Out+About: Have you considered PrEP to prevent HIV?

PrEP is a success five plus years out, even though it is not widely talked about. First, what is PrEP? According to the Centers for Disease Control (CDC), pre-exposure prophylaxis (PrEP) is daily medicine that can reduce your chance of getting HIV. Simply put, this daily pill can prevent HIV from spreading. The pill is called Truvada, a two-drug combination in one pill. A doctor prescribes the medication, and it is taken once a day. It is not just for the LGBTQ+ community, but our community benefits from it.

That is amazing. It has genuinely stemmed the transmission in those populations that use it by the guidelines — nearly 100 percent in some studies. Most literature states a success rate of more than 90 percent. But, wow, what a success. It is so effective, it can even prevent transmission from an intravenous injection more than 70 percent of the time.

So where is the problem? Why is it not in the water? There are a few issues. Some known, some not. The biggest barrier is cost, but there are some problems if you have kidney disease or can’t be regularly followed by a doctor with knowledge of the prescribing guidelines. There is also a disparity in use in populations of color, as well as a lingering stigma.

If you had no insurance or assistance, PrEP would cost $2,000 per month. The state of New York has determined it is more cost-effective to make sure it is as close to free as possible and will even cover co-pays, which can be more than $90 a month. Massachusetts has it’s own version of such a plan. According to the Marybeth McCabe, of the Massachusetts Department of Public Health, The Pre-Exposure Prophylaxis Drug Assistance Program (PrEP DAP) was established in 2016 to ensure that individuals at high risk for HIV infection who could benefit from the intervention did not face financial access barriers. And to date, 197 clients have been enrolled in PrEP DAP. The median age of PrEP DAP enrollees is 35 years, and more than half of enrollees are black or Latino. The fact that more than half of enrollees are people of color is quite encouraging, since the CDC’s national statistics state that people of color are significantly less likely to be prescribed or take PrEP. In addition to the state funded PrEP DAP, the makers of Truvada also have a need-based assistance program that is useful as well.

Another barrier is a health risk if you already have kidney disease. The other health related barrier is finding a provider who is competent is prescribing Truvada. Most people must see an infectious disease specialist. This additional doctor appointment can be a barrier to access.

There is still a lingering stigma that I even hesitate to mention. However, to dispel it, we name it. The theory was that HIV prevention would cause risky behavior, but that has not been borne out by the research. There is an increase in other types of sexually transmitted infections, so you must be monitored, but it seems the fear of Truvada causing extreme behavior far outweighs the reality.

The good news is Truvada is effective. But we need more education. PrEP education should be part of sexual education.

The Community Research Initiative administers the PrEP DAP, so go and find out more here: crine.org. The CDC also has lots of info about PrEP at cdc.gov/hiv/basics/prep.html.

If you have ideas for Out and About, please email John@JohnArt.com.

John Trobaugh

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