Intended for healthcare professionals

Feature Feature

The Truvada wars

BMJ 2014; 348 doi: (Published 24 June 2014) Cite this as: BMJ 2014;348:g3811
  1. Julia Belluz, Knight Science Journalism fellow, Massachusetts Institute of Technology, Cambridge MA 02142, USA
  1. jbelluz{at}

Julia Belluz investigates the shifting landscape in AIDS prevention

Every night before going to bed, Patrick Buzzell steps into his kitchen and swallows a small blue pill that eases his worries about HIV. For more than a year, the 36 year old real estate agent, based in Boston, has been using a combination antiretroviral (brand name Truvada) for pre-exposure prophylaxis, or PrEP. The tenofovir/emtricitabine tablet was first approved by the US Food and Drug Administration to treat HIV positive patients in 2004, and licensed in 2012 for use among sexually active, seronegative patients—like Buzzell.

“My husband is HIV positive,” he told The BMJ. “PrEP moved HIV further on to the back burner so we are able to go about our lives every day. We talk more about the telephone bill now than his status or how it affects me.”

Not everyone has embraced PrEP. Michael Weinstein, president of the AIDS Healthcare Foundation, has called the pill a “party drug” and those who lived through the early days of the AIDS pandemic have raised concerns that PrEP undermines traditional advocacy messages about condom use.1 In fact, the notion of a pill for HIV prevention has triggered what AIDS activist Peter Staley calls “gay on gay shaming.”

“There’s a real stigma against this drug,” he said in an interview. “Any young gay man that considers using Truvada is viewed as somebody who must be putting himself at great sexual risk for HIV and therefore he gets stigmatized and called ‘Truvada whore.’”

Beyond controversy in the gay community, health officials are at odds with each other about the drug’s role in the prevention arsenal. In the UK, where HIV medication is free and the rate of treatment among positive patients is high, PrEP is being considered mainly for men who have …

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