AUDIE CORNISH, HOST:
The FDA has approved a pill called pre-exposure prophylaxis, or PrEP, that prevents the spread of HIV. Its brand name is Truvada. But the Centers for Disease Control cautions against prescribing it freely to adolescents until there's more research. Trials are underway for young people in Los Angeles, New York and other parts of the country. Giving this new drug to teenagers raises some sensitive issues, which Youth Radio's Rafael Johns explores in this report. He begins his story with Leon Richardson, an 18-year-old in Oakland.
LEON RICHARDSON: I was scared. I had to really think about it. Like, what is this drug going to do to me? How am I going to feel after I take it?
RAFAEL JOHNS, BYLINE: Leon is tall, charismatic and thoughtful about his sexual health. He understands that as a young, gay black man, he's in the demographic with the fastest-growing rates of HIV infections in the country. But when Leon learned that he could part of a research study about a daily pill called PrEP that blocks the transmission of HIV, he was skeptical. So was his mom.
RICHARDSON: She told me no. She was saying like - a lot, like - the medical industry tried to sterilize some people, like, they were trying to do it again.
JOHNS: But Leon was encouraged by another family member to join Oakland's HIV prevention study called CRUSH.
RICHARDSON: Well, actually, I talked to my grandfather, and he's HIV-positive, so we had a long discussion about this drug and what the side effects could be and he overall, like, supported me totally. And it was kind of like, why not? Let me just try it.
JOHNS: Currently, the FDA has approved PrEP for individuals who are HIV-negative. And it's covered under most insurance plans. The market for HIV-related drugs and services is lucrative. According to one report, its value is estimated at more than $18 billion a year. In Chicago, Daniel Zeh was 17 years old when he started taking PrEP.
DANIEL ZEH: I guess it was kind of weird during high school, too, like kind of popping it before lunch or something, trying to make sure nobody sees.
JOHNS: Daniel was recruited into the study through Facebook. At Chicago's Stroger Hospital, outreach coordinators also turned to gay hookup apps like Grindr and Jack'd to recruit possible subjects. It's a clever strategy, even if it's awkward to run into a researcher when you're looking for a date. Dr. Sybil Hosek offered to pay participants $50 per visit to the clinic. And when enough guys said yes, the psychologist got to work.
SYBIL HOSEK: What we wanted to do was design a study where they could try to take this pill every day and see whether number one, they were interested in taking it, number two, if it was hard for them to take it, and three, how it impacted their sexual behavior.
JOHNS: For instance, whether kids would take more risks. Some of Hosek's young adult participants have embraced the drug and even started telling their friends about it, like Curtis Lewis.
CURTIS LEWIS: So I say OK, well, PrEP is a pill, an HIV-preventative pill that you would take daily.
JOHNS: Inside a conference room at the hospital, a group of the guys in the study share stories about what it's like to field questions about PrEP.
DEXTER CANTY: You're automatically looked at as being promiscuous instead of safe.
JOHNS: Dexter Canty, who's also on PrEP, says the situation's not that unlike when he goes to the drugstore to buy condoms.
CANTY: Or a female going to Planned Parenthood and getting birth control.
JOHNS: The idea is that PrEP would be used with condoms. But critics worry that the pill will make users feel invincible, increasing the likelihood that they won't use condoms or follow through on taking the pill every day. Andrew Weinstein, president of the Los Angeles-based AIDS Healthcare Foundation, is against PrEP use, especially by young people.
ANDREW WEINSTEIN: Young people have unstable lives. They're sleeping on somebody's couch, you know, they're out for the weekend. You know, and that's not to stigmatize them. It's just the nature of youth is that it's a carefree time. You know, expecting people to take a pill every day is not realistic.
JOHNS: It's enticing to imagine a magic pill that could bring about the end of AIDS. But a recent study of young people taking PrEP shows they take it, at best, 60 percent of the time. And when you miss doses, the pill becomes less effective. For NPR News, I'm Rafael Johns.
CORNISH: This story was produced by Out Loud, a project of Youth Radio.
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