(CNN) Charlie Ferrusi is a 23-year-old gay man with a winning smile and an easygoing manner. In May, he completed a master’s degree in public health and recently began a job at the New York State Department of Health AIDS Institute.
Ferrusi said he is HIV-negative and would like to stay that way. He’s the kind of person that could be taking Truvada, a once-a-day pill that is nearly as effective as condoms in preventing HIV, the virus that causes AIDS. Some doctors and politicians have hailed the antiretroviral drug, known as PrEP, as a key to ending the AIDS epidemic.
“You go into a panic that wouldn’t be there if I was on PrEP,” Ferrusi said. “I’m having a good time and being a good person — and that comes with a risk sometimes. If I can eliminate those risks by taking PrEP, I think it would be a good idea.”
Still, like many others, Ferrusi is grappling with a decision to take the drug as a preventive. When taken as prescribed, PrEP can prevent more than 90% of sexually transmitted HIV infections. So why aren’t people jumping on the bandwagon?
The Food and Drug Administration approved Truvada in 2004 for treating HIV infections. In 2012, it was approved as the first — and still, only — drug for pre-exposure prophylaxis, or PrEP. It works by establishing a presence of the drug in the cells that HIV targets for infection; the virus can’t produce a genetic code, so it can’t replicate and cause an infection.
Men who have sex with men account for more than half of the 1.2 million people living with HIV in the United States.
“People at high risk who should be offered PrEP include about 1 in 4 sexually active gay and bisexual men, 1 in 5 people who inject drugs and 1 in 200 sexually active heterosexual adults,” according to the Centers for Disease Control and Prevention.
But not everyone is applauding the pill as a major advancement in the fight against HIV and AIDS.
No one, at least publicly, is advocating for using PrEP without condoms. Still, it erodes the “condom culture,” said AIDS Healthcare Foundation President Michael Weinstein, who is among PrEP’s most prominent critics.
“If people take this drug, they’re not going to use condoms. Let’s just be real about it,” Weinstein said.
“The reality is that condoms are 98% effective. So if people use condoms, they don’t need to take this pill.”
Weinstein said it might be the best choice for people who refuse to use condoms. But for many people, taking the pill as prescribed could be a challenge. Without insurance, the drug can run about $1,500 per month. Many insurance plans, as well as Medicaid, cover it, and the drug’s maker, Gilead Sciences, offers assistance for people who can’t afford the cost.
“The record of people taking pills for every disease is bad,” Weinstein said. “I know that personally when I’ve had to take an antibiotic for 10 days, I’m sure I’m taking it the way I’m supposed to be, and yet I wind up with a bunch of pills in the bottle at the end.”