Mapping Pathways is a multi-national project to develop and nurture a research-driven, community-led global understanding of the emerging evidence base around the adoption of antiretroviral-based prevention strategies to end the HIV/AIDS epidemic. The evidence base is more than results from clinical trials - it must include stakeholder and community perspectives as well.

30 May 2011

To PrEP or not to PrEP?

An ongoing development in the PrEP landscape is the AIDS Health Foundation’s (AHF) campaign against Gilead Sciences – more accurately, Gilead Sciences’ pursuit of a new indication for prevention from the  FDA for its “AIDS drug” Truvada. While Truvada is currently approved by the FDA for use as part of antiretroviral therapy combinations for individuals already living with HIV or AIDS, whether the pill should be used as a form of pre-exposure prophylaxis for those not infected is what’s under contention by the AHF.

The Truvada pill, a drug compound that consists of Gilead’s drugs Viread (tenofovir DF) and Emtriva (emtricitabine), was studied in both the iPrEx and FEM-PrEP trials to test its efficacy as a form of treatment as prevention. iPrEx showed this successfully, and FEM-PrEP not so successfully. (Read the Mapping Pathways blog post about this here.)

AHF’s campaign to halt Gilead in its pursuit of FDA approval gained new momentum after the FEM-PrEP trial closure. Read more about the AHF’s thoughts about this here and at

The organisation also recently conducted a survey with 822 men to examine “real world” reactions from prospective consumers about taking PrEP and gauging potential adherence issues. Among the findings: 79% of respondents answered “Yes” to the question: “If you could take a pill on a daily basis to prevent HIV, would you take it?” However, only 63% of respondents said they would be “Very Likely” to remember to take the prevention pill every day. Read more about the survey here.

While no-one is contending that PrEP requires a lot more thought before being rolled out fully, many advocates feel that the AHF’s methods of gathering “real world” information are based on half-truths and stereotypes rather than a solid evidence-base. Read this critical analysis of gaps in the AHF survey here.

All this just confirms the need for a lot more objective information from a variety of sources – communities, academics, policymakers and those infected with HIV – to help us understand the rapidly evolving and dynamic PrEP landscape and the various strategies that can be deployed to prevent and eradicate HIV/AIDS.

Jim Pickett, from the AIDS Foundation of Chicago, a Mapping Pathways partner organization, sums this up best: “This discussion is of the moment, everything has just coalesced now, everything is happening now, and communities across the world are grappling with these strategies, wondering, ‘How in the world do we do this when we have all these other struggles? But on the other hand, how do we ignore it; how can we possibly ignore a new tool that could reduce so much suffering?’ And we have to realize that there are going to be different answers for different places in the world, or even in different parts and populations of one country. We’re hoping that the Mapping Pathways initiative will be able to provide some guidance to help figure all this out. There are so many complex issues to unravel and it is our duty to weed through all of these challenges, all of the promises, and all of the potential perils of these new strategies.”

The Mapping Pathways project is also in the process of trying to gather perspectives on these questions from folks in our current focus areas – the US, South Africa, and India. If you’re interested in new ways to prevent transmission of HIV – and want to help shape our project goals and deliverables – we encourage you to take a few minutes and fill in our survey.

Your efforts will be greatly appreciated!

Take the survey now.

[Content that is linked from other sources is for informational purposes and should not construe a Mapping Pathways position.]


  1. It just doesn't make sense to me to give daily pharmaceuticals to a person who doesn't have an illness when there are considerably less toxic, considerably more effective and considerably less expensive ways of preventing transmission of that disease. I can just barely see it as reasonable in the case of a serodiscordant couple or a sub-Saharan sex worker… for the average gay man in the English-speaking world, it just seems ridiculous. But what it really sounds like to me is Big Pharma seizing on an opportunity to sell something at $35 a day instead of not making any money on condoms, and starting websites like this to demonstrate "grass roots" support.

  2. Big Pharma has not lead the research into PrEP, or ARV-based microbicides. It has been led by institutions like the NIH and universities for many years - with lots of grass roots (no air quotes) support. Condoms - and other methods of protection - are only as effective as they are used, economical or not. The point is having choices - whether they are yours or not. And averting an HIV infection with PrEP DOES make economic sense - comparing the cost of lifetime treatment (if it is available) to a few years perhaps of PrEP...

  3. I didn't suggest that the research was led by Big Pharma -- I suggested they were seizing on it as an opportunity to sell drugs. And, no, sorry, I cannot accept that it makes economic sense. Averting an HIV infection is cheaper than not averting it, certainly -- but using an inexpensive/free condom to do it is cheaper than spending $35 a day on drugs. If you want choices, fine, lots of people don't like using condoms and some have $35 a day to waste on indulging that dislike. I live in Canada and our public health care system would no more pay for that than they would for Botox, but I don't mind people paying for it themselves as long as they don't mind what I think of their intelligence.

    By the way, if this is grass roots support without air quotes, who pays for this website? Oh, wait -- Merck & Co. Thanks for making that clear in the sidebar. In the public relations business, this is known as "astroturfing" -- artificial grass roots support.

  4. A few points, ANON:

    This project is about ALL ways to use ARVs as prevention - PrEP being one.

    Astroturf movements tend to hide their sponsors, donors, don't they? We don't.

    That said, Merck has no drugs currently being studied for PrEP. As you know, so far the only science has been on Truvada and tenofovir. Though maraviroc (selzwentry) - a Pfizer drug - is being looked at as a microbicide.

    Canada doesn't pay 35/day for Truvada - neither does the rest of the world outside the U.S. In developing countries - Truvada is about $140 per year. And the U.S. AIDS Drug Assistance Program pays about7k and change a year per person for the drug (exact price is not available - though it is about half the "list" price). So, the $35 is retail or list - and it is not expected even those of us in the U.S. will pay those rates for PrEP.... Incidentally, some insurance companies here are already covering PrEP...

    If people won't or can't use condoms, it matters not how cheap or effective they are. And there are lots of reasons not to use them - regardless of how "valid" or not they are.

  5. Nicholas S. Literski31 May, 2011 11:42

    Ironically, it appears that the so-called "AIDS Healthcare Foundation" is the group posting around the web to demonstrate fictitious "grass roots" support for their position. Note how many of these naysayers are posting as "Anonymous." Michael Weinstein and his cohorts appear to be repetitiously posting their organization's talking points on every discussion they can find, whereas real "average people" would use their own words and thoughts.

    I don't understand why we let AHF frame the discussion with their imaginary issues of limited resources, horrific side effects, and rampant resulting resistance to Truvada. Why do we let them frighten people with fabricated threats, suggesting that PrEP will somehow take treatment away from existing HIV positive patients? Why do we let them falsely pretend that the side effects of Truvada are frequent, or that PrEP users won't be monitored to avoid things like kidney damage, etc., before it becomes a problem? Why do we let them fool people into thinking that PrEP will cause resistance to Truvada, when we already have clear guidelines about testing patients' HIV status before beginning treatment, etc.?

    Now, AHF is even sending a video around the web, allegedly from a scholarly conference at UCLA, which gives their view of "real world" problems with PrEP. If it truly is a UCLA-sponsored conference, then it amazes me that a major university's school of public health appears unable to discern the difference between a properly designed study and a self-selected marketing company survey, wherein:

    (1) the results of the latter have been culled to skew the responding population,
    (2) the questions were remarkably leading in their wording, and
    (3) we are given zero information regarding the source from which this marketing survey company gathered their participants.

    At first, I was encouraged to see that they were representing the answers accurately, rather than only reporting the negative responses (as AHF did in a recent press release). The final wrap-up, however, wasn't in line with the survey responses. Instead, it reiterated the negatively perceived response choices AS IF they had been the predominant answers, and finally made a political statement (albeit in the form of a question) about how "limited resources" could be better used.

    If AHF was truly concerned about the best interests of gay men, they wouldn't be engaging in this vindictive, misleading propaganda campaign.

  6. Nicholas S. Literski31 May, 2011 11:50

    Anonymous AHF Poster, since I'm one of those people you can "just barely see" as a "reasonable" user of PrEP, I invite you to read my TRULY "real life" story, at .