[iBLASTinside] Plan T: Make Truvada Available OTC

[iBLASTinside]

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Getting barebacking recognized as a legitimate option in sexual relations will not happen as an issue by itself. Despite the studies that have appeared showing at least half of all gay men bareback just doesn’t capture the attention of those who live in that state of denial where safe sex is hot sex .

I wrote recently some ideas that need to be developed to reduce the chance of HIV transmission in barebacking*.

Most of them do not exist but one does*— sort of. That’s Truvada . It’s a cocktail antiviral that’s been shown effective as an anti-HIV prophylactic*— meaning that men in “high risk categories” take the drug and it essentially prevents the body from contracting HIV.

But tests also show that taking Truvada in the week following possible exposure to HIV also prevents contracting the virus permanently.

It’s like Plan B *for gays.

I think we should call it Plan T, for two reasons:

1. “T” for Truvada (or its generic name,*Tenofovir)

2. And the whole idea is to protect all the “T” cells.

If we, as a barebacking community, needed a rally cry, I think we might have found it. It’s captured some attention on Twitter. Even Paul Morris of Treasure Island Media agrees with this.

[h=2]Fighting Doctors and*Pharmaceutical*Companies[/h]Paul is right that doctors would fight it, but I think the greater fight would come from the drug companies. Just think of this: Have you heard of many cures of lately? Is there a cure for cancer? A cure for anything?

I have this fungus on my chest, right between my pecs. I’ve now had it for more than 10 years. Seems like I should be able to get rid of it. But every six months or so, it flares back up. It’s just this red, splotchy thing that comes out of no where and thrives due to*— of all things*— water. I put the designated medicine on it and it goes away. And for months after it disappears, I keep applying it. But it lies dormant until I stop applying the medicine then it comes back out of its hiding.

I believe that this is the ultimate plan of the drug companies. They are not out to create cures. They’re out to create treatments.

Gilead Sciences, who make Truvada, must be shown that it would benefit from a lot more men taking the short-term Plan T than waiting for men to go onto the long-term HIV-Positive treatment with Truvada or one of the other cocktail options. Once Gilead crunches those numbers and sees the cost analysis benefit,I think they’ll start pushing for over-the-counter dispensing of Plan T as an option.

But if the cost analysis doesn’t go Plan T’s way, Gilead will oppose it.

[h=2]Worth a Shot[/h]I still think it’s worth a shot. It’s time barebacking had an issue that wasn’t just about sexual freedom. And this one may be it.

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[fskn]

This is an excellent idea in theory. Adherence and testing are my only concerns. In the initial PrEP studies, patients who didn't take Truvada daily had much less protection against infection. Truvada has very uncommon but very serious liver, kidney and bone side effects, for which regular tests should be performed. It is also has resistance issues when used alone in treatment of HIV, hence the need for ongoing HIV testing. For all of these reasons, the FDA mandated special prescribing instructions when it approved preventive use of Truvada last year. Some of us read labels, take medicines daily, and ask for tests when we need them; many others benefit from active medical supervision.

To pick a different but related example, home-use HIV tests have been available for over a decade, and have gone through three different generations. The first generation required patients to collect several drops of blood and FedEx the test strip to a laboratory for analysis. The second generation required a single drop and provided a result at home, in 20 minutes. The third generation involves scraping the inside of your cheek, and also provides a result at home, in 20 minutes. When instructions are properly followed, all three home tests, and the classic laboratory tests, have comparable rates of accuracy. Why on earth are we still doing most HIV testing in clinics? I guarantee that, at a system level, the $45 to $60 retail price (to say nothing of the lower cost price) of a home testing kit is lower than the unit cost of a test administered by a clinic, when you consider the phlebotomist, the counselor, the receptionist, the building, transportation of the patient to the building and transportation of the specimen to the lab.

The recent court-ordered decision to make the "morning after" pill available over the counter at least gives us some hope that the system is beginning to dignify patients and that patients are beginning to take responsibility for their own medical needs.

I think Gilead would love nothing better than to see Truvada available over the counter, especially with a (necessary and justifiable) government subsidy. The fact that Gilead pushed for FDA approval of PrEP tells us that the company sees prevention as a viable market.

Edited July 22, 2013 by fskn
Added comment about drug companies

[wood]

This is an excellent idea in theory. Adherence and testing are my only concerns. In the initial PrEP studies, patients who didn't take Truvada daily had much less protection against infection. Truvada has very uncommon but very serious liver, kidney and bone side effects, for which regular tests should be performed. It is also has resistance issues when used alone in treatment of HIV, hence the need for ongoing HIV testing. For all of these reasons, the FDA mandated special prescribing instructions when it approved preventive use of Truvada last year. Some of us read labels, take medicines daily, and ask for tests when we need them; many others benefit from active medical supervision.

The recent court-ordered decision to make the "morning after" pill available over the counter at least gives us some hope that the system is beginning to dignify patients and that patients are beginning to take responsibility for their own medical needs.

I think Gilead would love nothing better than to see Truvada available over the counter, especially with a (necessary and justifiable) government subsidy. The fact that Gilead pushed for FDA approval of PrEP tells us that the company sees prevention as a viable market.

I am a huge proponent of PrEP, and even I don't think it should be OTC.

The United States in general have a huge over reliance on drugs, both OTC and prescription. Its not a great idea to play home doctor and take whatever you feel like without consulting a doctor. Tylenol is a perfect example of this. Tylenol usage is one of the main causes of liver failure in the US because people assume its safe. Yet even exceeding the box dosage by as little as 2 weeks in some cases have produced significantly elevated liver function (precursor to liver failure) in some people. A good family friend had that when she went in for a knee replacement. She could't tolerate opioids so she use a high dose of tylenol as her doctor reccomended. She was on that for 3 weeks and was on the verge of liver failure for 1.5 years afterwards. People should NOT be taking drugs as a crutch for everything in their life. I still support PrEP however because it can prevent a very serious illness that can cause people to need medication for the rest of their

My ideal PrEP scenario is something like this. I would like to see it be availiable from a pharmacist, not just a doctor. So you could go into any pharmacy, say you want to go on prep, you take an oraquick test, and then you get your script. With that said I would REALLY like to see a weekly or monthly version of PrEP in the future if it turns out to be something that really works. One of the major issues with PrEP's efficay right now is taking it on a regular basis. A Once a week pill, or hell once a month injection would take care of much of those problems. In reality i dont see once a month anytime soon, but I think once a week may be possible.