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Janet Weinstein/Inside Story/Al Jazeera America

How a daily pill is reshaping the fight against HIV infection

Taking Truvada can cut HIV infection risk by 92 percent, but some doctors fear its adaption will lead to more unsafe sex

Three years ago, Nicolas Gourdine had the scare of his life.

"I had put myself at risk by having unprotected sex," he said. "Someone I deemed a friend didn't disclose their HIV status, and I learned they were positive. And I learned it sometime after."

Gourdine ended up testing negative for HIV, but the experience left him shaken and with an awareness of what engaging in risky behavior could mean. "I was quite alarmed, quite concerned … devastated," he said.

Now he takes Truvada daily, which he says protects him from ever feeling that fear again.

The pill is a part of a program of pre-exposure prophylaxis (PrEP). The Centers for Disease Control and Prevention says PrEP, if properly followed, reduces the risk of HIV infection by 92 percent. PrEP includes taking Truvada every day and checking in with a doctor every three months.

"Where pre-exposure prophylactic is so helpful is that it prevents that initial infection," explains Dr. Richard Elion, clinical research director at Whitman Walker Health in Washington, D.C. "HIV doesn't get into cells. It's met on the surface of the cells by the drug."

A year of Truvada can cost about $13,000, but most health insurers cover it. An estimated 4,000 people who are HIV negative regularly take the drug.

Elion says PrEP's adoption, especially in a high-risk population like Washington, could be the answer to the city's HIV epidemic.

"Washington, D.C., has the highest prevalence of any … city of HIV in the United States," he said. HIV-positive residents are "a bit shy of about 3 percent, overall, of the [city's] population — which is higher than some rates of countries in Africa."

"If you're an African-American man who has sex with men and you're between the ages of 20 and 40, your chances of having HIV is 1 in 5," he added.

Janet Weinstein/Inside Story/Al Jazeera America

“I had put myself at risk by having unprotected sex. Someone I deemed a friend didn’t disclose their HIV status, and I learned they were positive. And I learned it sometime after. I was quite alarmed, quite concerned ... devastated.” — Nicolas Gourdine, PrEP patient

For decades, gay health advocates have centered efforts on pushing condom use and awareness about HIV status. In the 1980s, when contracting the virus was essentially a death sentence, that message largely worked. Now, 30 years later, some medical professionals are skeptical about promoting PrEP.

"PrEP, in fact, may quiet our conversations with each other around sex because why bother if everyone is just either HIV positive and taking their medications as they should or negative and taking their PrEP?" said Dr. Dan O'Neil, a second-year resident at George Washington University Hospital. "In a way, it could be seen as an excuse to not take responsibility for our actions."

A lot of that worry stems from what many in the gay community attribute to a generation gap, with today's young people simply having no idea what it was like to go through the early days of the HIV crisis.

“We have a major crisis going on in the United States, specifically in youth," said Dr. Gary Blick, a co-founder of World Health Clinicians. "In youth, we have about 18 percent of people who are HIV positive and they don’t know their status."

Earlier this month, the Washington LGBT community tried to bridge this gap by offering a free photo shoot to anyone who got tested for HIV, because many young people in the capital don't know their HIV status or have protected sex. Every year there are an estimated 50,000 new cases of HIV in the U.S.

"You know, youth think a whole lot differently than we did in my generation," said Blick, who co-founded the event. "If you were 10 years old in 1996, well now as a 28- or 29-year-old, you’ve never seen that death and dying. We changed our behavior [by using condoms] because of a fear of dying."

Devin Barrington-Ward says one of the reasons he chose to take Truvada is that he knows more HIV-positive men than negative.

Devin Barrington-Ward, 24, has chosen to take Truvada. "I've seen friends get sick, but I've never seen a friend die of HIV," he said.

As an African-American gay man, he says he can see the skeptics' side. "I think because that trauma [of the early HIV crisis] is oftentimes not dealt with appropriately, there is some angst about supporting something like Truvada or PrEP just because of they've seen so many of  friends die off."

"But we have to recognize we're in a different space of the epidemic and we kind of have to evolve with the times,” Barrington-Ward added.

He knows he lives and dates in a community with some of the highest HIV infection rates in the country. "At this point in my life, I do know more men who are HIV positive than are negative," he says.

Every week he attends meetings at the DENIM (Developing and Empowering New Images of Men) Collection, a community center where he talks with other African-American gay men about tough topics like sexuality.

"When we're talking about the conversation of being for or against PrEP, I think that's the wrong frame. We really should be talking about giving people choices and access to additional needs of prevention," he said.

"We can't hold gay men to a standard we don't hold heterosexual people to, which is that fact that people don't use condoms 100 percent of the time."

Barrington-Ward works as a public health advocate full time, so he says he can see the bigger picture. "[Taking Truvada] is an opportunity to take some responsibility for my own sexual health ... and not place that burden or put that responsibility in someone else's hands," he said.

At the current rate of HIV infection, there could be more than half a million new cases in the United States in the next 10 years. The question is whether wider use of Truvada and PrEP would help slow the virus' spread.

On this edition of Inside Story, our host Ray Suarez asked the following on-air panel of experts for their views on Truvada and PrEP.

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