A few weeks ago, Steve Weinstein, editor-In-Chief of the Boston-based Edge, commented on “Disco dosing”, the alleged Gay-men practice of taking a cocktail made of a psychostimulant, methamphetamine, an antiretroviral, Tenofovir, and a drug used to treat pulmonary arterial hypertension Viagra, better known for its ability to correct erectile dysfunction, before going clubbing. Such mix even has a name: “MTV”.

Disco dosing has been around for years. It was reported that Gay men were taking the antiretroviral Tenofovir before going on the prowl for the weekend and enjoy unprotected sex, hopping that the drug will protect them pre-emptively against any HIV virus they may come into contact with. In 2005 the LA Times wrote:

“Taking a T.” That’s what HIV-negative gay men call the growing practice of downing the AIDS drug tenofovir and, with fingers crossed, hoping it protects them from the virus during unprotected sex. It’s being sold in packets along with Viagra and Ecstasy in gay dance clubs — and even prescribed by physicians, say doctors and AIDS prevention experts. The trend has alarmed public health officials.”

Then, a survey conducted at gay pride events in four cities by the U.S. Centers for Disease Control and Prevention found that “7% of uninfected men had taken an AIDS medication before engaging in risky behavior and that about a fifth had heard of someone who had.”

Meanwhile and possibly with delay, the medical and scientific community has adopted the approach under the name of PrEP: Pre-Exposure Prophylaxis.

Both Viagra and Methamphetamine have well described properties and known effects but what about the prophylactic use of antiretrovirals for HIV prevention?

The idea that taking an antiretroviral before being exposed to the HIV virus could protect against infection dates back to the early 90s when it was shown that Zidovudine could reduced the risk of mother to child HIV transmission by approximately two thirds the in pregnant women with mildly symptomatic HIV disease. Since then, Prevention of Mother to Child transmission (PMTCT) is commonly carried out with a combination of AZT and nevirapine in resource limited settings and has been endorsed by the WHO, but not by the FDA (another of these tickling incongruity).

However, there to date no evidence that Tenofovir taken before unprotected sex could protect against HIV. In fact there are currently several clinical trials in preparation which purpose it to test this hypothesis. A few years ago such clinical research was the object of a serious debate when a trial of daily Tenofovir in Cambodian sex workers had to be cancelled under the pressure of ill-informed AIDS activists.

To date, only one trial has been completed in Ghana, four have been cancelled, and seven are planned in the forthcoming years, all detailed and tracked by the useful PrEP Watch website.

The jury is not out yet; it has not even been convened, so let’s focus on the other component of the MTV cocktail.

“Meth” is a a psychostimulant that increases sexual drive but can also cause impotence, hence the need to take Viagra to counteract this embarrassing side effect. Meth and Viagra are a dangerous cocktail for the health of the party goer. Meth alone, or in combination with Viagra, has also been associated with an increase in unsafe sex practice, hence an increased risk of HIV infection. Though data about Meth use amongst MSM are inconsistent, its effects on sexual behaviour are well known and characterised.

There are complex and multiple reasons why men and in particular but not exclusively Gay men, use these cocktails of drugs and they might boiled down to the necessity to perform sexually, especially after hours of jumping up and down in a night club. But a parallel with the Disco Matanga springs to mind. Psychotropics, drugs or alcohol are used along or to facilitate sex, leading to unsafe sex practices and further spread of the HIV epidemic as a consequence.

Drug use amongst gay men is still a problem and not merely because it affects the user’s health but because it is linked to an increase in unsafe sex acts. As such, drug use is rarely part of HIV prevention intervention that tends to focus on either one or the other, as if they were two different and unrelated issues.

HIV prevention is changing, and in the process needs to be much more comprehensive and aggressive when it comes to messaging. There has been a trend during recent years to abandon the finger waving approach for that of providing information because it was believed that when faced with a difficult choice, well informed people would take the right decision, make the right choice. There is little evidence of this happening. Education may provide people with a choice but not with the will to take the right decision. And how strong is the will when under the influence of psychotropic drugs?

In Africa young people are being infected during disco funeral because they know little about HIV and because alcohol make them more vulnerable to HIV. In the developped World, well informed men under the influence of a different kind of psychotropes are not behaving any better whilst partying over the weekend. In both case a deadly virus has found a way to spread by exploiting its host behaviour.

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