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18 Jun 2010

Will a Pill a day keep HIV at bay?

Fridae’s Men's sexual health columnist Jan Wijngaarden discusses PrEP, PEP and iPrEP, and the extent to which anti-retroviral drugs for HIV can indeed help prevent HIV (but not STI) infection.

Sometimes we forget how important some things are in life, especially if we use them often. Take acetylsalicylic acid. Usually when I ask for it, people don't know what I am talking about, but it sounds impressive, nevertheless. Until I use its most common brand name: Aspirin. Acetylsalicylic acid was discovered in 1853 by the French scientist Charles F Gerhardt. One could say that this was the best French invention since the French kiss! It took a bit more effort by several other scientists before it became clear what it was that he had created. In 1897 scientists from the German firm Bayer discovered its pain-killing effects and as soon as 1899 Bayer was selling Aspirin around the world. After its patent expired (in 1918), other companies were also allowed to produce acetylsalicylic acid under their own brand-names. New pain-killers, based on other chemicals, followed soon: Paracetamol (1956) and Ibuprofen (1969).

Apparently, according to Wikipedia, the world defeats hangovers, converts unwilling sex-partners with headaches, and oh yes, also reduces the effects of fever, flu and pain using 40 million kilos of Aspirin per year! Imagine! While Aspirin lost a lot of market share to Paracetamol and Ibuprofen, its sales have recovered since the mid-1990s when it was found that acetylsalicylic acid can help PREVENT heart attacks and strokes. So many (mostly older people) use one pill a day to keep heart attacks away...

Interesting - taking a pill not to treat a disease, but to prevent it from occurring!

What do anti-retroviral (ARV) drugs do?

This brings me to the topic of this column. Many of you must have heard about the existence of medicines that can reduce the effects of HIV infection in those who are infected. These medicines can, in different ways, block HIV from reproducing in the human body. Usually people are prescribed three drugs at the same time, often combined in a single pill, sometimes called a 'cocktail' (sorry guys no alcohol in this one!). Each of the drugs in the cocktail works in a slightly different way, and together they are much more effective than each of the drugs by itself. The medicines can be so effective that (when they are duly taken according to the prescription) it becomes impossible to measure the amount of virus that an infected person has in his blood. This is good for the health of a person taking these drugs, and it probably also makes a person using these drugs much less infectious to others. The drugs I am talking about are called 'Anti-RetroViral Drugs' (ARV) and the process of treating HIV infection with a combination of ARV drugs is called Anti-Retroviral Treatment (ART).

The introduction of ARV drugs, and the increasing variety of slightly differing ARV drugs, allowing for changes in the treatment if a person becomes resistant to components of the cocktail, has led to big advances in the life expectancy of people living with HIV. The nasty side-effects of earlier medicines tend to be less in the newer generation of ARV drugs, although side effects remain. It is now believed that people who live in countries (or cities) where they have access to very good health care, the chance is high that they will survive their infection for several decennia, and end up dying of 'old age' rather than of AIDS. THIS IS WHY YOU SHOULD GET TESTED FOR HIV, if you haven't already done that for a while!

Coming back to the Aspirin example... Many people use Aspirin (or similar drugs) to reduce the chances of a stroke (or of a hangover – even though the effectiveness of this has not been proven). So how about I take ARV drugs before having unsafe sex – can that prevent HIV infection from happening?

That is, literally, the One Billion Dollar question. Just imagine: you take a pill, go out, meet someone and have fun without bothering about condoms! Drug companies would make billions in profits. (Maybe Hugo Chavez and other socialist leaders would even start mixing the drugs in the drinking water!).

Currently, in several countries around the world, research is being conducted to look at the extent to which ARV drugs for HIV can indeed help prevent HIV infection. The use of ARV drugs for this purpose is called 'Pre-Exposure Prophylaxis' (PrEP). This to distinguish it from 'Post-Exposure Prophylaxis' (PEP) – which is the use of ARV drugs AFTER possible exposure with HIV – most often this is used by medical personnel who have accidents with (potentially) infected blood during their work, or by people who were raped and possibly exposed to infected semen. PEP is also more and more often used by gay men who experienced condom breakage or just 'forgot' to use condoms, in the heat of the moment... By the way, if you think you could have been exposed to HIV, you have to start PEP as soon as possible, and not later than 72 hours after possible exposure. Usually you have to keep using the drugs for a period of four weeks. Since it is during the first months of using ARV drugs that the most severe side-effects usually occur, this is NOT a nice experience, I can promise you, and its actual effectiveness in preventing infection is still debated.

Preventing HIV infection by taking ARV pills BEFORE sex

So back to the topic: Preventing HIV infection by taking ARV pills BEFORE sex. Several research trials are looking at that at the moment. Put in simple terms, the research works as follows: a group of volunteers is recruited and randomly assigned to two groups. There is one group of people using ARV every day, and one group of similar people using a fake drug. The participants are 'blinded' – i.e. they do not know in which group they are. They are both counselled and told to be safe and use condoms (or, in the trials with injecting drug users, follow harm reduction principles). The scientists then look if the ARV-using group gets infected less rapidly than the latter.

This takes several years to follow up. So far there are no results from these trials. The problem with these trials is that they all focus on populations that have to take the ARV drug every day. Just like women who use the pill to prevent pregnancy. However, if the trials work, daily PrEP may not be a feasible option for most gay men. Because using these drugs daily is not pleasant in terms of side-effects. Also, the chance of forgetting to take it is always there – especially if you are on a normal work/study day and do not plan to have any sex. Indeed, the majority of gay men are not exposed to HIV on a daily basis and therefore probably do not need to take ARV drugs every day. Finally, while they have become much cheaper recently, ARV medication remains quite expensive for most gay men, particularly those in poor countries or settings.

Therefore, rather than only focusing on daily use, we should also have information about the effectiveness of using ARV drugs intermittently - in other words, not every day, but only on the days that we have sex. This proposed regimen is called iPrEP – which stands for 'Intermittent Pre-Exposure Prophylaxis'. The benefits would be obvious: no need to take daily pills; it would be more convenient and cheaper, and probably also better for your health.

Unfortunately currently there are no clinical trials evaluating the efficacy of iPrEP, even though this regimen has, according to available science (including results in test animals), the same biological plausibility of effectiveness as daily PrEP. It is not likely that such trials WILL be held. Because if the ongoing studies demonstrate that daily PrEP does indeed protect against HIV infection – which very likely will be the case – it will become difficult to evaluate the efficacy of iPrEP, because – for to ethical reasons – daily PrEP would need to be given as comparison drug to the volunteers in the fake-drug-group. 

Because the differences in effects between daily PrEP and iPrEP are likely to be very small, such a study would need more than 10,000 randomly assigned volunteers to prove whether iPrEP is as good as daily PrEP. It would take several years to conduct and would require enormous financial resources. Who would invest in this? Surely not the pharmaceutical industry, which is heavily invested in the ongoing daily PrEP trials... They want, after all, to sell drugs. Loads of them. Every day. 

This is a pity - because even if positive results are shown by the daily PrEP trials, probably in practice most gay men would be taking the pills intermittently anyway – because they can't afford daily pills, because they don't want daily pills or because they simply forget to take them every day. This is a complicated issue which has, unfortunately, hardly been taken up by gay activists. 

I would be interested to hear your views about this new potential, but still controversial HIV prevention technique. 

Would you be willing to take a pill every day if you could ditch condoms and be 100% sure it would prevent you from HIV infection (but not from other sexually transmitted infections)? And how about if you could be 70% sure? Or 50%? 

No easy answers here, I am afraid! 

PS: To pre-empt renewed hate-crimes against me from the Condom Mafia, let me repeat here, again and again, that I LOVE condoms, under all anal circumstances. They are much healthier for you than pills, as long as you don't swallow them! Also they prevent against many sexually transmitted infections – something ARV drugs do not.

Jan Wijngaarden has worked, in different functions and roles, on promoting HIV prevention, care and support for men who have sex with men (MSM) since 1994. He is also the moderator of MSM-Asia, an information network on MSM, HIV and human rights, with nearly 600 members from across the region. If you want to become a member of MSM-Asia, or for information requests or comments, pls contact him at jwdlvw@gmail.com

Reader's Comments

1. 2010-06-18 17:16  
Take PrEp before sex to "prevent" HIV {+ V + (whatever stuff)}
Take Penicillin shot before sex to "prevent" syphillis {+ V + (whatever stuff)}
Take antibiotics before sex to "prevent" gonorrhea {+ V + (whatever stuff)}
.....etc

Sure, something has to give. Eventually resistance to all these anti-"drugs" will set in and there will be an era of the Superbug, like what is happening now with STIs. :P
Comment edited on 2010-06-18 17:17:34
2. 2010-06-18 22:19  
If you have taken PEP before, the answer would be easy.
NO WAY!

The side effects are just too strong.
Safe Sex is still the way to go mate.
3. 2010-06-19 05:24  
I wonder how many of the guys who talk about the horrible side effects of PEP have actually been on a PEP treatment??? I went on it once last year, after I shagged an incredibly hot guy without rubber before he vanished into thin air the next day. Giving the fact that I don't suck cock or rim ass, let alone allowing anything near my ass the chance of getting infected is relatively low, yet I went straight to the GUM clinic and asked for a PEP treatment.

The only annoying thing for me was that I kept forgetting taking on time(missed by 30 mins instead of every 8 hours on the dart) and swallowing 3 gigantic sized pills (about the size of the largest cod liver oil capsule) every 8 hours for a month wasn't exactly a pleasant routine! I personally didn't experience any side effect at all. Neither did a friend of mine who's been on it a couple of years before I did.

I reckon in most case, the "side effects" of the PEP treatment is actually psychological! I still remember how ill I was when I had my first HIV test on my own in mainland China 7 years ago. It was a torture to wait a week before the result came out and I nearly threw up when I was queueing for my result! And all the "HIV/STD symptoms" I had disappeared immediately after the doctor told me I was neg!!!!

Play Safe, get tested on regular basis and get on a PEP treatment as soon as you think you've been naughty with potential HIV carrier!!!
4. 2010-06-19 05:31  
Bad idea for a few reasons:
1) HIV will build up resistance on any anti-viral used too commonly over too long a period;
2) Beside HIV there are other STDs which this cannot prevent
3) This cannot provide 100% protection against HIV
4) Side effects
5) High costs
6) Availability: health authorities of certain countries may not approve use of it as preventive measure where there hasn't been any suspected exposure to HIV yet
7) Those who are unknowingly HIV-positive who use this may end up increasing the resistance of the HIV already inside his body
8) May reduce HIV screening rate, makes prevention & treatment more difficult

More sensible ways to fight HIV are:
1) Regular HIV screening
2) Counselling and free or subsidised treatment for HIV-positive
3) Access to condoms and lub (e.g. lower production costs which lead to lower retail price; widespread distribution)
4) Increase awareness of safer sex
5) Invention of condoms and lub that are safer (e.g. silicone-based), give more sensual pleasure (e.g. thinner, conducts heat better) and provide anti-viral protection
6) Comprehensive sexuality education in schools
7) Enhance narcotic forces and reduce drug-taking behaviour
8) Licensing of sex workers requiring them to undergo safer sex training and regular STD screening
9) Repeal of anti-gay laws. Govt to work directly with MSM community
10) Access to gay saunas which provide condoms, lub and safer sex info (with info on where to go for PEP once a person suspects he'd been exposed to HIV)
11) 24/7 clinics or hospitals located near to gay district which provide PEP
12) Subsidies/use of Medisave or insurance for PEP costs
13) Free anonymous oral HIV screening provided twice a year in Jun & Dec.
14) Legislate law to ban companies from asking whether job applicants are HIV-positive unless there is a medical ground for an applied job to be given only to HIV-negative. This will give HIV-positive a fairer treatment in the job market and financial security required for them to live well, which, in turn, makes it less likely for them to turn into anti-socials.
15) Provide opportunities for HIV-positive persons to network and build up monogamous relationships among themselves


5. 2010-06-19 09:14  
I'm for it when they make it more affordable and accessible. It's the evolution of technology. Diseases are gonna evolve as we take more pills true. But right now it seems almost impossible to give out our busy lifestyle in the world today. We want convenience, and in return we don't live in the country side with cleaner air, nor eat more organic food.

Like it or not, technology has to catch up with diseases. When it is more affordable and accessible, they will be able to create more competition and make the drugs better and better. And hopefully in the future, prevents the other STDs as well.

I'm probably 70% for this. 30% of me wants us to live better responsible lifestyle. But they are easier said than done. At least this drug is good for you. Unlike the ABCD-E pills you take in the club.
6. 2010-06-19 12:24  
They can do a RESTROSPECTIVE STUDY by collecting a large sample of people that practices iPreP and monitor them for seroconversion HIV, if the incidence is low then it would tell us that it might have a chance to reduce infection. This is not as powerful as the PROSPECTIVE RANDOMIZED PLACEBO CONTROLLED trials mentioned but it may give some meaningful result.

That being said, I do agree that this is not a good idea to practice iPreP as it promotes resistant strains that would haunt us later.
7. 2010-06-19 16:04  
PREP is an ethical problem. We know that drugs are expensive, very expensive. How can we spend so much to ensure the pleasure of gays in the North while people still die in the South because they have no access to care! This is unacceptable ...
8. 2010-06-19 16:53  
Just use a damn condom. Is it SO difficult???????
9. 2010-06-19 17:16  
Why the negative comments? This research is still on its infancy stage. Of course there are risks on the people its being tried on (In case they do human trial) and there are also ethical concerns. But on the long run, it tackles one of the biggest medical problem we are having now. Lets just cross our fingers hoping it will work.
Comment edited on 2010-06-19 17:17:25
10. 2010-06-19 17:23  
v take certain supplement like vitamin C, zinc, herbs to prevent certain illness. May b this suggestion might do the same, to prevent right?
11. 2010-06-19 17:46  
There is one trial of iPrEP called IAVI E001/E002 testing the safety and acceptability of intermittent doing vs. daily dosing of PrEP in Kenya and Uganda.

It is very unlikely that PrEP based on the use of one ARV will work. There is ample evidences from treatment trials that more than one ARV is needed to keept the virus in check. This means that for PrEP to work, a cocktail of drugs will be needed but so far, only mono- or dual therapy are being trialed.

Now that Jan has introduced PrEP, maybe the next article will be about "Test and treat?" ?

PS: The results of the first large scale trial of PrEP (CAPRISA, where ARV are used as a pre-sex vaginal gel) will be presented at the AIDS conference in Vienna this July. This result will be critical for the future of PrEP and beyond, of HIV prevention.
Comment edited on 2010-06-19 18:06:10
12. 2010-06-19 18:19  
I could think of a more useful column.

[Improving on suggestion #15]: Because it is inconclusive, impractical and apparently the author's own pet idea.

A comment on the recent advices about risky lubes would have been more helpful, if it were informed.
Comment edited on 2010-06-20 17:03:03
13. 2010-06-20 09:17  
A useful option in the kitbag but resistance (as discussed) is a big issue.....and taking any drug regularly can't be good for you, I think personally.

How about some conspiracy theory here. The drug companies just love resistant bugs - gives them the mandate to create a new expensive drug to make even more profits.
Why should pink dollars support drug companies - or grey dollars etc etc.

So be smart guys, use a condom, yeah??
Wrap it and spend your pink dollars on Gucci and Louis Vuitton....
14. 2010-06-20 09:30  
I think I've said this before Jan... An interesting and informative article but the trouble is its pegged at someone with a PhD in Epidemiology.

Please summarise the important facts in a point by point format so that mere mortals can read, understand and learn

Take note of sunthenmoons technique
15. 2010-06-20 11:39  
Thanks for the comment.
@ Cat_Boy: thanks for sharing this.
@ Sunthenmoon: 'Bad idea': this may be true, especially if PREP or iPREP was the only strategy gay men used for HIV prevention... I see it as a possible strategy only for those of us who are a very high risk of infection.
@ Dynhoyw: For me it is not difficult to use a condom, but perhaps it is for others :-)
@ Drelin: .... (comment deleted by the author - hahaha)
@ Denseaus: Thanks for thinking I have a Ph D in Epidemiology! Maybe next life :-D ... But I think more than 75% of Fridae's audience will be intelligent enough to read and understand the article. But I like your suggestion to have summarizing bullet points at the end. Or the beginning.
@ Everglaid: It is obvious that Big Pharma is interested in PREP and NOT in iPREP... For obvious reasons... Rather than a conspiracy, it may be just because of the global capitalist system... :-)
Cheers
Jan
16. 2010-06-20 20:42  
@janbkk: The only 2 main categories of ' those of us who are a very high risk of infection' are 1) medical/research workers; 2) sex workers. I'd think that your idea might work for (1) as long as the costs are subsidised and they do screening often. However, for the majority, (2), I don't think it's a good idea because: (a) they are sex workers because they are not loaded in the first place, so would they be willing to spend everything they earn from providing sex services on such expensive drugs? (b) Or would any govt consider sponsoringthese for sex workers? I doubt so. For these reasons, it's still not a good idea for the majority. But you could seriously think of this idea for researchers or medical workers who need to expose themselves to HIV-positive persons or HIV samples during a short period, and hence would be safer if they are protected against HIV during those short periods. So, it's still a valid solution, but mainly for this small group of people.

I am quite concerned that if this becomes available in the community, HIV resistance may build up faster and the medical community may then have a harder time trying to out-smart the intelligent virus. Secondly, it may give the impression that it's OK to have unprotected sex as long as one takes the preventive medicine. But it's not true. It's not 100% effective even for HIV-negative persons. (For HIV-positive persons, it's worse if they take such drugs for a few weeks then stop taking them) And, there are other STDs that may not be prevented.
17. 2010-06-20 22:06  
I really like Jan's column's he seems to be the only one who can speak up and tell it like it is with good science to support his conclusions and willing to engage in a dialogue on those grey areas which still need to be explored and studied

Anyway, its Father's Day and kudos to Ricky Martin and all those cool gay dads raising kids and having a blast out there. You will find its a lot more fun then sitting around worrying about sexual diseases. Its great to have kids that challenge you and push you to be a better man whether you are gay or straight.
18. 2010-06-21 05:25  
While the trials may prove PrEP useful for prevention, common sense tells me that the use of daily drugs is a bad idea if there is a simpler alternative (ie using condoms). I would be reluctant to take a daily drug (especially if there is no conclusion about the longer term side-effects) just for the benefit of having sex without condom. For the same reasons I quit using Lariam (a malaria prophylaxis) after prolonged use.

Onno

19. 2010-06-21 09:55  
Jan... the guys who will read and understand your article are the guys who are already aware... if not too aware.

Its the 25 % who cant be bothered to plow through such a long article are the ones who need to be educated
20. 2010-06-21 14:36  
Need some encouragement? Check out the music video embedded in my profile.
21. 2010-06-21 17:17  
it's almost always certain that many are gonna abuse the system, thinking PEP can get them out of unsafe sex practices!
22. 2010-06-21 21:16  
what is STIs?
23. 2010-06-22 00:44  
Many people are allergic to latex, but non-latex polyisoprene condom is not as available. Most people find condom reduces pleasure and it is beyond one's control if it breaks during sex. People's judgments often be compromised by alcohol, drug, rising hormone or...love. Condom is the only effective safe sex solution available today but it is hardly the ideal solution for all.

New medicines become cheaper when their patents expired. Medicines can be improved to better target the disease with lesser side effects. The idea of ignoring possible life saving medicines due to potential "abuse" is absurd. One more preventive option means one more weapon to combat new infections. The more we know about the disease the better we can fight it. I say we leave no stone unturned; every possibility is worth exploring.
Comment edited on 2010-06-22 01:04:07
24. 2010-06-23 00:57  
I need an aspirin now after reading so many condescending & mean spirited comments on here telling others what they should be doing. I now have a headache.

When will manners come back? Stop telling other people what they should be doing. We are all adults and know full well what the right thing to do is without someone on a pedestal telling us.

(reaches for a ibuprofen) works better on me for head pain.
25. 2010-06-23 07:21  
hahahaha...
i cannot agree more with Lagunabro and DA90027.
at least the author has taken the time and effort to give an analysis and his opinion in a well written article.
that article does not serve as an instruction as to how we should live our lives, please bear in mind. its just an opinion by an individual.
26. 2010-06-23 12:32  
it is very interesting that in our community clearly people prefer to give judgement like statements instead of for example answering the authors questions. although i must say it is very interesting to read many of the opinions.
but we can all conclude that despite the condom is the most safe way of prevention during sex it still isn't perfect and it is also clear that many gays don't like to use condoms (all the time).
so any alternative is welcome and than people can make their own choice. before hiv came up, many gays did have unprotected sex and just got treatment for the other diseases which weren't (and aren't) killingly dangerous.
so to answer the author's questions if a pill a day could guarantee to keep HIV away? i would certainly take it and the un might set up distribution programs for the less financial powerful.
but if it would be 70% or less, it could only be something to reduce risks if a condom breaks otherwise it would just be playing russian roulette which you can play many times if lucky but also not win forever...
27. 2010-06-24 04:38  
@Gaction: STIs = Sexually Transmitted Infections
28. 2010-06-25 06:32  
I am a physician. In my opinion, HIV prevention should safe and sensible sex instead of using any form of medication. All the ARV drugs out there should be reserved for treatment of HIV infection. It is bad enough that people realized HIV infection has become a chronic illness and subsequently changed their once safe sex practices.
ARV is not without problems and the side-effects could be fatal (i.e. lacticacidosis). Why would anyone use up one option of treatment for prevention while safe sex is the best prevention of them all. A object patient can potentially develop unexpected drug resistant before even get infected. Treatment should be appropiately administrate after vitrual phenotype is being done. I can never understand why people want to do this type of research.
I remember during my med school years, the AIDS ward could be packed with 30+ people at any given time. Now, I would be surprised to see more than 5. Most of them are drug users or mentally derailed whom refused or ignored the ARV regimen.
I want people to understand that prevention is safe sex and not all these ARV drugs out there. Scientists need people's help to fight this disease. They need us to work with them. We use them when it is necessary instead of using it so we can have wild unprotected sex again like a few decades earlier.
29. 2010-06-25 08:55  
Anyway, while Jan hasn't got a PhD in virology, pharmacy or medicine, he did complete a Master's degree in Public Health, and he's working professionally with anti-HIV organisations in Asia to fight the war against HIV.

Please note that he is NOT suggesting that this technique should work. He is merely asking for opinion on someone else's --not his--idea. Quote: "I would be interested to hear your views about this new potential, but still controversial HIV prevention technique." He has also made it clear that condom is still his preferred method of intervention. [Quote: "PS: To pre-empt renewed hate-crimes against me from the Condom Mafia, let me repeat here, again and again, that I LOVE condoms, under all anal circumstances. They are much healthier for you than pills, as long as you don't swallow them! Also they prevent against many sexually transmitted infections – something ARV drugs do not."]

Clearly, while he floats this idea in the article, he's made it clear that he'd still suggest sticking to condoms. And that's what I agreed with also (see my above comments). I had also listed some major reasons why this idea is a bad idea. I repeat that this is NOT Jan's idea [Quote: "Currently, in several countries around the world, research is being conducted to look at the extent to which ARV drugs for HIV can indeed help prevent HIV infection."]. So I am not criticizing Jan in any way.

It's always good to keep an open mind and explore as many ways as possible in which to fight HIV, even though some ideas may sound silly at first. That's how we invented aeroplanes and even aircraft which speeds exceed that of sound. However, this idea does have many obvious problems, which I had listed in my above comments, to deal with.

For reason of these obvious problems, then, I suggested that looking into condom and lub should be more fruitful. Currently, a promising, NIH-sponsored lub technology is undergoing advanced-stage clinical research. [Ref: http://www.starpharma.com/vivagel.asp ] If further validated in a series of clinical trials, this technology (used with good old condoms, of course) may prevent not only HIV but other STDs like Herpes. According to its developer, it may be available by 2012. [REF: http://www.businessweek.com/news/2010-06-01/vaginal-gel-that-kills-herpes-may-be-ready-by-2012-update2-.html ]
Comment #30 was deleted by its author on 2010-06-25 09:09
31. 2010-06-25 09:21  
According to a US government-funded recent clinical trial on Vivagel, the promising technology that I mentioned, COMPLETE INHIBITION of HIV was achieved in Vivagel-treated CVS. Now, IF we can achieve COMPLETE INHIBITION of HIV also with Vivagel-treated anal wall, isn't it better to use it rather than 'a pill a day'? Isn't it a more practical, safer, convenient and more cost-effective way?

Let's wait for the results of further clinical trials to be reported in the coming couple of years. If Vivagel could come in the form of a silicone-based lubricant (which, in an earlier Fridae article has been reported to be more anus-friendly than water-based ones), then it should be an ideal HIV-fighting tool for anal and vaginal sex alike. The lubricant reduces friction and prevent cuts while the active ingredient in Vivagel inhibits HIV and other STDs. It should be a perfect combination.

If such a Silicone-based Vivagel becomes available, what we need to do is to use it consistently during penetrative sex, preferably with condoms for double protection. While condoms and ordinary lubricant alone could prevent MOST HIV risk, the active ingredient in Vivagel can help, in such a combination, to inhibit HIV should there be any leaks. This combination should, thus, should provide near to 100% protection.

Ref:
http://www.starpharma.com/data/090803_VivaGel-Anti-HIV_%20and_Herpes_%20Activity_%20following_human_admin.pdf#search="clinical trial antiviral hiv"
[Quote:
"The study showed that cervicovaginal fluid samples (CVS) obtained immediately after vaginal administraion of VivaGel provided effectively COMPLETE INHIBITION OF HIV and HSV in vitro. At 1 and 3 hours following administration of product, the initial high level of inhibition of HIV and HSV was RETAINED IN ALL WOMEN TESTED."]

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