Sex workers worry HIV prevention drug Truvada raises spectre of clients refusing to wear condoms

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      Sex workers want to have their say regarding a game-changing drug for HIV prevention.

      They are holding a national consultation to discuss among themselves and their supporters how the prescription pill Truvada may affect their well-being.

      There are worries that with its availability they could face pressure to engage in unprotected sex, resulting in other infections like chlamydia and gonorrhea.

      Truvada was approved in February this year by Health Canada as a medication to reduce the risk of a person without HIV being infected with the AIDS-causing virus. It is recommended to be used in combination with safe-sex practices such as condom use.

      As the first drug accepted for pre-exposure prophylaxis, or PrEP, Truvada heralds a new chapter in the fight against HIV in this country.

      A group of doctors and other health professionals is currently drafting national standards on PrEP. The guidelines will also include medical procedures (known as nPEP) for people who have been exposed to HIV in nonoccupational settings, such as needle-sharing.

      Andrew Sorfleet, president of the Triple-X Workers’ Solidarity Association of B.C., noted that among the concerns about PrEP is how it will affect the use of condoms.

      “In other words, pressure from the marketplace or from clients for sex workers to provide services without condoms because they could be on PrEP instead,” Sorfleet told the Georgia Straight in a phone interview.

      Sorfleet’s Triple-X group is helping to organize the national consultation to be held on October 19 and 20. The event is funded by the Elton John AIDS Foundation. Assistant professor Dan Allman of the University of Toronto’s Dalla Lana School of Public Health, venue of the consultation, received the grant.

      Using the birth-control pill as an analogy, Allman indicated that PrEP holds both promise and peril.

      “It had the promise of liberating women, on one hand,” Allman told the Straight about the contraceptive. “On the other hand, it had the perils of potentially increasing STIs [sexually transmitted infections] and STDs [sexually transmitted diseases], and potentially changing the moral fibre of society. Well, all of that came to pass.”

      In the case of PrEP, the public-health researcher said that it may give people a false sense of protection.

      “Sex is about joy and pleasure, and health as well, and one of the promises of pre-exposure prophylaxis for many sexually active individuals is that it does hold the promise of giving a rebirth of sorts to a kind of sexual health that we in the West haven’t seen for a really long time,” Allman explained. “Since the advent of HIV, sexual health has been, in some instances, less about sexual expression and more about prevention of harms from STDs and STIs, from infections like…HIV.”

      He noted: “Condoms are a lot of things, but, you know, an enhancer of intimacy they’re not.”

      Kevin Pendergraft works as the manager of communications and knowledge translation with the CIHR Canadian HIV Trials Network (CTN), a partnership funded by the federal government through the Canadian Institutes of Health Research.

      According to Pendergraft, the CTN is providing support in the ongoing preparation of national PrEP and nPEP guidelines. The work is led by Dr. Darrell Tan of St. Michael’s Hospital in Toronto and Dr. Mark Hull of St. Paul’s Hospital in Vancouver.

      Pendergraft said the guidelines will be finished by either the end of this year or early 2017.

      “People right now are taking it,” Pendergraft told the Straight about Truvada, a product of Gilead Sciences Canada Inc. “Doctors are prescribing it. But because there are no guidelines, some doctors don’t know how to prescribe.”

      A draft of the PrEP and nPEP guidelines was presented at last May’s annual Canadian Conference on HIV/AIDS Research in Winnipeg.

      The document identified men who have sex with men, injection-drug users, people in “survival sex trade”, certain aboriginal populations, and individuals living with a partner with HIV to be vulnerable to HIV. It also mentioned “sex trade workers” as one of the groups with a “significant risk of having transmissible HIV”.

      However, the preliminary guidelines do not include sex workers among those eligible for either PrEP or nPEP. Under the proposed standards, people who buy sex, which is a crime under current prostitution laws, can ask their doctor for nPEP.

      Anna Smith is on the board of Triple-X. The former sex worker is of two minds about PrEP. According to Smith, taking the medication could be helpful in protecting sex workers from HIV risk arising out of “unusual situations” like condom breakage.

      However, she also noted that Truvada can cause side effects, like liver problems and some kidney-function and bone-density declines.

      Smith, who said that PrEP may be irrelevant for most sex workers who practise safe sex anyway, told the Straight by phone: “There’s more reasons to wear a condom than just HIV.”