Researchers call it a miracle drug: one blue pill, taken every day, that can reduce the risk of contracting HIV by almost 90 per cent.
But one year after it was approved by Health Canada, Toronto Public Health is concerned PrEP provides a false sense of invincibility for some users that could contribute to the city’s rising rates for other sexually transmitted infections.
“People on PrEP for prevention could be more likely to acquire STIs because they may not be using condoms,” Dr. Rita Shahin, Toronto’s associate medical officer of health, told CBC News. “Once the risk of HIV is eliminated, people may be less likely to use condoms.”
Dr. Rita Shahin, Toronto’s associate medical officer of health, says she hopes the city’s safe sex advertising on hookup apps will have an impact. (CBC News)
PrEP stands for pre-exposure prophylaxis, and is sold by pharmaceutical giant Gilead under the name Truvada. It’s prescribed mostly to gay and bisexual men who are considered at high-risk of contracting HIV.
Pharmacist Michael Fanous says everybody knows somebody on PrEP in Toronto’s gay community.
He has hundreds of clients taking the drug, including sex workers and even a customer in Nunavut who gets his medication shipped by plane.
Toronto pharmacist Michael Fanous says he has hundreds of clients taking PrEP, including sex workers and even a customer in Nunavut who gets his medication shipped by plane. (CBC News)
Fanous takes the pill every day himself.
“Nobody can know with certainty if their significant other, whether male or female, has any other sexual partners.”
No ‘cure-all’
CBC News spoke with men in Toronto’s gay village, several of whom said they feel safer thanks to PrEP. But some said they’re concerned that without the threat of HIV, condomless sex is becoming more popular.
Matthew Young said he definitely felt “a little bit more free” when he started taking the drug.
He took PrEP for one year as part of a clinical trial in Toronto and says some men will “assume that [they’re] immune to other things, if [they’re] not well-educated.”
Matthew Young says he took PrEP for one year as part of a clinical trial in Toronto. (CBC News)
John Carpenter said he sees changing attitudes online, with some PrEP users acting like they are “invulnerable.”
“I do know that a lot of people attempt to use it [PrEP] as some sort of cure-all and it’s not that,” said Carpenter, who lives in Toronto with his husband.
“You’re putting a lot of trust in someone you’re just meeting on Grindr or Scruff, and that can often be misplaced.”
A look at interactions and profiles on hookup apps like Grindr and Scruff reveals many men are now seeking “raw” or “bareback” sex, explicitly saying it’s safe because they’re on PrEP.
Raising awareness
Although concerned by this behaviour, Toronto Public Health says after only a year of tracking the effect of PrEP, “it is very hard to say with certainty if there is any impact yet” on the city’s infection rates.
“We have done some advertising on these apps to raise awareness […] about syphilis in particular and hopefully that will have some impact,” said Dr. Shahin.
According to a report issued last year by the health agency, nearly 90 per cent of all syphilis cases in the city involve men having sex with men.
Data compiled by Toronto Public Health shows that in the nine months after PrEP was approved, reported cases of syphilis did go up seven per cent compared to the same period in 2015, rising from 534 to 573 confirmed cases.
The agency says these numbers are preliminary and could change as cases are investigated. The data doesn’t specify what proportion of infections are linked to PrEP users.
But the health agency does say the popularity of anonymous hookups with apps like Grindr and Scruff combined with the declining use of condoms is playing an important role in the “significant hike” in sexually transmitted infections observed in many North American cities, including Montreal, New York and San Francisco.
Toronto Public Health isn’t the only agency monitoring this closely.
A 2015 report by the U.S. Centers for Disease Control and Prevention (CDC) noted a “troubling rise in syphilis infections” as well as a growing trend of men having unprotected sex with men.
CDC data shows that since the U.S. Food and Drug Administration approved PrEP in 2012, gonorrhea cases reported in San Francisco jumped 80 per cent, while syphilis cases in New York increased by 52 per cent. In New York, health department officials attributed much of the increase to men having unprotected sex with men.
More screening means more cases
Dr. Darrell Tan, an infectious disease specialist at St. Michael’s Hospital in Toronto, says millennials’ perception of HIV has changed now that the disease is “very treatable,” which can lead to a “laissez-faire” attitude when it comes to using condoms.
Dr. Darrell Tan, an infectious disease specialist at St. Michael’s Hospital in Toronto, led a clinical trial on the impact of PrEP. (CBC News)
But he points out a hike in reported sexually transmitted infections could actually be good news.
“Patients on PrEP are screened more often than the average patient. They must submit to blood tests and STI screenings every three months to see how their body is responding to the drug.”
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Tan, who led a clinical trial on PrEP users in Toronto, said he believes the repeated screenings could lower infection rates in the long run.
If doctors spend more time testing and helping high-risk patients, he says, infections can be treated faster, which can stop further spread and eventually lead to healthier populations.
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Does new HIV drug increase risky sex behaviours?1:34