This video showcases a TEDx Talk by Will Nutland, a research fellow at LSHTM. He has been working on the acceptability of pre-exposure HIV prophylaxis (PrEP) in the gay community in London. PrEP has been immensely promoted in the recent years as a prevention technique of individuals at increased risk of HIV exposure. He adopts a fun and demonstrative approach to convey the message of PrEP.
Nutland begins the talk on a very interesting note. He talks about a 1989 movie based on AIDS called, Long Time Companion. He reminisces the final scene of the movie where the protagonists talk about envisioning the moment of ‘end of HIV’. That sentimental and emotion scene from the Hollywood movie, not only inspired hope in the people but also introduces the idea of a moment in the future when the end of HIV would advent. However, Nutland says that the end of HIV will not be just one moment but a number of endpoints and milestones, spanning over years.
He further discusses the various reasons behind the fact that in spite of being proved to be highly effective, PrEP is still not very widely used. The price of the PrEP drug, Truvada is one of the main reasons. The price range of Truvada from private STD Clinics discourages most middle class as well as underprivileged population from adopting it. However certain individuals, like Nutland himself, have taken a path less expensive. They have started acquiring generic Truvada, which is basically the same drug but imported from low-labor-cost countries like India and Indonesia. This practice is highly cost effective and might become widely popular if the public health authorities do not step up. It is imperative to make Truvada not just much cheaper but also more accessible to all classes of people.
Alternative Truvada Regimen
Nutland also introduces an alternative regimen of Truvada which is based on event-based dosage. It has been designed for individuals who have the risk to HIV exposure only occasionally. A major hurdle in following this alternative regimen is the pre-planning of sexual encounters. This inconvenient and also impossible on several occasions.
Topical PrEP
New developments in the field of PrEP were also discussed in the talk. Nutland talks about topical PrEP or microbicide, which is application-based. Since it is for external application only without any pills or ingestion, it could be an attractive option. In addition, clinical trials with women using vaginal microbicide in the form of gels has shown promising results. HIV contraction has been reduced significantly. This solution can also be used for anal sex in case of gay men or women interested in anal sex. However, there are a number of practical impediments in using anal microbicides. Nutland studies its applications and if homosexual men are willing to use rectal gels requiring an applicator. Upon talking to them, certain fundamental questions like how to apply the gel, if the application will hurt or does one need assistance in application come up. He takes up a very innovative approach in demonstrating the practical limitations of using rectal gel.
A major issue with using rectal gels which discourage many people from adopting them as a preventive measure is the possibility of leakage and spillage. Since it has to be applied certain hours before planned sexual encounters, physical activities might lead to spillage and leakage episodes. Also, the necessity to pre-plan sexual encounters is not eliminated by this option. Thus, several innovations like lubricant containing microbicide and anal douche are being introduced.
New Innovations in PrEP
In order to make PrEP the weapon to eliminate HIV, it has to be made available cheaply and more accessible even to the most repressed classes, who face greatest health inequalities. New developments in the field of PrEP are ongoing at an alarming rate. Several innovations like injectables, long-term treatments, rectal douche etc. are being introduced.
It has been 25 years since the movie that Nutland mentioned came out. With the introduction of PrEP, PEP and innovations in HIV Testing, the end of HIV is very close. Nutland ends the talk on a very sweet note. He says that the numerous techniques of preventions and protections has enabled people to have safe sex without compromising the pleasure, intimacy and connection during sex.