“Always be prepared,” the Boy Scout motto, may someday serve as the sex
worker’s mantra if PREP, or pre-exposure prophylaxis, proves
effective. A daily HIV med taken by high-risk neggies, it holds
hope as a cheap and easy virus blocker. But right now, politics is
trumping science: Long-awaited tests have been hampered by protests
over research methods, shutting down trials of the leading PREP
contender, Gilead’s nuke, Viread. If it works, Viread could be used by
millions unable to negotiate condoms. With so much at stake, feuding
activists, funders, scientists and officials met in Seattle in May to
try to hammer out their differences. “It didn’t make sense to be
shouting at each other,” says Gregg Gonsalves, director of treatment
and prevention advocacy at Gay Men’s Health Crisis, which helped plan
the meeting.
Researchers have long theorized
that if an HIV med given within days of exposure could prevent
infection, taking it before exposure might work, too. But there’s a
conflict of interest in running prevention tests: Ethics dictate
that subjects get the best counseling and care available, but in
order to determine that the drug stops HIV, some subjects must risk
exposure. “You only know if prevention technologies work if you have
infections,” says Mitchell Warren, head of the AIDS Vaccine Advocacy
Coalition. Stuck on these scientific and moral hooks, PREP trials took
until 2004 to launch.
And the trouble only
mounted. No sooner were sex workers in Cambodia enrolled than they
began organizing against what they said was a lack of informed consent,
hinting that participants were mere guinea pigs of researchers
interested in better trial data. Activists jumped on the bandwagon,
too, blasting funders for failing to offer lifelong meds to subjects
who got infected.
In a Cameroon trial, ACT UP
Paris raised its own red flags. “The screening and consent forms were
in English,” says ACT UP Paris’ Fabrice Pilorgé (some Cameroonians
speak French). “Another problem was that they wouldn’t provide the
female condom.” In the Thai trial, drug-using participants were
denied free needles. Well-organized protests at Bangkok’s 2004 global
AIDS confab grabbed headlines, causing Cambodia to pull out and
Cameroon to suspend tests. “I was furious,” says Gonsalves. “Is that a
victory—to shut down research?”
But in Seattle,
some common ground was reportedly reached. “It’s safe to say nobody
left that meeting against the research itself,” says Warren. Gonsalves
agrees. “Research is important,” he says. “But it’s also important that
it’s done ethically.” Meanwhile, trials proceed in San Francisco,
Atlanta and six foreign countries, while UNAIDS plans its own talks on
the ethics of prevention studies. As for Cambodian prostitutes, they
take their risks as they come,
PREP-lessly.
