Every gay and bisexual man on the planet was told to start taking drugs today – for as long as they are sexually active, even if it is the rest of their lives.
That was the message on Twitter from no lesser body than the World Health Organization (WHO).
And they meant it.
By getting gay and trans people who have sex with men to take Pre-Exposure Prophylaxis – a drug regimen for people who don’t have HIV – they hoped to cut the number of people worldwide who contract the virus by 1million over the next 10 years.
The Twitter message read: ‘For the first time, WHO strongly recommends men who have sex [with] men to take antiretroviral meds as an additional method of preventing #HIV’
But all was not as it seemed. The press release they issued contained a more nuanced message.
It said: ‘WHO strongly recommends men who have sex with men consider taking antiretroviral medicines (PrEP) as an additional method of preventing HIV infection alongside the use of condoms.’
For health-watchers, even this instruction to ‘consider’ it marked a major shift in policy.
But for gay, bi and trans people – and other groups at high risk of HIV infection, including prisoners, drug users and sex workers – it implied something even bigger.
How should they go about ‘considering’ this?
For a start public health bodies, like Britain’s National Health Service, don’t generally offer PrEP for free. And the cost to an African, where the drugs are generally cheapest but the affordability lowest, the cost is $115 (€85) a year.
If heeded by all men who have sex with men, it would mean a multi-billion dollar boost to the global drug industry.
Even more importantly, while the drugs are generally safe, experts told GSN they do have long-term side-effects, some of which are not yet known. For example, they can damage your kidneys, leading to protein being destroyed with serious knock-on effects.
One expert told GSN the danger was that people would start buying PrEP online, as it is not widely on offer elsewhere, and taking it without being properly monitored.
And aother expert told us: ‘It is not going to be for everyone. It is going to have to be very, very targeted on those people who are having issues with other methods of prevention.’
So what did WHO mean by ‘consider’?
Everyone GSN has spoken to has agreed that the average gay, bi or trans person – not being a statistician or sexual health expert – doesn’t have all the facts they would need to make a fully informed decision.
You would need to know how risky your sexual practices are – some like fisting put you at more risk, others like wearing a condom dramatically reduce the risks. Drug taking and group sex are also far more risky than completely sober sex with one monogamous partner.
And you would need to know the prevalence of HIV in your village, town, city and country, among various different races. Another factor is how many of those people with HIV know their status. If they do and are on drug treatment, they are far less likely to pass on the virus than those who are positive and don’t know they are.
GSN spoke to WHO and they agreed with this analysis.
Despite the press release, and the tweet, it was not their intention to get every man who has sex with men to take PrEP tomorrow. Or even to rush off to their family doctor to ask if they should.
Instead, despite the reaction they created, the new policy is a ‘guideline targeted at decision makers’, not really at gay and bi or trans people at all.
In fact, WHO’s real aim today was to put pressure on governments sitting on an HIV timebomb and failing to do anything about it.
PrEP may well suit some people and it is worth learning about, the experts told GSN.
But as UK HIV charity Terrence Higgins Trust said, the advice for now remains the same today as it was yesterday: ‘Condoms and regular testing remain our best weapons against HIV and other sexually transmitted infections.’