New guidelines say ALL men who have sex with men need antiretroviral medication

The HIV/AIDS epidemic that started 33 years ago is once again exploding around the world, and now experts from the World Health Organization (WHO) say all men who have sex with men are strongly advised to take antiretroviral medications in addition to condoms.

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“We already know if someone has HIV, using treatment drastically reduces the likelihood of them passing it on, as does using condoms,” Dr. Rosemary Gillespie, the chief executive of the British charity Terrence Higgins Trust, told the BBC. “The idea of treatment as prevention is not new, but the idea of extending treatment to HIV-negative people from high-risk groups is.”

Gay men aren’t the only groups identified as high-risk by WHO; however, the infection rates among this group have remained high despite improvements in treatment and awareness regarding sexually transmitted diseases.

According to the WHO report, men who have sex with men are 19 times more likely to contract the virus than the general population. With antiretroviral use, the spread of HIV among men having sex with men could decrease 20 to 25 percent throughout the next decade, potentially preventing 1 million infections.

Others indicated in the report who should seriously consider antiretroviral medication include female sex workers, transgender women, and those who inject drugs.

“None of these people live in isolation,” Dr. Gottfried Hirnschall, Director of the HIV Department at WHO, said in a statement. “Sex workers and their clients have husbands, wives and partners. Some inject drugs. Many have children. Failure to provide services to the people who are at greatest risk of HIV jeopardizes further progress against the global epidemic and threatens the health and well-being of individuals, their families and the broader community.”

Female sex workers are 14 times more likely to have HIV than other women, while transgender women are almost 50 times more likely to have HIV than other adults. Individuals who inject drugs can have as much as 50 times higher HIV/AIDS risk than the general population.

WHO experts explain the new recommendations have come about because HIV/AIDS has become less of a concern compared to when it was first discovered. Now, as treatments improve and more people with HIV are living long, comfortable lives, the fear regarding HIV has diminished. Lack of fear, coupled with a lack of access to HIV/AIDS screening methods and regular clinics is why the epidemic is still moving in full-force.

“Bold policies can deliver bold results,” Dr. Rachel Baggaley, from WHO’s HIV Department, said. “Thailand was one of the first pioneers of programs to recognize the need to keep sex workers healthy and reduce new HIV infection. Malaysia, Spain and the United Republic of Tanzania have made major advances in providing opioid substitution therapy and needles and syringe programs for people who inject drugs. Data show that where a combination of effective HIV prevention and treatment services for people who inject drugs are available, HIV transmission among people who inject drugs is minimal.”

HIV antiretroviral medication is not something new; in 2012 the Food and Drug Administration (FDA) approved Truvada, also called PrEP (pre-exposure prophylaxis) as a part of a prevention regime. The medication gained a poor reception in doctors’ offices, however, because physicians were afraid it would encourage people to avoid using condoms.

“It’s telling, how reluctant I am to talk about this, even anonymously,” a gay New York City doctor with many gay patients told OUT in an interview, explaining the reluctance in the medical community to discuss a pill to prevent HIV comes from a fear condom usage will diminish. “This isn’t being talked about in our community at all,” he said. “Gay men talking about not using condoms is really stigmatized. Most of us have never known sex without condoms or without threat of a ‘deadly disease.’ I think it’s a lot to ask an entire generation of gay men to use condoms forever.”

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WHO stresses that in order for the HIV/AIDS epidemic to be contained, antiretroviral medication and condoms must be used in conjunction, but measures to better manage sexual and reproductive health, mental health and co-infections such as tuberculosis and hepatitis are also needed. The report highlights the need for needle and syringe and opioid substitution therapy programs that include recommendations for treatment of overdose in the community.