An Australia man is now one of a small number of people worldwide diagnosed with HIV, despite practicing PrEP, an HIV prevention strategy that when taken as prescribed should make it nearly impossible to contract HIV.
Steven Spencer, 27, told The Sydney Morning Herald he used PrEP "on demand," a phrase referring to taking the medication before and after sexual encounters on the advice of doctors. Spencer had been on the medication for over five years.
However, the out gay man was diagnosed with HIV in December 2017 even while taking the "game changing" medication. And even so, he maintains that the drug is still crucial in the fight for HIV around the world after his own diagnosis.
"What happened to me doesn’t change the fact that PrEP is still the most powerful HIV preventative we have ever had," Spencer said. The drug has proven more than 99 percent effective, according to numerous research studies.
Spencer describes his use of PrEP as diligent before and after sex, but he was not on a daily regimen of PrEP, which many doctors still urge patients to do so as research regarding "on demand" usage is produced.
Other clinics and local organizations have embraced on-demand PrEP as well. As reported by The Bay Area Reporter, San Francisco leaders have also promoted a new dosing regimen that doesn't require continual usage of the drug.
Dubbed "PrEP 2-1-1" (named for it’s 2 pills, 1 pill, 1 pill strategy), its design is for those who are only intermittently sexually active, rather than those who have sex regularly. It requires a person to take two pills of Truvada at least two hours — but preferably 24 hours — prior to engaging in sex. They then take another pill 24 hours later, and if done having sex, a final pill another 24 hours after that.
The 2-1-1 strategy is particularly packaged for those going on vacation for at least a week, and plan to have sex during the entire time. These folks would continue to take one Truvada pill every day of their break. When done with their vacation, they would need to take one last dose of PrEP 48 hours after their last sexual encounter, The Bay Area Reporter further explained.
Australian health organization ACON released a statement about Spencer's diagnosis and stressed that he has already started treatment for HIV and now has an undetectable viral load.
“We know that for any person diagnosed with HIV, early treatment of HIV ensures the best long term health outcomes,” the statement reads. “Further, studies show that a person living with HIV who achieves a sustained undetectable viral load cannot transmit HIV, even if a condom is not used during sex.”
The organization stressed the overall effectiveness of using Truvada, and also said daily use remains the preferred regimen.
“This case does not change the strong evidence that PrEP is a highly effective HIV prevention strategy,” the goverment said. “Alongside regular HIV testing and other HIV prevention strategies, such as condom usage, maintaining an undetectable viral load or Post Exposure Prophylaxis (PEP) in an emergency – we know we can dramatically reduce new HIV transmissions."
The drug was just brought into Australia’s Pharmaceutical Benefits scheme last year, greatly reducing the cost of the drug.
In the U.S., the Food and Drug Administration began recommended daily use of PrEP as early as 2012 for men who have sex with men.
While some at-risk communities are encouraged to take Truvada every day — like trans women, for example, since recent studies suggest that feminizing hormones could lead to Truvada filtering out of a person's system faster than those who aren’t on feminizing hormones — other low-risk communities have found ways of practicing PrEP through on-demand strategies.