HIV - the pill before it

Christiane Fux studied journalism and psychology in Hamburg. The experienced medical editor has been writing magazine articles, news and factual texts on all conceivable health topics since 2001. In addition to her work for, Christiane Fux is also active in prose. Her first crime novel was published in 2012, and she also writes, designs and publishes her own crime plays.

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A drug that reliably protects against HIV has been around for years. But the hurdles for a broader application in Germany are still high. This could change now.

In 1981 sex lost its lightheartedness. It was then in California that the first patients died of a mysterious and cruel illness. Their victims were young homosexuals. And while the researchers were still looking for the pathogen, the virus spread across the globe. And with him fear.

The fear remains

Since HIV was no longer a death sentence, this shadow has lost its horror. At least in regions of the world where medical care is good. In Germany, people infected with HIV have a life expectancy that almost corresponds to that of those who are not infected. "But even if the fear has diminished - it has not gone," says Armin Schafberger, advisor for medicine and health policy at Deutsche Aids-Hilfe, in an interview with

An HIV infection means carrying a dormant enemy within you that you have to suppress with medication for your entire life. If left untreated for years, the virus has already caused irreparable damage. And last but not least, HIV infection still carries a stigma.

Safe sex is not a guarantee

Even those who practice strictly safer sex are not automatically on the safe side. Rubbers can tear. Application glitches are always possible. And apart from that: sex with rubber is something different than without it. The fumbling right at the moment when it gets really exciting. The sterile smell of latex. The feeling of rubber on skin instead of skin on skin. And oral sex with rubber or licks for the ladies? It's not sexy.

Whether a woman, a man or something else, whether homosexual, straight or bi: Many people get along well with safe sex. Others don't give a damn and take the risk. But then there are those for whom both are problematic. Their erection collapses as soon as they put a condom on them. The fear, despite the condom. Or who simply want more intimacy than a latex cover allows.

Safe sex in pill form

For some time now there has been another option: safe sex in pill form. The combination of two active substances (emtricitabine and tenofovir disoproxil) prevents the virus from multiplying in body cells. It was originally marketed as an AIDS medication under the name Truvada by the pharmaceutical company Gilead.

But it also works against pathogens that have just entered the body. The infection is nipped in the bud. Doctors refer to this preventive therapy as pre-exposure prophylaxis, or PrEP for short.

"Incredibly high protection"

“The protective effect is incredibly high, that's fascinating,” says Schafberger. In fact, there are only four documented cases worldwide in which users became infected despite taking pills every day. The HI viruses they caught were resistant to the drug. On the other hand, there are now tens of thousands of people who have remained healthy. "If you are honest, PrEP is even safer than a condom," says the AIDS advisor.

Cash registers are not (yet) taking over the costs

The drug has also been approved for HIV prophylaxis in Germany since 2016, and generics have been available for 50 to 70 euros per month since October 2017. However, you have to pay for the tablets out of your own pocket. In addition, there are often the costs for regular examinations - not only for HIV, but also for other sexually transmitted diseases such as gonorrhea, syphilis or hepatitis.

Kidney function must also be tested regularly. "A rare but serious long-term side effect is damage to the kidneys," explains Schafberger. Some doctors bill for such examinations through the health insurance company. Others, however, fear recourse payments. Then users can quickly add another 50 to 100 euros or more.

HIV protection for people with little money

The German AIDS Society demands that the means should also be accessible to people who are less well off financially. "Protection against HIV shouldn't be a question of the wallet," says Schafberger. It could help that PrEP has recently been officially ennobled in the German and Austrian guidelines on HIV infection as an official preventive option - for all people with a high risk of infection. In the meantime, Health Minister Jens Spahn (CDU) has also spoken out in favor of PrEP becoming a health insurance benefit for people with an increased HIV risk.

No protection against gonorrhea, syphilis & Co.

But there are also critical voices. Mainly because, unlike a condom, PrEP does not protect against other sexually transmitted diseases. Schafberger sees it calmly: “HIV is a disease that doesn't go away for a lifetime. For us this is a different league than diseases that can be got rid of with a few tablets or injections. "

Possibly the PreP could even help contain the spread of gonorrhea and syphilis and the like - simply due to the fact that the users have to be tested for it regularly. Without an examination there is no follow-up prescription. "However, whether this really works and whether other sexually transmitted diseases will also become rarer as a result of PrEP will only be revealed in a few years," says Schafberger.

PrEP on time

Some also find it strange to take a drug as a healthy person just to avoid having to take the same drug in the event of an infection. Schafberger sees it differently: "With HIV you have to take another drug - and you have the pathogen in you for the rest of your life."

Most users would also probably not swallow PrEP for decades. “It is relevant in certain phases of life, but at some point later it will be superfluous,” says the AIDS advisor. Some even only take the pills on certain occasions and a few days before and after. However, the drug is not approved for this and how well it works has not yet been adequately researched.

Return to freer love?

Will PrEP make love life in Germany freer again? "Yes, for the individual. But we'll only know in a few years whether something is fundamentally changing in the scene, ”says the AIDS advisor. Studies from the USA and France, where PrEP has been available for a long time, show that by no means everyone who has risky sex also uses PrEP.

And that, although the drugs are even given there free of charge. There, but also in Germany, users are well informed and educated almost across the board, reports Schafberger. The socially disadvantaged are less open to the drugs. The AIDS expert says: "At some point in the USA they even advertised at bus stops in order to reach people."

Even with us, no hordes have stormed the doctor's offices so far. After all, the number of users in this country has risen to 4,500 since the cheaper generics came on the market. This was recently the result of the "PRIDE study" on PrEP use in Germany. Scientists from the Erasmus University Rotterdam, on the other hand, calculate that PrEP could prevent up to 9,000 HIV infections in Germany alone by 2030.

Not an attractive clientele

However, many interested parties have difficulty finding a doctor who will prescribe PrEP for them. "PrEP users are not attractive customers." The consulting effort is high, there is no corresponding remuneration from the cash register. If Minister Spahn gets to grips with his head, that should change soon. Schafberger recommends that interested parties, meanwhile, turn to regional AIDS -Consultation centers: “They usually know who is prescribing PrEP for them”.

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