As I type tonight, somewhere in New York City Frank Ocean is presiding over an exclusive queer party in an undisclosed location. The event is called "PrEP+" after PrEP, the acronym for pre-exposure prophylaxis, the newly-mainstream practice of people at high risk of contracting HIV taking the anti-retroviral drug Truvada on a regular basis to prevent infection. PrEP works, remarkably well; Ocean's press release claims use of the acronym to pay "homage to what could have been of the 1980s’ NYC club scene if the drug.... had been invented in that era".
My first reaction was that this sounds like a very cool party. My second reaction was to see if I could make a WI out of this. Could PrEP have been invented in the 1980s?
It actually is just barely imaginable. At least as early as 1990, the Centers for Disease Control had suggested that people who suffered occupational exposure to HIV--needlesticks and the like--should consider the use of AZT to prevent themselves from becoming infected with HIV, getting on a regular schedule of doses as quickly as possible to keep HIV from getting a foothold. Over the 1990s, this preliminary and almost improvised use of anti-retroviral drugs matured into the established practice of post-exposure prophylaxis. From that point, it was only a short distance towards the idea of taking anti-retroviral drugs before possible risky encounters.
Against this, the state of knowledge of HIV and HIV treatment was decidedly poor. Doctors had barely gotten the news that retroviruses could cause disease among human beings before the first cases of AIDS began being noticed in North America and western Europe in the very late 1970s. AZT did work, but for too short a time as the early 1990s Concorde study demonstrated, HIV nimbly mutating around the use of a single medicine with a single mechanism of action. The costs of producing AZT, meanwhile, made its use something only the very lucky, and the very desperate, could use. Since AZT was, for years, the only medicine acting directly against HIV, this means the idea of PrEP would have been unimplementable even if it had been imagined.
This brings me to two questions.
My first reaction was that this sounds like a very cool party. My second reaction was to see if I could make a WI out of this. Could PrEP have been invented in the 1980s?
It actually is just barely imaginable. At least as early as 1990, the Centers for Disease Control had suggested that people who suffered occupational exposure to HIV--needlesticks and the like--should consider the use of AZT to prevent themselves from becoming infected with HIV, getting on a regular schedule of doses as quickly as possible to keep HIV from getting a foothold. Over the 1990s, this preliminary and almost improvised use of anti-retroviral drugs matured into the established practice of post-exposure prophylaxis. From that point, it was only a short distance towards the idea of taking anti-retroviral drugs before possible risky encounters.
Against this, the state of knowledge of HIV and HIV treatment was decidedly poor. Doctors had barely gotten the news that retroviruses could cause disease among human beings before the first cases of AIDS began being noticed in North America and western Europe in the very late 1970s. AZT did work, but for too short a time as the early 1990s Concorde study demonstrated, HIV nimbly mutating around the use of a single medicine with a single mechanism of action. The costs of producing AZT, meanwhile, made its use something only the very lucky, and the very desperate, could use. Since AZT was, for years, the only medicine acting directly against HIV, this means the idea of PrEP would have been unimplementable even if it had been imagined.
This brings me to two questions.
- Was it conceivable that the knowledge of retroviruses among human beings, and the treatment of said, could have been substantially more advanced. Were there obvious pathways that were overlooked? (People with biomedical backgrounds, please get involved.)
- If the scenario imagined in Ocean's press release did materialize, with anti-retroviral treatments appearing in the 1980s capable of treating the infected and limiting the spread of HIV to the uninfected, what sort of impact would this have had? A HIV that was both known and uncontrolled for only ten years, or five years, would have had a decidedly different impact on pop culture than in OTL. Might this translate into greater confidence in science, for instance? The impact elsewhere, for instance on the NYC club scene, of an apocalypse cut short would also be noteworthy.
