WASHINGTON, DC—Less than two weeks after the US Food and Drug Administration approved the first pill to prevent HIV infection, researchers, health advocates, and potential consumers are all wondering who will take the drug and how it will affect public health.
In a recent survey of 38 gay and bisexual men in the Providence, R.I., area, presented Tuesday at the 2012 International AIDS Conference, researchers from Yale University and the Fenway Institute in Boston found that most of the men were interested in using the drug.
“The upshot is that there’s a market for [the preventive pill], and that a lot of people anticipate it will be a great benefit to their community and to them personally,” said Yale scientist Kristen Underhill, who led the research in collaboration with Dr. Kenneth Mayer of the Fenway Institute.
However, many participants expressed concerns about the drug’s cost and side effects, and a number said it would tempt them to engage in riskier sex. Underhill is planning follow-up studies to understand how gay and bisexual men will decide whether to use the drug.
The researchers held eight two-hour focus groups between January and June 2012, ending about five weeks before the FDA approved Truvada to prevent HIV infection on July 16. The men answered questions about their knowledge, beliefs, and attitudes about the preventive drug.
The men in the study were 79 percent white and 21 percent black, and they ranged in age from 21 to 61. Nearly 40 percent of the men had no health insurance, and one-third relied on Medicare or Medicaid. A handful were homeless.
“Cost is crucially important,” said Underhill. “It’s still not clear whether everyone’s going to cover it, much less Medicare or Medicaid.”
Without insurance, the drug would cost at least $13,900 a year. In Massachusetts, representatives from Harvard Pilgrim Health Care said they would cover Truvada as HIV prevention at a patient cost of about $25 per month. Tufts Health Plan decided this week to also cover the drug. Representatives of Blue Cross Blue Shield of Massachusetts, the state’s largest health insurer, said the company is still reviewing whether to cover the preventive pill.
The most common side effects reported in clinical trials included nausea, diarrhea, abdominal pain, weight loss, and headache.
Among participants who were interested in the drug, some wanted added security in continuing what they knew to be risky lifestyles.
“I would take that pill every day because I’m going to have unsafe sex if I take it or if I don’t take it. So for someone like me, I think it’s great,” said one participant.
Other participants reported that they would use the drug to engage in new, riskier behaviors.
“Many of the men who were talking to me said that they would use condoms less, that they would have more partners,” said Underhill.
The FDA hasspecifically approved the use of Truvada “in combination with safer sex practices,” and many public health specialists stress that the pill should not replace condoms, which also protect against other sexually transmitted infections.
The coming months and years will reveal how healthy consumers act on these recommendations.
“I think some people will change their behaviors and some people won’t,” said Underhill. “One of the goals of my study is to figure out what’s going to motivate those two types of actions.”