Scott Wiener, a member of the San Francisco Board of Supervisors, made an unusual public announcement on Wednesday: He takes Truvada, a daily antiviral pill, to greatly reduce his risk of contracting H.I.V. 
 
 Taking the pills is a practice known as pre-exposure prophylaxis, or PrEP, and some researchers believe it may reduce the risk of infection by 99 percent if patients take their medication daily as prescribed. Approved by the Food and Drug Administration in 2012, PrEP has increasingly been embraced by public health authorities and is one of three planks of Gov. Andrew Cuomo’s plan in New York to sharply cut new H.I.V. infections. 
 
 But it carries a stigma in some parts of the gay population, and Mr. Wiener appears to be the first public official to disclose that he’s personally on it. ||||| Each morning, I take a pill called Truvada to protect me from becoming infected with HIV. This strategy, also known as pre-exposure prophylaxis, or PrEP, reduces the risk of HIV infection by up to 99 percent if the pill is taken once a day. This makes PrEP one of the most effective HIV-prevention measures in existence. After consulting with my physician, I went on PrEP to further protect and take personal responsibility for my health. I'm HIV-negative, and I want to remain that way. 
 
 I recently decided to be public about my use of PrEP in order to raise awareness about this relatively new tool for preventing HIV. It's important to encourage people at risk for HIV to talk to their medical providers about all the tools and methods available for preventing infection, including PrEP, and to choose the methods that are best for them. 
 
 As an elected official, disclosing this personal health decision was a hard but necessary choice. After all these years, we still see enormous stigma, shame, and judgment around HIV, and around sexuality in general. That is precisely why I decided to be public about my choice: to contribute to a larger dialogue about our community's health. I have the honor of representing a district that includes the Castro -- ground zero for the HIV epidemic. I represent a community that has been profoundly impacted by HIV, with a large number of HIV-positive people -- nearly one in four gay men in San Francisco is HIV-positive -- and an even larger number of people at risk of becoming positive. As an elected official in this role, I have an obligation to do everything in my power to support those living with HIV, increase public awareness about effective HIV prevention, and reduce stigma and shame. 
 
 My journey to PrEP was a long one. I came to terms with myself as a gay man when I was 17 years old in 1987, at the height of the HIV epidemic. Many gay men were getting sick and dying. Like many in my generation, I came of age associating sex with illness and death. That association -- with all the fear, anxiety, guilt, and shame that go along with it -- is still very real for many of us. 
 
 As time has gone by, I've seen people become healthier, and I'm continually in awe of those who have survived the epidemic and thrived. Yet new HIV infections continue -- 50,000 annually in the U.S., and over 2 million annually worldwide. Despite all our prevention efforts, I continue to know people who've remained HIV-negative for 20 or 30 years, only to become HIV-positive. I regularly meet young men, some barely out of high school, who have the virus. 
 
 None of this is preordained. People don't need to continue to get infected, and we know that PrEP has the potential to help stop the epidemic in its tracks by ending new HIV infections. It's one pill a day, with few side effects for most people. 
 
 Condoms remain critically important for HIV-prevention efforts, but they have their limits, as demonstrated by the continuing new infections after 30 years of robust prevention efforts. Only one in six gay men uses condoms consistently and effectively enough to be fully protected from HIV. For those who do use them consistently, condoms offer significant protection but have a failure rate, and condom usage among gay men reduces HIV risk by 76 percent, not 100 percent. 
 
 Given the challenges many gay men have with consistent condom use as well as the continued risk of HIV transmission even for those who use condoms, PrEP provides a powerful additional level of protection. It's not a question of either condoms or PrEP. It's about both important tools. 
 
 PrEP has broad support in the public-health community. The World Health Organization and Centers for Disease Control and Prevention have recommended its use by those at risk for HIV, including gay men. The state of New York and the San Francisco Department of Public Health have adopted PrEP as a core prevention strategy. The HIV advocacy community overwhelmingly supports PrEP. Most insurance companies cover it fully despite its considerable cost, precisely because it is so effective at preventing a serious illness for which there is no cure. 
 
 Some aren't sold on PrEP. Skeptics question whether people will adhere to a daily pill, which is a legitimate concern. Protection decreases if usage is inconsistent. This challenge can be overcome with effective education, and drug adherence is a challenge that isn't unique to PrEP. 
 
 Some critics also view PrEP as a license for people to engage in risky behavior and assert that it will cause non-HIV sexually transmitted infections to increase. No study to date has shown that those using PrEP increase risky behavior -- such as reducing condom usage compared with before using PrEP -- and there is evidence to the contrary. Indeed, this line of thinking -- that promoting an effective prevention method will lead to irresponsible behavior -- resembles some of the phony arguments used to attack the HPV vaccine by suggesting that getting vaccinated will lead young girls down a path to promiscuity. And, since PrEP users are regularly screened for HIV and other sexually transmitted infections, PrEP use will increase opportunities for prompt detection and treatment of STIs. 
 
 PrEP isn't only about gay men. Women can benefit tremendously from it as well. Many women are using PrEP to conceive a child with an HIV-positive partner, a new approach dubbed "PrEP-ception." PrEP can also protect women (and men) in abusive relationships. Too many women -- and gay men as well -- don't fully control how or when they have sex, whether their partners use condoms, and what risks their partners are taking elsewhere. People facing these challenges can take control of their infection risk -- and essentially eliminate that risk -- by using PrEP effectively. 
 
 In addition to lack of education and stigma, another significant barrier to fully realizing PrEP's potential benefits is lack of access. PrEP isn't cheap, and for the many people who are uninsured or underinsured, cost can effectively deny access. PrEP needs to be easily available to all communities and all income levels through public healthcare programs, including Medicaid. Otherwise we risk accentuating health disparities among our diverse communities. 
 
 Many people and organizations have gotten us where we are with PrEP. The University of California San Francisco is responsible for some of the earliest clinical studies of PrEP, and organizations like San Francisco AIDS Foundation, Project Inform, and the AIDS Vaccine Advocacy Coalition have been working on the front lines to ensure that the promise of PrEP is fully realized, including advocating for FDA approval, helping establish expanded access programs from the drug manufacturer, ensuring PrEP is covered by insurance plans, and disseminating information to consumers and clinicians. 
 
 We know how to end HIV infection. We simply need the political will to ensure that the community has accurate information about and access to all prevention methods, including PrEP. I hope my disclosure can play a role in moving us toward these goals. 
 
 Scott Wiener is an elected member of the San Francisco Board of Supervisors. For more information, visit scottwiener.com. ||||| Bloomberg News 
 
 Healthy people at risk of HIV are advised to take daily pills that cut the odds of infection by more than 90 percent, U.S. health officials said in the first formal recommendation on using the drugs as a preventative. 
 
 The group urged to take the pills includes people with HIV-infected partners and those who inject illicit drugs and share equipment, or have been in treatment programs for injection medicine use, the Centers for Disease Control and Prevention said in a statement. Gilead Sciences Inc. (GILD:US)’s anti-AIDS pill Truvada has been approved as a preventative medicine for the virus that causes AIDS. 
 
 Also advised to take the medicines are heterosexual men or women who don’t always use condoms with at-risk partners and gay or bisexual men who have sex without a condom or aren’t in mutually exclusive relationships with partners testing HIV-negative, the agency said. 
 
 For HIV, “there’s no vaccine and cure in the near horizon. Prevention is key,” Jonathan Mermin, director of the CDC’s national center for HIV/AIDS, Viral Hepatitis, STD and TB prevention, said in a telephone interview. 
 
 The strategy of using the pills, call PrEP, or pre-exposure prophylaxis, is a step toward combating the AIDS-causing virus that infects 50,000 new patients each year in the U.S. Gilead’s Truvada was approved for sale by the Food and Drug Administration in 2012 to be used as a prevention regime with safe sex practices and regular HIV testing. 
 
 ‘Life-Saving Tool’ 
 
 “It’s a potentially life-saving tool,” Mermin said. Fewer than 10,000 people are prescribed the drugs for prevention while about almost 500,000 are eligible. 
 
 Mermin said the CDC wants its new guidelines to help promote mass distribution of the HIV medicine. The agency is working with other health organizations to conduct pilot programs to demonstrate the effectiveness of the approach. The recommendations follow interim guidelines on the prevention strategy issued in August 2012. 
 
 Truvada, a combination of two drugs from Gilead, is usually covered by insurance, Mermin said. 
 
 The medicine generated more than $3.1 billion in sales last year for Foster City, California-based Gilead, the world’s largest maker of HIV medicines. 
 
 While the drug costs about $15,000 a year in the U.S., “it is important to note that those taking Truvada for PrEP may not take it for an entire year,” Cara Miller, a Gilead spokeswoman, said in an e-mail. The company also assists patient who need the medicine but aren’t covered by insurance, she said. 
 
 Cost Factor 
 
 For many, cost is an inhibiting factor in using the medicine as a preventative, said Victoria Richards, associate professor of medical sciences the Frank H. Netter School of Medicine at Quinnipiac University in North Haven, Connecticut. 
 
 “In other countries, companies have reduced the cost of the medication, and that’s where research is coming from,” Richards said in a telephone interview. 
 
 A push for the drug “on this type of a scale with the CDC involved, there might be some type of mechanism in place to alleviate the cost of the medication,” she said. 
 
 The AIDS Healthcare Foundation, a Los Angeles-based nonprofit group that provides medical care to more than 300,000 patients, said they oppose the recommendation. The group said it could lead to a decline in use of condoms, which can prevent the spread of other sexually transmitted diseases. 
 
 There also is a concern that patients won’t take the drug as directed, the group said in a statement. 
 
 “This is a position I fear the CDC will come to regret,” AFP president Michael Weinstein said in the statement. 
 
 ‘Catastrophic Consequences’ 
 
 By making the recommendation, “the CDC has abandoned a science-driven, public health approach to disease prevention —- a move that will likely have catastrophic consequences in the fight against AIDS in this country,” Weinstein said. 
 
 The FDA and CDC urge HIV testing before prescribing the drug as a preventative and at three month intervals while using the medicine. If patients contract HIV, they should discontinue using the drug, or else risk that the virus becomes resistant to the treatment. 
 
 The CDC’s Mermin said the agency will roll out pilot programs in four cities -- Chicago, Philadelphia, Houston and Newark, New Jersey, -- that have federally qualified health centers in areas with high HIV rates. 
 
 “It is not a magic pill,” said Princy Kumar, professor of medicine and microbiology at Georgetown University and chief of infectious diseases at MedStar Georgetown University Hospital in Washington. 
 
 Taken Daily 
 
 “It’s one more intervention that’s shown to work,” she said. “And it works well provided that it is taken every day” and in conjunction with safe sex practices, consistent counseling, and with the population at high risk of contracting the disease. Because the drug has to be taken each day for years and years, it can be difficult to administer, she said. 
 
 Kumar said the most significant side effects of the drug are weakness of bones in healthy people over a period of time, and renal issues in people with underlying ailments including diabetes or hypertension. 
 
 A number of physicians are hesitant to prescribe the medicine as a preventative because of associated risks, according to a December study by the National AIDS Manual. 
 
 “There’s potential to adverse effects with any medication,” Mermin said. “The two drugs that are used in PrEP are very safe medicines. Most people have no side effects even after taking it daily for year,” according to studies that informed the CDC’s recommendation. 
 
 “PrEP has the potential to alter the course of the epidemic,” he said. “Having these guidelines come out now will hopefully prevent thousands of people from getting and spreading a potentially fatal disease.” 
 
 To contact the reporter on this story: Sonali Basak in New York at sbasak7@bloomberg.net 
 
 To contact the editors responsible for this story: Reg Gale at rgale5@bloomberg.net Andrew Pollack, Bruce Rule
– A San Francisco official looks to be the first public figure in the country to "come out of the PrEP closet," as he puts it in a piece for the Huffington Post. Scott Wiener—who represents a district he calls "ground zero for the HIV epidemic"—says he takes the daily antiviral pill Truvada to lower his risk of contracting HIV. He's urging other gay men to do the same. "A much larger segment of gay men should be taking a close look" at what's known as pre-exposure prophylaxis, Wiener tells the New York Times. Truvada as PrEP has been very slow to catch on across the country, which Wiener writes sees 50,000 new HIV infections each year. Researchers say PrEP could reduce the risk of HIV infection by up to 99% if taken as prescribed. The World Health Organization made a similar case to Wiener's this summer, but the San Francisco Chronicle calls Wiener's announcement "significant because so few people have been willing to talk openly about their use of Truvada." Though the drug's list price is just over $1,000 a month, Wiener says PrEP is covered by most health insurers (he personally pays $15 a month). For the uninsured or those with high-deductible plans, however, the price can be a problem. Wiener's colleague, David Campos, says he will ask the city's health department to develop a strategy that "addresses the educational and affordability issues" by December. "We have to start somewhere," says Campos, who adds that every prevented infection saves $355,000 in treatment costs.