Joel Alcatraz, a 26-year-old Californian, carries the paranoia of becoming infected with HIV since he accepted that he was gay. "After every sexual contact I inspected the condom," he says. He rejected any seduction attempt by someone who had the retrovirus. "I was afraid of them, I did not want to become one of them." He investigated until he found the Truvada, known as pre-exposure prophylaxis (PrEP, for its acronym in English), which reduces the risk of infection by more than 90%. The pill made him leave the prophylactic on many occasions. Of course, has contracted other sexually transmitted diseases. However, nothing compares to the peace of being free of HIV. 80% of those affected by AIDS are gay, but the disease can affect both men and women, regardless of their sexual orientation.
In the United States, the marketing of PrEP was approved in 2012. The daily use drug costs $ 1,300 per month without health insurance, to which we must add laboratory tests and a doctor's appointment every three months. The financial fence that has to be avoided by the interested parties - in most cases cushioned by health plans - has not prevented consumption from growing at cruising speed. From 2016 to 2017 the increase was 30%, surpassing the 172,500 consumers, according to Gilead Sciences, the manufacturer of Truvada. The figure is still small if we consider that only the LGBT community is made up of more than eight million people. Since the introduction of the medicine, not yet approved in Spain, there is a correlation between the increase in the use and and the fall in the diagnosis of HIV, as stated at the International AIDS Conference last July.
Last week, PrEP became an "A" category drug in the ranking of the US Preventive Services Task Force (USPSTF). The news was very popular because the Affordable Care Act requires that most private health plans cover the total cost of preventive services recommended by the group. "The recommendations made by the USPTF should be complied with because they are not based on opinions, but on realities. PrEP is the biggest advance in HIV prevention since the epidemic began, "says Dr. Carlos del Río, co-director of the HIV Clinical Trials Unit of Emory-CDC.
The main public of the recommendations are men who have sex with men, couples where one of the two is infected with rotavirus, people who inject drugs and share syringes and sex workers. Del Rio recognizes that consumers of PrEP have relaxed about condom use, which has led to an increase in other sexually transmitted diseases (STDs). "It is difficult to calculate the increase because now we are also doing more tests. It is a combination of both, but we must see it with perspective: STDs can be cured and HIV can not, "says the doctor.
It's Thursday night in Washington and Cristián Valenzuela, a 27-year-old Chilean, reviews the profiles of Scruff, a dating application for gays. In a quick inspection you can make an estimate that three out of four users share in their personal information that they are consuming PrEP. Valenzuela, who began acquiring the drug three months ago to have "peace of mind" and recognizes that his use of condoms has decreased. "Many people put into the application that they want to do it without a condom, something that was previously totally stigmatized. Now with the pill is much more common, "he says. As several, the introduction of PrEP to the market changed the perception of people with HIV. Today she is more open to having sex with a person infected with the retrovirus. "I started to see people with HIV more as human beings and less as ghosts," said Alcatraz.
In a bar environment, Jhonny Hadlock, 34, teaches a list of the 17 guys he has had sex with since he left with his boyfriend in June. He acknowledges not being a regular in the use of condoms and for a month began to protect himself with the drug "I wanted to do it because I had complicated health episodes and I wanted to have control. There are people who tell you that they do not have HIV, but they may be lying to you, "she says. His friend Kevin Holender, 26, supports the use of the pill, but does not consume it because being active (he penetrates) considers that he is less prone to get infected and his sexual life is calm [aunque el riesgo persiste].
When Alcatraz started using it four years ago and put it on its Grindr profile, the biggest dating application for gays, many attacked it. "Often, people who were HIV positive." However, that stopped with time and now he says he is totally integrated into the gay culture. "In fact, if you do not take PrEP, it's kind of weird," he concludes.
The US government argues that people at high risk of contracting the retrovirus can benefit from a program in place in some areas that gives PrEP free of charge. "The problem is that those who really are at risk of contracting HIV do not get tested," says Deborah Birx, the special ambassador and coordinator of the US for AIDS. About 40,000 people were diagnosed with HIV in the US last year, adding to the little more than one million people who suffer from the disease.
The AIDS Foundation of San Francisco is one of the health centers that offers free pills to people with limited resources. Felipe Flores, spokesman for the foundation, maintains that despite the financial efforts of several organizations, there are areas where there are no alternative options for those who do not have insurance. They subsidize the generic that is sold in Thailand for 50 dollars. "In San Francisco you do not see much, but in other cities, where there are no free clinics, yes," he explains. The beneficiaries of the AIDS Foundation range from 15 to 81 years, concentrated mainly between 25 and 35 years.
Those under 25 are not as frequent with PrEP. Flores explains that it is due to three reasons: many depend on the medical insurance of their parents, who have not been told about their sexual orientation; the stigmata of being sexually active; and the bad sex education in the United States that has repercussions in that many do not know of the existence of the drug.