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This New HIV Vaccine Might Look Irrelevant, but Maybe That's Because You're a First-World Straight Dude

This week the FDA approved for the very first time an HIV vaccine. It's called Truvada and costs $10,000 a year (about $30 a day) and appears less effective than condoms in its preventative mission; in a trial published last week, researchers found it...

This week the FDA approved for the very first time an HIV vaccine. It’s called Truvada and costs $10,000 a year (about $30 a day) and appears less effective than condoms in its preventative mission; in a trial published last week, researchers found it decreased infections in individuals with HIV-positive partners by 75-percent. In another, earlier trial, infections decreased by 44 percent in men having sex with men, according to Nature. It’s also a potentially risky solution in terms of drug resistance.

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Nature explains:

… concerns emerged on 10 May at a public meeting of a panel that advised the FDA on its decision. Most members voted in favour of approval, but the researchers, doctors and patient advocates in attendance wrestled with the issue of drug resistance. The two drugs in Truvada, emtricitabine and tenofovir, are effective antiretroviral treatments, but trials have shown that viruses exposed to lower doses in the acute phase of infection can become resistant, said meeting attendees. In six people who tested negative on enrolment but turned out to be HIV-positive, the drugs were no longer effective. Another fear, unconfirmed in trials, was that people might not take the pillconsistently,and might contract a strain of HIV that became drug-resistant as a result of exposure to low levels of anti­retrovirals.

All this looks pretty bad actually, like the FDA’s unleashed an HIV vaccine solely for the sake of symbolism and/or boosting some drug-maker. And meanwhile, in the real world, it’s too expensive and risky to do all that much good. Wayne Chen, acting chief of medicine at the AIDS Health Foundation, tells Nature, "the best thing would be to have this drug withdrawn from the market, and if it's not, there should at least be mandatory testing because we know that people don't take this as prescribed." He cites one particular study in West Africa that had to be cancelled because less than half of participants were actually taking the drug.

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“Truvada is now the only technology we have that empowers women."

Instead, Chen says people should just use condoms prevent HIV, as they’re cheaper and likely more effective. Which is true, but there’s a big difference between the at-risk population and the rest of the world. While the vaccine might run $10,000 a year, a course of anti-retroviral treatment for HIV infection runs about twice that per year and patients are stuck taking it forever. If you’re a public health agency, those organizations (on behalf of public money) actually footing a whole lot of the HIV bill, spending money on vaccines for gay male IV drug users likely to be having unprotected sense might make a bit more long-term sense. (While, yes, condoms and pills are both dependent on people actually using them, they’re still different things with different likelihoods of usage.)

Understand that relying on condoms is also relying on another person. And other people have long track records of being shitty and thoughtless. If you are, say, a woman living in South Africa, where HIV infection rates run as high as 25 percent in women under 20-years-old, a vaccine is potentially a very, very big deal and perhaps for deeper reasons than personal health. "Truvada is now the only technology we have that empowers women," Salim Abdool Karim, director of the Center for the AIDS Programme of Research in South Africa tells Nature. "I don't think we'll be able to slow the HIV epidemic in South Africa without something to protect them."

Of course, FDA guidelines demand the new drug be used with condoms because it would be fairly insane to suggest otherwise. But we all know the real world isn’t really like that and, in that real world, Truvada is another few handfuls of water to throw on a raging epidemic. It is also a crucial check on a particularly awful power dynamic among individuals — wherein a man dictates the rules of a sexual encounter — that has global health consequences.

Reach this writer at michaelb@motherboard.tv.

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