When we used to look at her, we would both cry, because of the miracle that she was. Erm, you know like I said, she would not be here without PrEP, there’s no way we could have had her without PrEP, erm, so that’s the only reason she’s here.
00.13.25-00.13.26
[Morgan]
Yummy!
00.13.27-00.13.51
[Morgan]
I don’t think I would wanna stay on PrEP, we can use condoms, that’s okay. I don’t know though. I have to think… you know, I think about it all the time, should I or shouldn’t I? But, um, I just think it’s… at this point, I think it’s too risky, the side effects and exposing my body to such strong medication might not be the best healthy choice.
00.13.59-00.14.01
[Almanza]
Are you doing ok?
[Man]
Yeah, yeah, yeah.
[Almanza]
Okay.
00.14.05-00.14.13
[Almanza]
So, today, er, your result is HIV negative. If it’s hard for you to wear condoms, I would consider maybe using PrEP.
00.14.14-00.14.24
[Narrator]
PrEP costs about 1000 euros per month.
In America, the costs are often covered by insurance.
After an additional examination, Kenneth’s insurance fully covers the medication.
00.14.24-00.14.37
[Almanza]
This PrEP study’s only gonna last two years. So after that I have to figure out, am I gonna continue PrEP, and what insurance provider am I gonna have at that moment-
[Interviewer]
Can you afford it?
[Almanza]
I couldn’t afford it, no. No, I couldn’t afford it otherwise.
00.14.37-00.15.04
[Grant]
Public insurance companies as well as private insurance companies do pay for PrEP, and they pay for PrEP because they’d much rather pay for a few months of PrEP than lifelong HIV treatment, and um, and that’s an important point to make. By preventing an HIV infection, er, with a few months of PrEP use, we can prevent the need for lifelong HIV treatment, which is more expensive, and more toxic than, than PrEP.
00.15.05-00.15.29
[Narrator]
The World Health Organization is pro PrEP, but
In most European countries it is not yet registered.
The drug's manufacturer Gilead has not yet submitted the PrEP to the EU for approval
It's waiting for further European research.
GGD Amsterdam wants to start a pilot project with PrEP in 2015,
for men having sex with other men.
Professor Grant believes that Europe has to take quick steps.
00.15.29-00.16.06
[Grant]
It can save lives, it will save lives, and so I would encourage the European Medical Authority to review the available data, and to, er, to make decisions as quickly as possible. One thing that I would add, is that, erm, these, er government institutions typically do not act unless there’s demand. And so, er, people in the Netherlands, if they want PrEP, should let their elected officials know that and say you know, why are we allowing HIV to continue to spread in our, in our country? Why aren’t we doing everything we know how to do to, er, stop the spread of HIV?
00.16.06-00.16.37
[Weinstein]
At the end of the day, we’re gonna have the result of this grand experiment in about two years. We’re gonna have the people on PrEP, who sero-convert, we’re gonna have the people who develop drug-resistance, we’re gonna have, er, you know, increasing rates which we already have, for syphilis, gonorrhoea, chlamydia, okay. And so we’ll see how this experiment works, so you know, we’re not going to wage a huge campaign, um, but we’ve been through this before and we’re confident that the results will bare out what we are saying, and if we’re wrong we’ll be happy to admit it.