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   From: kjarrett@emule.com   
      
   AIDS researchers and policymakers from around the globe are   
   gathering in Melbourne, Australia, for a major international   
   conference that starts this Monday. They'll be mourning dozens   
   of colleagues who died in the crash of Malaysia Airlines Flight   
   17.   
      
   But the work of the conference will continue, and one of the   
   major topics to be discussed is expanding the use of a pill that   
   prevents HIV.   
      
   The drug, Truvada, has been shown to be highly effective at   
   preventing new infections. Public officials in New York are   
   ramping up efforts to distribute the pill widely — but not   
   everyone thinks that's a good idea.   
      
   Truvada has been around for a decade as a treatment for people   
   who are already HIV-positive. It's only in the last few years   
   that it's also been approved to prevent transmission of HIV.   
      
   That's why Damon Jacobs, an HIV-negative therapist in New York   
   City, is taking it: "I had been newly single after being in a   
   relationship for seven years, and found that people were not   
   using condoms in 2011 the way they had been in 2001," he says.   
      
   Jacobs started taking Truvada three years ago for pre-exposure   
   prophylaxis — also known as PREP. Since then, Jacobs says, he no   
   longer uses a condom every time he has sex, but he's not worried   
   about getting HIV.   
      
   "I didn't fully understand what it meant to live in fear every   
   time I had sex," Jacobs says. "And it wasn't until about a year   
   after I was using PREP that I had the experience of pleasurable   
   intimacy, and realized: I'm not afraid anymore."   
      
   Studies have shown that Truvada can be more than 90-percent   
   effective against the transmission of HIV, as long as it's taken   
   every day. The drug has been approved for PREP by the FDA and   
   endorsed by the Centers for Disease Control and Prevention.   
      
   At New York's Gay Pride parade last month, Gov. Andrew Cuomo   
   announced that his state will be the first to make Truvada part   
   of its ambitious plan to cut new HIV infections.   
      
   "The state of New York ... in many ways was ground zero of the   
   HIV and AIDS crisis when it first started," Cuomo said. "I think   
   it's fitting that New York should then be the state that is the   
   most aggressive in eradicating this disease, in actually ending   
   this disease."   
      
   Michael Weinstein, president of the AIDS Healthcare Foundation   
   and a prominent critic of Truvada, calls this "a very dangerous   
   experiment."   
      
   Weinstein points out that Truvada only works when you take it   
   almost every day. He's worried about what will happen to those   
   who don't.   
      
   "If people are taking this medication, they're definitely not   
   going to use condoms. And if they're not taking it regularly,   
   they're not going to be protected when they think they are,"   
   Weinstein says. "We would have many, many more infections in   
   this country — particularly among men who have sex with men — if   
   no one was using condoms. And we can do harm by telling people   
   that you can pop this pill."   
      
   But public health officials in New York say that pill could be   
   key to cutting the number of new HIV infections — a number that   
   has held roughly steady for the past decade. Daniel O'Connell,   
   who directs the AIDS Institute at the New York State Department   
   of Health, says it's time to consider new approaches.   
      
   "We're trying to do education and give options to people in   
   terms of staying safe. So for some people, condoms are that. For   
   some people, monogamy is that," O'Connell says. "But for some   
   people, the only answer that's going to work right now is PREP."   
      
   Truvada is not the cheapest option. The drug costs $1,300 a   
   month, though it is covered by most insurance plans and   
   Medicaid. But those who are most at risk of getting HIV often   
   have limited access to health care.   
      
   Perry Halkitis, a professor at New York University, says, "I   
   will believe that PREP is truly going to be effective in the gay   
   community if it gets in the hands of those who need it most in   
   the gay community: young, black, gay men. And I have no evidence   
   to suggest that it's getting there right now."   
      
   So far, the number of people anywhere taking Truvada for PREP   
   seems to be small: just a few thousand nationwide. Prominent   
   AIDS activist Larry Kramer, a co-founder of the Gay Men's Health   
   Crisis, has publicly questioned why anyone would want to put   
   "poison" into their body when they could wear a condom instead.   
      
   But public health officials like O'Connell say the side effects   
   are minor — especially compared to the potential benefits.   
      
   Transcript   
   SCOTT SIMON, HOST:   
      
   This is WEEKEND EDITION from NPR News. I'm Scott Simon.   
      
   A number passengers on Malaysian Airlines flight 17 downed in   
   Ukraine this week were AIDS researchers, health care workers and   
   activists. They were in route to a conference in Melbourne set   
   to begin tomorrow. One of the major topics to be discussed at   
   that gathering is expanding the use of the pill that prevents   
   HIV. Truvada has been shown to be highly effective at preventing   
   new infections. Public officials in New York are ramping up   
   efforts to distribute the drug widely, but not everyone thinks   
   that's a good idea, as NPR's Joel Rose reports.   
      
   JOEL ROSE, BYLINE: The drug Truvada has been around for a decade   
   as a treatment for people who are already HIV-positive. It's   
   only in the last few years that it's also been approved to   
   prevent transmission of HIV. That's why Damon Jacobs is taking   
   it.   
      
   DAMON JACOBS: I had been newly single after being in a   
   relationship for seven years, and found that people were not   
   using condoms in 2011 the way they had been in 2001.   
      
   ROSE: Jacobs is a therapist in New York City. He's HIV-negative.   
   He started taking Truvada three years ago for pre-exposure   
   prophylaxis - also known as PREP. Since then, Jacobs says he no   
   longer uses a condom every time he has sex, and yet, he's not   
   worried about getting HIV.   
      
   JACOBS: I didn't fully understand what it meant to live in fear   
   every time I had sex. And it wasn't until about a year after I   
   was using PREP that I had the experience of pleasurable intimacy   
   and realized I'm not afraid anymore.   
      
   ROSE: Studies have shown that Truvada can be more than 90   
   percent more effective against the transmission of HIV, as long   
   as it's taken every day. The drug has been approved for PREP by   
   the FDA and endorsed by the Centers for Disease Control and   
   Prevention.   
      
   At New York's Gay Pride parade last month, Gov. Andrew Cuomo   
   announced that his state will be the first to make Truvada part   
   of its ambitious plan to cut new HIV infections.   
      
   (SOUNDBITE OF ARCHIVED RECORDING)   
      
   GOVERNOR ANDREW CUOMO: The state of New York, which in many ways   
   was ground zero of the HIV and AIDS crisis when it first   
   started, I think it's fitting that New York should then be the   
   state that is the most aggressive in eradicating this disease   
   and actually ending this disease.   
      
   MICHAEL WEINSTEIN: It's a very dangerous experiment.   
      
      
   [continued in next message]   
      
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