Truvada, which prevents HIV infection with a single daily pill, is the miracle drug that almost nobody takes. It prevents HIV more reliably than condoms, which can break. It has exceedingly minimal side effects. It’s covered by most private insurers and state Medicaid programs. But because of its novelty, doctors have been wary of prescribing it—and because of the absurd stigma it still carries, its target audience has been hesitant to take it.
That’s all about to change. This week, as part of its cheerfully named Morbidity and Mortality Weekly Report, the CDC came out swinging for Truvada, unequivocally encouraging health care professionals to prescribe the drug to numerous at-risk groups. So far, those groups include anybody in a serodiscordant relationship, non-monogamous gay and bi men who sometimes have unprotected sex, straight men and women who sometimes have unprotected sex with drug users or bi men, and anybody who injects illicit drugs.
To my mind, these categories are still a bit under-inclusive. It’s alarmingly easy to get HIV through anal sex: Condoms are more likely to break during anal intercourse than vaginal intercourse, and the HIV transmission risk from anal sex is 18 times higher than from vaginal penetration. As I’ve written before, there’s nothing inherently unhealthy about anal sex. But unless you’re in a monogamous relationship with someone who’s HIV-negative, the risk of HIV transmission during gay anal intercourse is always going to be a little higher than you’re probably comfortable with.
Of course, I understand why the CDC didn’t simply recommend Truvada for all sexually active gay men: That’d be going too far, too soon, and might carry an insulting, even condescending undertone. But the spirit of the new guidelines clearly leans in that direction. Truvada isn’t necessary for every man who has sex with another man. But if you’re a man who has sex with men, plural, you should consider getting a prescription. By this point, the science on Truvada is largely settled. It’s only the stigma that continues to prevent gay Americans from fully embracing a drug that could save their lives.
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