The Prep Recommendation: the Inscribed Disease in a Healthy Body

THEMES AND DEBATES

The PrEP recommendation: the inscribed disease in a healthy body

Simone Wolfgang, PhD; Denise Portinari PhD

In July 2014, the World Health Organization This measure also exposes a delicate aspect of (WHO) recommended that all gay men join the the social conduction of the HIV/Aids epidemics: “pre exposal medication Truvada” as a valid the stigmatization related to the gay community as resource to prevent HIV. The PrEP, prophylaxis the ultimate risk group. Affirming that every consists in taking a combination of antiretroviral homosexual should take the PrEP pill, may have medication once a day, in order to prevent HIV the effect of perpetuating the idea that gay men are infection. The WHO promotion of a policy that the main vector of this disease. Among the recommends all HIV negative gay men to join the misconceptions that this may involve are the PrEP, may be seen, in the context of contemporary perpetuation of prejudice related to Aids and gay biopolitical techniques and strategies, as a form of men, leading heterosexual populations to believe control and medicalization of homosexual bodies that they are not connected in the epidemic chain. and practices. It´s important to explicit the life- Keywords: HIV/Aids, Pre exposure prophylaxis, related effects linked to a measure like the PrEP homosexuality, biocontrol, male body, biopower program, considering this as a paradigm shift in HIV/Aids strategies. The shift involves the gradual 1- Introduction substitution of the “condom use” The main goal of this article is to explore the recommendations for the use of permanent possibilities and consequences of the PrEP1 prophylactic medications, and may be understood recommendation, (pre-exposure prophylaxis for as a move away from the abstinence paradigm – HIV) through the analysis of media discourse, sexual behavior control – to a more contemporary literature and scientific articles related to this form of individual medicalized body biocontrol, subject, that have been published in the last couple as outlined by Foucault in his later texts. of years. The PrEP prophylaxis is a therapeutic hypothesis, concerning the prevention/treatment of Simone Wolfang HIV, that consists in taking one pill of a specific Title: PhD. in Design. antiretroviral as an alternative prevention form for Affiliation: Professor-researcher, Institute of Studies in Public Health, Federal University of Rio de Janeiro, HIV/Aids. Some double blind studies are being Brazil, and Pontifical Catholic University of Rio, conducted in countries of South America and Brazil. Africa, with serodiscordant couples. Gilead, the E-mail: [email protected] pharmaceutical industry that manufactures this medicine, actually sponsors most of these studies, Denise Portinari. in partnership with some research institutes like Title: PhD. in Clinical Psychology. US NIH and the Bill and Melinda Gates Affiliation: Professor-researcher, Institute of Studies Foundation. The PrEP protocol has been used as in Public Health, Federal University of Rio de Janeiro, an official public health policy in the United States Brazil, and Pontifical Catholic University of Rio, 2 Brazil. since 2014 supported by the government and the E-mail: [email protected]

Received: May 25, 2019. Accepted: June 12, 2019. 1 Short for Pre exposal prophylaxis Conflict of interests : none. 2 CDC means Center for Disease Control, it´s the US govern agency that establishes the rules for the control

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CDC. In 2014 there were about 3253 people using volunteers, or as researchers. The other significant PrEP therapy in different parts of the United source is a collection of textual data gathered from States. a variety of sources such as PrEP manuals and In the course of our argument we will seek to study protocols, institutional online sites, mass examine some aspects connected to the usage of media vehicles and scientific journals, the PrEP as a public health policy, exposing some commenting on different aspects of the of the possible reasons that led to the emergence prophylaxis. From these sources of information we of this method of prevention, and discuss some of have gathered observations on several important the issues that can be related to this prophylaxis. In aspects of the PrEP usage, such as the different the middle of July 2014 the World Health regimen choices in the multiple studies that are Organization (WHO) recommended that all HIV- conducted and their consequences, the point of negative, sexually active "men who have sex with view of those who support the prophylaxis and of men" or "MSM" and transgender women should those who look at it more cautiously, and some of consider joining in a permanent basis the pre- the most common issues related to this form of exposure prophylaxis (PrEP), which consists in profilaxy, such as cumulative toxicity and the the daily use of Truvada, an antiretroviral drug possibilities of a widespread relaxation in safer sex combination, in order to prevent HIV infections. practices. “Clinical Study Data Sources. Clinical data are now available from several relevant 3- A little bit more about the PrEP human studies on ART PrEP for sexual PrEP, short for pre-exposure prophylaxis, are transmission of HIV-1. All studies of ART a series of studies to assess whether the use of a PrEP were conducted in the public health pill that combines two antiretroviral drugs, setting and sponsored by one or more non- industry organizations. All of the studies tenofovir (TDF) and emtricitabine (FTC) - evaluated ART PrEP concurrent with a marketed as Truvada - can significantly reduce the background of HIV-1 risk-reduction spread of HIV virus in seronegative people. The counseling and provision of conventional site of the French National Agency for Health HIV-1 prevention methods. For each of the describes several benefits of PrEP such as that it studies, Gilead provided study drug (ie, "may be effective in preventing HIV infection in Truvada or Viread) but did not participate in men who have sex with men and transvestites." In protocol design, study administration, or France, the study is conducted by ANRS (National data collection. (…) Study sites are located Agency for Research on AIDS and Viral in 6 countries: 3 in Peru, 1 in Ecuador, 3 in Hepatitis). In Brazil, the study is conducted by the Brazil, 2 in the United States, 1 in Thailand, and 1 in South Africa.” (Gilead 2012 p.8) National Institute of Infectious Diseases Evandro Chagas - Oswaldo Cruz Foundation. 2- Methodology The prophylaxis, in most sources, is usually This article is part of the initial and exploratory presented as a new form of HIV/Aids prevention, stage of a postdoctoral research in which the and often described as quite revolutionary, in a universe that for nearly three decades was activities are to be conducted bilaterally, in Brazil 3 and France. Its main goal is to investigate the populated mainly by messages of "safer sex" and similarities and differences of PrEP in these two condom usage. countries. The information that is used in this Emerging from a very restricted universe, article was obtained from two different sources: with quite limited prevention options regarding an one consists mainly in participant observation in incurable condition, PrEP´s popularity has grown Brazilian, north American and French online 3 groups for PrEP discussion, and informal Safer sex messages can be taken as “the status quo” of conversation with participants of both nationalities the prevention since de 1990´s and it consists in the in actions related to PrEP protocol, either as condom usage recommendation advertisements that are commonly displayed in HIV/Aids prevention and prevention for the infectious diseases in the United campaigns. States and all its territories.

Social Medicine (www.socialmedicine.info) - 273 - Volume 12, Number 3, September-December 2019. widely, mostly for accomplishing good results in Today, in 2015, it´s been about a year since most researches, and due to the 2014th WHO´s the first research related to the pre-exposure recommendation. The prophylaxis reputation prophylaxis has been applied in Brazil. This seems impeccable, and lots of people are research is conducted by Fiocruz in Rio de interested in joining the therapy that is much Janeiro. Currently, there is more than one type of acclaimed among certain social groups; in fact it is PrEP protocol under development in Brazil and not uncommon to see news about the PrEP in the from what one may infer about the prevailing news and in discussion groups in social networks. attitude in user, media and scientific discourse, That said, it is also absolutely necessary to mostly related to the North American experience, put the PrEP in perspective: issues related to its it seems well on its way to being integrated into practice should be raised and a questioning of the Brazilian public health policies in the near future. all aspects of the therapy should be exposed and Currently, the main Brazilian research is the discussed. From the perspective of human and iPrEx4 Protocol, which has about 650 volunteers. social sciences, this can be done in different ways. What we have observed so far is that this increase In this research, we are combining the analysis of of PrEP studies is gradually changing the focus of the study protocols and manuals for the prevention. Since the beginning of the 1990´s most implementation of PrEP and its results, with of the HIV/Aids prevention actions were based information from program researchers and almost exclusively in the promotion of safe sex volunteers, as well as textual data derived from practices. Now, we seem to be facing a very various sources, and crossing these data with the significant shift from the safe sex paradigm to a current literature related to the issues of public new, almost entirely medicalized form of health, sociology of health and social medicine. prevention. Most PrEP protocols that are currently underway, involve the use of a daily pill of 3.1 – The implications on WHO5 Truvada – an antiretroviral drug used in the recommendation. treatment of patients with HIV – to prevent The WHO recommendation in July 2014, infection by the HIV virus. A series of double- stimulated several movements around the advent blind studies using the protocol of a daily dose of of PrEP: "WHO recommends that men who have Truvada in medium and long term basis, are sex with men consider the possibility of taking carried out in Latin America, Africa and Asia with antiretroviral medication as an additional method serodiscordant couples, transsexuals, men who to prevent HIV infection". (WHO, 2014) Perhaps have sex with men and sex workers. Most of these the most expressive implication here is the studies are sponsored by Gilead, a pharmaceutical transformation of pre-exposure prophylaxis in a company that manufactures the drug, in consolidated public health policy in the United partnership with research institutes such as the US States. Currently people living in serodiscordant NIH and the Bill and Melinda Gates Foundation. relationships or who feel otherwise vulnerable to According to the disclosure of the company: HIV infection, may apply in counseling centers, or "All PrEP studies were conducted as part of their family doctor, to join the PrEP therapy. This Public Health Issues and sponsored by one can be done free of charge from the insertion in a or more non-industrial organizations. The PrEP study, or by funding the drugs through health PrEP studies are being conducted with HIV- insurance or paying for the prescribed drugs in a 1 counseling funds and supply of pharmacy. conventional methods of preventing reduction risks. For each study, Gilead Another consequence of the WHO supplied the study drug (Truvada or Viread), recommendation is the popularization of PrEP. In but was not involved in protocol design, the US is not unusual to see debates about PrEP on administration of the study or data collection TV, and on social networking, the facebook group (...) There are study sites in six countries. Peru, Ecuador, Brazil, the US, Thailand and 4 IpREX is the PrEP protocol that consists in taking one South Africa "(2012, Gilead p.8) pill of Truvada daily. 5 WHO short for World Health Organization

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“PrEP Facts” has over 10.000 followers. In France biomedical control – the Foucauldian model the health minister Marisol Touraine, announced provides us with a conceptual matrix which may the adoption of PrEP as a health policy in the near help us to clarify and to outline some of the most future. In Brazil, information about the FIOCRUZ important implications of the PrEP model study is gradually becoming more widespread adoption. especially among LGBTT people. Brazilian mass Seen from this perspective, the adoption of media started disseminating news about the PrEP may be understood as a contemporary form success rates related to PrEP studies, and called on of health management, where security mechanisms recruiting volunteers to take part in research. News and risk management, based on individual headlines related to PrEP proliferated in the biocontrol and medicalization, rise to the surface. international media after July 2014. The Fiocruz For the time being, the previous preventive model Brazil PrEP project gained ground in social will probably not be discarded and will coexist networks and currently in 2015 has over two with the new one; what we see today is arguably thousand followers on Facebook. the beginning of a coexistence between the two strategies; discipline strategies and abstinence 4- A real shift in the prevention policies in HIV/Aids prevention are gradually paradigm? being associated with the use of medicines to As said in the previous section, the WHO prevent new infections in specific populations. recommendation was widely reported by the According to Foucault, it is precisely from inside media in different parts of the world, marking the the disciplinary forms that the new biopolitical entry of PrEP as a central device for the forms of social management emerge. prevention of HIV/Aids, and thus, as observed in “La encore, dáilleurs, il suffit de voir our research, promoting a paradigm shift in the lénsemble legislatif, les obligations previously consolidated scheme of prevention that disciplinaires que les mécanismes de was in operation since the 1990s, almost sécurité modernes incluent pour voir quíl exclusively focused on safer sex messages. In ný a pas une sucession : loi, puis discipline, puis sécurité, mais la sécurité est une Brazil most preventive campaigns that have been certaine maniére dájouter, de fair promoted over the last two decades essentially fonctioner, en plus les mécanismes emphasize in different ways the recommendation proprement de sécurité dans lórdre de la to use condoms. Thus, after almost two decades of médecine et on pourrrait multiplier les this basically 'safe sex' approach and its examples (...) il ságit de lémergence de accompanying effects on sexual practices, quite technologies de sécurité a línterrieur soit de suddenly a new feature related to prevention has mécanismes qui sont proprement just appeared: the prevention based on drug mécanismes de controle social, soit des therapies. mécanismes qui ont pour fonction de This movement shows as a paradigmatic modifier quelque chose au destin biologique de léspece.” (Foucault, 2004 p12) change in the practical field of risk management concerning the HIV virus – the use of a chemical Both the WHO recommendation about PrEP molecule to avoid contamination – that can and its use as a public health policy by the US drastically change the whole conceptualization and government, present themselves as a move application of prevention. This is associated with a towards risk management through medicalization, shift in the very idea of prevention itself, with the based on the adoption of a "security technology" displacement of abstinence practices in favor of a as a mean of protection and risk mitigation. In this form of medicalization closely related to the risk operation, the guarantee of an apparently healthy management model that characterizes biopolitics. body, through the ingestion of a chemical particle, By contrast, the safer sex model may be seen as can bring advantages and disadvantages; the more closely related to abstinence practices and/or promises of additional protection combined with the direct control of sexual behavior through possible side effects, cumulative toxicity, etc. discipline, due to the mandatory imperatives of condom usage. A shift from disciplined bodies to

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According to LeBreton (2003 p65), this is a registered in 2012 resulted from psychopharmacological, chemical modulation of heterosexual sex with HIV-infected people. behavior and affection – or in the case of PrEP, Among men, 43.5% of the cases are given eroticism – "which demonstrates a fundamental by heterosexual contact, 24.5% by question about the body that should be maintained homosexual and 7.7% for bisexual. "(Brazil, 2014B) captive through the appropriate molecule.” We can think of PrEP, also as a mechanism of “social This kind of recommendation, targeting control” and a new event in prevention policies specific populations for the prophylaxis, has to be that promotes a leveling or a reduction in the carefully considered while developing a complexities and specificities involved in its older, preventive strategy anchored in PrEP, specially in more disciplinary form. order not to encourage the stigma attached to In this context, one may observe that the HIV/Aids that is currently one of the major trouble widespread educational system connected to the factors for prevention policies, since it feeds the HIV/Aids, which was at least ideally intended to belief that only the GLBTT people would be promote awareness and dialogue between the susceptible to infection by HIV. Furthermore, research centers and the population, may be PrEP involves medicating a healthy population, reduced to the ingestion of a drug, in a and every medication has its pros and cons, mostly prophylactic measure, that most of the times every molecule that we ingest have an effect over suppresses additional information concerning our bodies. prevention and self-awareness regarding HIV.

The advent of prevention is passing from the 5.1 – The two point of views behavioral prescription – always use a condom – Despite the fact that antiretroviral drugs usage which implies a certain minimum level of dialogue for HIV prevention is considered to be a relatively and participation – to the simpler form of the drug recent option, the use of this artifice arouses prescription: one tablet daily can prevent Aids. different opinions; some people think it´s a Thus the new form may exclude an entire liberating initiative and others look at it with a subjective dynamics linked to the social status of little bit more caution. the HIV/Aids epidemic. It´s possible to say that there are two main

opinions on PrEP. On one hand, we have 5- Some reasons for PrEP: the inscribed organizations that are in favor of the WHO disease in a healthy body recommendation, supported by physicians and Why does the WHO recommendation researchers, in addition to pharmaceutical emphasize certain groups of society instead of companies that make this kind of study possible. others? The main target seems to be the men in The WHO, claims that PrEP is a fast and secure LGBTT groups rather than the sexually active way of improving the healthcare services population as a whole. The official discourse that concerning HIV/Aids prevention among concerns this choice, passes through economy, as “vulnerable social groups” such as sex workers, regards the high costs of such treatment, and an male homosexuals, and transgender communities. epidemiological belief that the incidence of the They affirm that these populations aren´t getting disease is higher among men who have sex with the specialized health services that they need, so, men, than in the rest of the population. However, using a drug such as Truvada would lower the risk the annual Aids/STD report of 2013, issued by the of contamination among these social groups. Brazilian government shows a different scenario, “These people are most at risk of HIV infection in which heterosexual contact is accounted for yet are least likely to have access to HIV over 40% of male contaminations, while prevention, testing and treatment services. In many contamination linked to homosexual and bisexual countries they are left out of national HIV plans, sexual interactions are around 30 %: "As for ways of transmission among people and discriminatory laws and policies are major over 13 years old, there´s a sexual barriers to access.” (WHO, Media Center 2014) prevailing. In women, 86.8% of cases

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The majority of the reasons claimed by those a real opportunity towards its adoption as a public who support PrEP are similar to those given by the health policy. In Fiocruz webpage, where WHO, such as the sensitivity and vulnerability of information about the Brazilian study is available, socially marginalized groups and the lack of the welcome message is displayed below. support for targeted prevention, or that the “Since 2010 the results of several studies prophylaxis is a simple way to prevent HIV with a have proved that daily use of one pill that single pill a day. combines two antiretroviral drugs, tenofovir Obviously, WHO, did not decided to (TDF) and emtricitabine (FTC ) , marketed recommend PrEP without any research and study under the name Truvada is effective in preventing HIV acquisition among men who to support this decision. Since 2006 some of the have sex with men (MSM) and transvestites, major pharmaceutical companies have been the efficiency can reach 99% if the developing studies on PrEP and PEP (the initials individual makes regular use of the drug , 6 for Post Exposition Prophylaxis). PEP has that is , if you take one pill every day of the actually been used for a while now, and it´s the week. The studies also showed that daily use current prophylaxis for healthcare providers who of Truvada is safe because the most get hurt in their professional duties with common side effects were mild and contaminated needles, or as part of the “rape kit” temporary without causing serious side and in some countries it´s part of a harm reduction effects. (…)In Brazil, this study is strategy being used in serodiscordant couples. conducted by the National Institute of Infectious Diseases Evandro Chagas - “A half-dozen studies are happening now. Oswaldo Cruz Foundation” The trials all focus on tenofovir (marketed (http://prepbrasil.com.br/sobre-nos/) under the brand name Viread), a drug that appears safer than the other Aids medications on the market. Placebo- There are some related factors that also end controlled trials are enrolling 5,000 people up supporting a decision for adopting Truvada as a on four continents who are in high-risk prevention tool, such as the positive experiences groups, including gay and bisexual men, sex with PEP standard medical protocol for health care workers and injecting drug users” (COHEN, professionals who are injured with contaminating 2006) material, or as part of "rape kit". In some countries PEP is part of a harm reduction strategy used in The double blind studies made by some people who may have been exposed to the virus, research institutes, mostly financially supported by with a very high success rate. "The success rate of some of the biggest pharmaceutical companies PEP sex therapy was 78%, while the healthcare through the last 10 years, ended up leading some providers who used the PEP after a labor accident governmental agencies like the USA CDC to have success rates between 45% and 68%" adopt PrEP as a health care intervention towards (Salvador, 2013). It should be noted here that the HIV/Aids. “The FDA approved Truvada for this PEP is applied after a suspected contact with HIV intervention in July 2012, and the CDC earlier this virus and it is not used continuously for more than year released new clinical guidance for PrEP 2 consecutive months. which also cites the efficacy of everyday use of PrEP in preventing infection”(Heywood 2014) 5.1 – The stigma factor Other countries like Brazil are running tests However, it remains to be known if indeed with some antiretroviral for PrEP use, and PrEP is effectively a way to "quickly and safely seriously considering the possibility of making this improve health services in the prevention of HIV/Aids among vulnerable groups", as stated by 6 Short for Post Exposure Prophylaxys, it consists in the WHO. Is it really as simple as that? Is the “one taking antiretrovirals for a period of time after being in pill a day can prevent Aids” message the ultimate contact with the virus. It is very common in the medical prevention tool with zero risks? Does it not simply field in case of accidents with needles or scalpels. But it conceal and strengthen certain issues at the heart has been used among serodiscordant couples, in case of of the social conduction of HIV/Aids such as condom breaks for a while in Europe, US and Brasil.

Social Medicine (www.socialmedicine.info) - 277 - Volume 12, Number 3, September-December 2019. stigma, strengthening the notion of risk groups, or affecting the decision to abandon or follow a the belief that Aids is a disease limited to certain treatment. Gilead, the manufacturer of the drug segments of the population, like homosexuals, Truvada, has reported some side effects due to the transgenders and sex workers? continuous use of antiretroviral medication, among the most common are "Nausea, vomiting, diarrhea, 5.2 – The treatment adhesion factor headache, dizziness, sleep disorders, back pain, Another question that should be made, osteoporosis, thrombosis, skin discoloration on the beyond the levels of success of PrEP as an palms or soles of the feet." (TRUVADA. Drug effective prevention method, are the practical leaftlet). The importance of these side effects in problems of PrEP, and the most expressive of treatment adhesion cannot be discounted in them is probably medication adherence. That is a considering the possible benefits and costs of the known issue among HIV positive patients who protocol. take medication, and is a reality shown in some PrEP studies. There is not a safe way to establish 5.3 – The possibility of a cultural condom effectiveness if the volunteers do not take the drug dismissal as prescribed by researchers. The FEM-PrEP study Another relevant question regarding PrEP is is a concrete example of it. the possibility of opening a breach in safe-sex A decrease medication adherence was a practices, leading many people to believe that real problem found in the FEM-PrEP protocol, habits such as condom use are no longer where the study was severely jeopardized due to necessary, since they would be replaced with the difficulty of the volunteers with the daily Truvada as a new form of prévention. This may medication regimen; originally the FEM-PrEP open the way for a premature cultural rejection of study was unable to reach conclusive results on the safe-sex practices, with no evidence yet of long- reduction of cases related to the use of Truvada term side effects or the full effectiveness of among women. medication used in PrEP. This is one of the main "Although specific advice and support aspects that should be pointed while conceiving a was provided, the treatment adhesion PrEP related prevention project. was low, suggesting that women in the This possibility of “behavioral disinhibition” population chosen by the clinical trial has been pointed out by some concerned may have had difficulty in taking a pill researchers such as Dr. Susan Buchbinder, head in daily basis. Because of poor of the HIV research section at the San Francisco adherence, the study could not Department of Public Health: determine if the drug Truvada may “Dr. Susan Buchbinder, (…) says she reduce the risk of HIV infection, initially had "big reservations" about the according to the latest analysis of the research, because she worried about what FEM-PrEP study, the researchers are psychologists call "behavioral disinhibition": what if fear of H.I.V. still studying behaviors, clinical declined in people who took the drug, and measures and health outcomes that may they then skipped using condoms or have contributed to the low adhesion increased their number of sex partners?” It's between the study participants (The scary as an investigator, as a public-health New England Journal of Medicine, official and as a person who has worked 2012) with the community for many years to think about doing something that could There are also some problems with the paradoxically make the epidemic worse adhesion to the drug regimen presented in the rather than better," she says.” (COHEN, PrEP studies, due to the unpleasant side effects 2006) and also the obligation of taking the pill daily in a disciplinary regimen that has to be followed in The recommendation of PrEP for certain order to guarantee legitimate results in this kind of target groups may have a huge impact on how study. Side effects are a very important factor people perceive the HIV/Aids issue. Approval and

Social Medicine (www.socialmedicine.info) - 278 - Volume 12, Number 3, September-December 2019. dissémination of PrEP as a prevention tool, simply sure. A segmented and personalized orientation is establishing that a significant portion of the absolutely necessary in this case in order to GLBTT comunity should join PrEP, without establish if PrEP is the best prevention tool for further information and dialogue between health each individual. It has to be carefully discussed institutions and the population, may perpetuate the and directed towards the different realities idea that gay men are the main vector of the between the populational groups. disease, and the « behavioral disinhibition » effect of PrEP may backfire on epidemics prevention and References control. The deconstruction of this kind of stigma, which reinforces the message that Aids is a "gay Brasil, About us LapClin Aids INI in Fiocruz, Rio de disease" is absolutely necessary to educate and Janeiro, Fiocruz, 2014a. make aware that anyone is vulneable to HIV. Brasil, Aids in Brasil, Brasília, Ministério da Saúde, 2014b 6- Conclusion Cohen, J. “Protect or Disinhibit”. New York Times, The discussion on PrEP must begin with a January 22, 2006 honest dialogue on its possibilities and limitations. Foucaut M. Homeland security and population, São If PrEP can prevent HIV infection during Paulo, Martins Fontes, 2008 J.M. Baeten et all. “Preexposure Prophylaxis for HIV unprotected sex, it can be an interesting tool for Infection among African Women.” The New those who are more vulnerable to HIV infection; England Journal of Medicine. 367, 5 (2012): 399- but it should be discussed with the full disclosure 410 (407) of all the advantages and disadvantages of this Heywood, T. “The Truvada Wars: AHF Launches strategy. Misinformation Campaign on PrEP – HIV”. HIV The PrEP strategy has a very high cost, it´s a Plus Mag, Kentucky, August, 22, 2014. huge investiment in research and application, and Leal A. “Aids incidence among young homossexuals if the results end up showing it as an effective tool concern health minister” EBC, December, 20, to prevent HIV, PrEP can be seen as an 2014. opportunity for prevention, in a field that counted Le Breton D. L´adieu au corps. France, Metailie, 2013. Pollak M. Homossexuals and Aids, São Paulo, Estação basically with educational campaigns and safe-sex Liberdade, 1990 practices. However, that should be done and World Health Organization “key populations to HIV” thought out carefully, thinking about the pros and Media Center release, 2014 cons of this decision. Last modified June 11, 2014, Mostly the PrEP strategy is about the sale of a http://men.prepfacts.org/the-basics/ security concept to a population that is eager to Michael T. “Aids War profitering with PrEP” Last have one; but this kind of information must be modified, December, 9, 2014 accurate in order to make those willing to adopt it http://www.terrymichael.net/hiv-aids/prep.html aware of the risks involved in a program such as Gilead “Truvada drug description leaflet.” , Last PrEP. Establishing a specific target for PrEP in modified, July, 2012, http://www.truvada.com/truvada-faqs LGBTT people can be a mistake that perpetuates Gilead, “Partial results of PrEP protocols.” Last the stigma bonded to HIV. Truvada is medication modified, 2011, that can have severe side effects, some of them http://www.projectinform.org/pdf/PrEp%20Financing% very harmfull and health threatening ; healthy and 20Report.pdf productive people may get sick by taking it, with no certitude that he/she may risk viral exposure for

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