Professor Bob Grant has been one of the world’s leading HIV/AIDS researchers for over 30 years with his development of PrEP revolutionising the way we look at HIV prevention and saw him named as one of Time Magazine’s 100 Most Influential People. QNews sat down with Professor Grant during his recent trip to Australia to learn more about his work.
Having been at the forefront of HIV research for almost the entire epidemic and seen many breakthroughs, where would you place PrEP on the importance of everything?
When I look back on more than thirty years in HIV-AIDS research I think there’s three really powerful moments. One was really the clear identification of HIV as the cause of AIDS in the early 80s, the other moment was in 1996 when we realized that combination and anti-retroviral therapy would prolong life indefinitely, and now I think that PrEP is in that realm. It portends the end of HIV transmission and that that has been the goal of my career.
Take us through the thought process of you and your researchers in developing PrEP.
I think the idea really started with post-exposure prophylaxis. In the mid 1990s we saw some research in animal models, namely monkeys, that showed that even started 72 hours after viral exposure, post-exposure prophylaxis could prevent animals from becoming infected. A series of research projects were done that made it pretty clear that that also could work for people.
Pre-exposure prophylaxis is different. And we designed it this way. It’s intended to be proactive, it’s intended to foster a sense of agency in people where they plan for what they want from sex and what they want from their connection with other people. People then build PrEP into those plans and as such, people have time to think through HIV and sex in calm moments before the heat of the moment.
What was the roll out of PrEP like in the US?
We first published that PrEP was safe and effective in the end of 2010. It was approved by the regulatory agency in 2012, and PrEP’s demand really started to take off the end of 2013 after this period of stigma dissolved and people using PrEP were able to stand up and say, look I’m doing the responsible thing, I’m protecting myself and my lovers and the community. So once people started to say that, demand for PrEP started to expand in the middle of 2013.
By the end of 2014, 10-15% of gay men in San Francisco were already using PrEP. The people who had the most to benefit from it were using it the most. What we saw over that period of time is that the number of new infections decreased 30%.
I know you’ve only been in Australia a short while, but what are you thoughts of the state of HIV prevention in Australia at the moment?
I’m happy that there are leaders in Australia who are embracing PrEP as an opportunity to end HIV transmission. I think that is the next big step for Australia. The number of new diagnoses every year has stayed relatively stable over the last three years, and some may say that’s good enough… but I really enjoy hearing Australian leaders say that’s not good enough! So I think Australia is poised to become one of the first countries, if not the first, to end HIV transmission.
Predicting the future is always fraught with danger, but as someone who has watched the epidemic unfold, what do you envisage will be happening in the foreseeable future?
On the one hand I think that we could have just an ongoing sense of complacency, that HIV wherever it is is contained enough and let’s just continue to survive, because there are times when survival is enough. On the other hand I can imagine a movement that says it’s time to end HIV, not just tolerate it but end it. And end it in a way that doesn’t sacrifice our desire and celebration of human connection. It could go either way but who knows?
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