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But doctors worry that others who are at risk for HIV might well put aside their condoms for unprotected sex -- relying on the partial protection of the drug.
The stakes are high in terms of human lives and health costs. Statistics released by the Centers for Disease Control and Prevention in mid-2008 show that in 2006 some 56,000 new cases of HIV infections were reported in the United States, and 1.1 million people have HIV, 25 percent of whom don't know they have it. Worldwide, some 33 million people are infected and 25 million have died of the disease.
Doctors in the trial say they are acutely aware of the possibility the drug may be misused.
"There have been reports that people may be using PreP out in the community even before it was in trial," said Dr. Albert Liu, director of HIV prevention intervention studies at the San Francisco Department of Public Health.
So Liu and his colleagues decided to investigate. They did studies in San Francisco, traveled to large "circuit parties" in Palm Springs, Calif., and San Diego, where gay and bisexual men go to dance and have sex on weekends.
Liu said out of 1,800 men questioned, only 16 percent had heard of using antiretroviral drugs to prevent HIV transmission, and 1 percent admitted to ever trying them on their own.
A similar study of more than 227 men in Boston, from the Fenway Community Health Center, found one person who had tried using PreP in place of a condom.
While those numbers seem low, doctors, HIV activists and public health officials believe that the number of people using PreP as an ill-advised condom replacement would grow with an FDA approval of a PreP regimen.
"The problem with it is the idea of a disinhibitor," said Sean Strub, founder of POZ magazine (www.poz.com/).
"I think of it more in terms of Gardasil and also, even birth control," said Strub. "Virtually every woman who becomes pregnant and did not want to be knows how to avoid it. It's applying that knowledge at the moment of sexual interaction that gets complicated."
Just as with many drugs or treatments that protect against risk, activists and doctors must evaluate whether people will gamble with semi-effective protection and further spread more disease than if they'd never had access to the protection in the first place.
But Strub, who had heard about the possibility of PreP years ago, said the public could also encourage safe-sex advances.
"Quite frankly, it surprises me that people aren't doing this," he said. "Most of the major advances of HIV prevention have not come from the CDC or the doctors or the government. It comes from the community."
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