November 24, 2010: “Halting Disease can outweigh Ban on Condoms” Pope Signals” is the headline in the New York Times today. This “personal pronouncement” from Pope Benedict, who also said that condoms could be used by man, woman or “transsexuals” to prevent the spread of HIV, may well bring around the end of AIDS. This huge step forward was heralded on the front page of the New York Times along with a picture of a blue pill, marked “Gilead” that was said to stop 90% of HIV transmission in men who used the pill before having sex, in a study called iPrEx, conducted in San Francisco.
These two interventions, combined (when used appropriately), may bring a significant reduction in transmission of HIV around the world, and will be of enormous value because they are cheap, safe, and effective and can be used at the time of ‘risky behavior’ by persons who know that they are about to take a risk. Those of us who have long been amazed by the insistence of the Catholic church that any condom use was proscribed, are relieved and excited that one billion Catholics around the world will now have access to a life saving measure when they need it. We will not pause to think how many might have died because of the ban on condoms, rather, we will celebrate the news and the man who struck the mote from his own eye, and saw the world in her imperfect splendor. Nor will we pause to consider the continuing problems with sexual abuse in the Church, but we hope that, too, will be addressed in the very near future.
The news that Truvada (Tenofovir/3TC), a combination drug produced by an unusual collaboration spearheaded by Gilead (California) can prevent HIV is also wonderful news, because the drug is already available by prescription. Physicians can prescribe the drug “off label” for use by their patients. This will be welcome news for discordant couples who are trying to have children (they can now reduce the risk of transmission from one partner to the other) and in many other situations. There is a very short trajectory from pre-exposure prophylaxis to post-exposure prophylaxis, and it is very likely that Truvada will also be the drug of choice where condoms have failed or following forced sexual encounters such as rape.
In other news today, the rate of spread of HIV has slowed dramatically due to interventions around the world. Among the interventions said to be the most successful, are condoms, mother to child transmission prevention, and improving access to HIV testing paired with improved access to HIV care (so those who know they are HIV positive can be treated). Michel Sidibe, the Executive Director of UNAIDS pointed to efforts by African countries to reach out to high risk cohorts including men who have sex with men, a group that has until now been increasingly stigmatized in African countries. That means that yet another taboo topic being discussed, and that there is significant hope for progress.
May this day, November 24, 2010 live in our memories. So much positive news in one day! This is truly a Thanksgiving to remember.