peru. >> there is more on the perils of climate change on our website. we've got all the day's news and all the latest on sport. that's at our www.aljazeera.com we. . >> for years the struggle to limit the spread of h.i.v. was to change people's before. does the use of a preventative drug treatment challenge the tech aids of hard work. it's inside story. >> i'm

ray suarez. the word went out people can stop the spread of the virus that causes aides in its tracks by stopping the behaviour that caused the infection. use condoms when having sex, don't sir needles, limit the number of sex partners because in terms of infectious disease, you were having sex with every partner the other person can have. the pharmaceutical resolution is now moving to prevention. this profill axis unravelled a message delivered - play safe. >> three years ago nicholas life. >> i had put myself at risk. i emily learned and was with a friend, and i learned

that they didn't disclose . with a new awareness of what engaging in risky behaviour could be. >> i was devastated. that's the one word that describes it. he takes a daily peel called truvada, which he says protects him feeling that fear again. the pill is part of a programme called prep or pre-exposure profill axis. the center for disease control say prep reduces the risk of h.i.v. by 92%. >> where preexposure profill axis is helpful, it presents the initial infection. it doesn't get into the cells, it's on the surface of the cells by the drug. >> the prep programme includes taking truvada every day and

checking in with a doctor. a year of truvada costs 13,000. most insurers cover the drug. an estimated 4,000 people who it. >> the doctor is a clinical research director at a clinic serving the gay committee. he said prep's adoption could be epidemic. >> in washington d.c., they have the highest prevalence of h.i.v. in the united states. we are shy of 3% overall of the population, higher than some rates of countries in africa. if you are african american and have sex with men and are between the ages of 20 and 40, your chance of having h.i.v. is one in five. >> gay health advocates centered efforts on promoting condom use and awareness of status.

in the 1980s, when contracting h.i.v. was a death sentence, it worked. 30 years later medical professionals are skeptical about promoting prep. >> we may lose the skills if we say we don't have to have the conversations any more. prep may quiet our conversations with each other. our discussions around sex, because why bother if everyone is just h.i.v. positive, and taking their medications as they should, or negative and taking their prep. in a way, it could be viewed as an excuse to not take responsibility for our actions. >> a lot of that worry stems from what many in the gay community attribute to a generation gap or an experienced gap where today's young people have no idea what it was like to go through the early days of the h.i.v. crisis much. >> we have a major crisis in the united states, specifically in

youth. in youth we have about 18% of people who are h.i.v. positive, status. >> earlier this month the washington d.c. lbgt community center tried to bridge the gap by offering a photoshoot to anyone tested by h.i.v. many don't know their status. every year there's an estimated 50,000 now cases of h.i.v. in the united states. >> you know, youth thing differently to what we did. in my generation, if you were 10 years old, as a 28-year-old we have never seen it. we changed our behaviours because of fear of dying. >> i have seen friends sick but never die from h.i.v. >> darron ward chose to take truvada. >> there's angst about

supporting true vardo or prep, because of seeing friends die, not wanting to see that. we have to recognise we are in a different space and have to evolve with the time. >> he knows he lives and dates in a community with some of the highest h.i.v. infection rates. >> i know the statistics not just from a place where i read them on paper. but those are my friends, people in my network. community. at this point in my life i know more men positive. >> he tands meetings at a drop-in center, where he talks with others about tough topics recording sexuality. >> i identified in that days, wow, that's how i felt.

we talked of the conversation being for or against prep. we should talk about giving people voices and access to drugsal means -- access to traditional moons. this is an opportunity to take responsibility for my own sexual health and for those using prep, taking responsibility for their own sexual health and not place the burden or their sexual health in someone else's hands. there could be more than half a million new cases this the next 10 years. the question is if wider use of truvada will slow the spread. preexposure profill axis and preventing the spread of h.i.v.

does it encourage ricky behaviour by removing the danger of contracting the virus or is it an insurance policy for life in the real world, where moralizing won't stop real people making less than real choice the. >> whitneyins us for that conversation, from the aides health care foundation. justin, director of community relations at the whitman walker health clinic in washington d.c. and from new orleans, dion haywood, executive director of women with a vision. given the direction of research, where the dollars were going, where the scientific energy was going, wasn't a preventive met sin one of the next steps, a place we were going to have to anticipate going? >> sure.

we want to find a vaccine and a cure. everyone wanted that. unfortunately vaccine research has not really gotten anywhere and we have not found a quur tore h.i.v. -- cure for h.i.v. >> so is truvada a great weapon in your armament or does it have to about carefully negotiated with an at-risk generation. >> it's not new, but people living with h.i.v., it's an effective tool for those living with h.i.v. the question is whether those not affected by h.i.v. should take the drug. that's something we need to talk about, how we talk to populations about it, the gay communities and all

communities. if you take the pill will you not do other things to protect yourself. discussion. >> you can do other things, but do other things fall by the way side because of human nature? >> the research tells us probably not the case. what you are talking about is risk compensation. there has been the argument that people may use more roirn. and the research shows that risk taking has not changed that. and if condoms work for you, they'll continue to work for you. the counselling around using other preventive strategies has to continue to be a part of someone who is in care, and

prescribed truvada or any other drug that comes along. >> dion, is it a different case with women. are they vulnerable and does it put strength on their side of the table when negotiating the sexual lives. >> when you think of women and prevention part of our concern and what i have heard clients talk about are things that are already a barrier. men women negotiate condom use, some do not. it would be up to the individual of what it would mean. how accessible is it for them. are their living covering -- living conditions in a positive

place where they can take it where needed. >> when you do counselling and introduce prep, do clients say "yes, that sounds like something i would like to try." some of them said "yes, i would like to try", others said, "i'm not stable." if you are homeless, in domestic violence situation, it may be difficult for people to adhere. some are concerned about the side effects to living every day life. they are the things. >> we'll be back with more inside story after a short break. when we return, is preexpercentage prophylaxis medicine promising or to be used with great care.

we are back with "inside story" from al jazeera america. i'm ray suarez. december 1st is world aids day, the world can look back at terrible tragedy, and more than ever triumph. medicines reduced mother to infant transmission and added millions of years to healthy life to infected people around the world. thousands of people are infected with h.i.v. today we are looking at preexposure prophylaxis, drugs that when used by high risk people can stop the spread of h.i.v. justin, what has been the change? as you look back over the last decade in change, of the introduction of anti-reteral virals, that may be a test case

as people take on information and inform. >> we had effective anti-retro virals as far as stopping the virus since the mid-90s. isn't until the mid 2000, that we had regiments of drugs easier to take, and had less side this this this is not going to be the preexposure profill axes of 2015 or 2017. it will evolve and we'll find ways to dose this.

less than once a day is great. an injectable, an injection every three months. we are in the beginning of trying to figure this out as a public health intervention. >> until that world gets here... >> sure. >> what can the way people integrated treatment into their lives tell us about how people will us prep. for instance, did people think "oh, well, if i get h.i.v., i can live with it, it's manageable. it's not as dangerous as i might have thought it was before." that's where people are thinking. i think much of the community doesn't understand what you said. what you said, actually, is the truth of where we are with h.i.v. treatment - that it is a chronic manageable illness if you are engaged in care and treatment. so, first, you have to have awareness, then education, and then adoption and engagement and care.

all of that has to happen with preexposure profill axis, we are at the beginning of that. they are the most effected communities that can use of intervention, and almost have no awareness that this exists. >> dion haywood, unfortunately the way americans thing about h.i.v. and aids is stuck in past decades. they don't thing of it as a small town or southern or rural disease. what should people know in 2014 about not l.a. and chicago and new york and san francisco and miami, but makin and victims burg and huntsville - what is different about being h.i.v. positive or trying to keep yourself from becoming positive in those places? >> you know, here in the south many of us, i am sure you have heard of social determinative

heads. if you are in a rural area people have access, it's hard to get where you need to go. we have the government that hasn't accepted medicated expansion. all the things, poverty education, unemployed are oisht and contribute to people being h.i.v. and make it hard for people that are h.i.v. hard to access services. the criminal justice system plays a large part. the fact that we have not adopted problems throughout the south, making it difficult. >> the social profile that you

laid out. when we talk about true vard area, it's expense -- truvada, it's extensive, but we have a population at risk of infection. where does prep fit in? >> i'm not sure. h.i.v. continues to be something where those at the bottom have a hard time accessing medication, getting to the doctors appointment and fitting it in with every day life. there'll be people who are accessing it easily. and there'll be people some of the same things, around who has access to the best medication and care.

i have clients that can't afford medication, so they can take it. a part of the anti-retro viral cocktails. i think if we don't do more about changing some of the systematic issues that put people, or assist h.i.v. numbers in the south, i don't know if much will change. >> help us out here. if this is not a silver bullet, and we agree it's not, are there populations where it's an ideal answer, where it may be introduced first, as a way of piloting this, and lampg lessons before moving forward. if you are right now not h.i.v. positive but you are sexually truvada.

>> i think it's possible preexposure profill axis may work in the future, but having to take 365 pills doesn't seem to be a good idea. as an example, i think it was mentioned earlier, you know, that anti-reter ill virals have been around. many on treatment are virally suppressed, which means there's no detectible virus in the blood. we have to work on the idea, think about your open lives, and whether you take all the dosage. so i think if we look at an injectable, if there are other interventions, we can't just throw out - we can't throw out condoms or the things we know work, and get a good number of people safe for many years because we have this truvada as

prep. it's terribly expensive, as you mention. we need to have a conversation as a community about how we are company. >> we'll be back with more inside story when preexposure profall abbing ticks are used in a wealthy country, it can make financial sense because aids is expensive to treat. dollars and cents, justice and fairness. does geography and bad luck mean >> i'm ali velshi, the news has become this thing where you talk to experts about people, and al jazeera has really tried to talk to people, about their stories. we are not meant to be your first choice for entertainment. we are ment to be your first choice for the news.

you're watching "inside story" on al jazeera america. oum ray suarez. we have been talking about developments in drug treatment around h.i.v. prevention over the last three decades. health workers have tried to get people to reduce behaviours that spreads the virus that causes outside. the preexposure drug is expensive. does that mean for the world's poor, the public education

doesn't change: whitney is with us, senior director. public health division at the aides health care foundation to los angeles, jason, director of community regulations at whitman walker health in washington d.c. and new orleans, dion haywood, executive director of women with a vision. you mentioned that you work with populations that may not have reliable access to health care. they may resemble people in much of the rest of the world, in latin america, asia, africa. do you anticipate the cost of the drugs will come down, and until it does, whether there'll be a social justice dimension to the introduction of truvada? >> i'm hoping it does. as the stands, the majority that we see, it would not be available to them if it

doesn't. in terms of social justice, we realise that we have to think of h.i.v. as a social justice issue, the right to health care and sex education, the right to prevention programs that fit individual communities, instead of a one-stop shop in making sure that we hold elected officials and health departments responsible for the type of getting. >> before the black, you called out gilliad, the company responsible for developing the drug. what has worked in the past, aides drugs have come down. can't we expect that truvada would do the same. >> it's come down a lot in the developing world. the same drug that you are talking about costs less than $500 in an african nation for a

year. it really is outrageous that we pay this sum. gilliad has made the money, it has its research. they could charge $1 a pill, and it would be okay. it's kind of the state of our affairs that we are not really pressing on them. to lower the price. and rather they'd like to see communities. >> anyone that watched the programme can conclude that we are not home, that truvada is not the answer to anything. does it bring an exciting possibility in its use for uninfected people. that is a bridge on the way to someone else. >> it's exciting. those that work in community health and public health, it's endumb want to figure out who this is a good intervention for.

the data on the effectiveness of if you take it as described is extraordinary. we don't get the data in public health. years of condom research, if used consistently. if you use truvada consistently we are talking 90th percentile effectiveness around h.i.v. this is exciting. around the financial issue, i'd did he have dovz like to say... did he have dovz >> very quickly. >>..gill yard has a good programme. ...

this is al jazeera. ♪ >> a warm welcome from me, david foster. you are watching al jazeera news. good to have you along. these are stories we will look at in detail in the next 60 minutes. a million and a half syrian