AIDSWEEKLY Plus; Monday, July 27 & August 3, 1998
Daniel J. DeNoon, Senior Editor
San Francisco health authorities say they will forge ahead with a controversial study that provides antiretroviral drugs to people who think they may have been exposed to HIV.
The trial program, known as post-exposure prophylaxis (PEP), is aimed at people who have had unsafe sex or needle-sharing with an HIV infected partner. Although the program provides anti-HIV drugs, it is intended as a risk reduction program and not as a medical intervention.
"If we get people in who are very scared after a high-risk exposure, this is a very good opportunity for counseling interventions," said J.D. Bamberger of the San Francisco Department of Public Health. "Our PEP program is not a drug program, it's a counseling program."
Not everyone agrees. The San Francisco media has referred to PEP as a morning-after treatment.
"It's not a morning-after pill, it's 28 days of toxic medication," Bamberger complained.
Typical of the type of criticism the plan has engendered was a comment by David Ostrow of the University of Chicago.
"You say you're going to do a counselling program, but you're only advertising for your study," he said.
Bamberger showed advertisements the health department plans to put on city buses. The ad prototypes feature a partially nude same-sex couple and the copy reads "Oh shit. The condom broke. There's a treatment that might protect against HIV, but you have to call right away. You only have 72 hours to start."
The PEP/counseling plan is the creation of esteemed HIV behavioral researcher Thomas Coates and colleagues at the University of California, San Francisco. To get the anti-HIV drugs, study participants must attend intensive counselling sessions on safe sex. They must attend at least three times to get the full course of medication.
Critics of the plan say that the ads will be misunderstood as offering a sure way to prevent HIV with drugs. They see it as undermining more than a decade of safe-sex education.
But Bamberger defended the plan as a possibly powerful means to teach safe behavior to people who may require intervention. Still, he expressed his own doubts.
"Are we praying at the church of medication?" he asked. "We know what works for prevention: condoms work, safe sex works, clean needles work. Are we now going to be using medication?"
He suggested that it would be unethical to refuse medication to an HIV exposed person, but that the ethical obligation extended to providing behavioral intervention as well.
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