Public health services add ‘game changer’ HIV prevention pill
According to the Center for Disease Control, more than 1.2 million people in the U.S. are HIV-positive, and almost 13 percent don’t even know that they carry the virus. A disproportionate number of those infected are black and Latino. And while the virus is no longer an automatic death sentence, there is still no cure.
However, a three-year-long study of a drug used to treat HIV had a 100 percent success rate in preventing new infections when taken daily. Lena Nozizwe reports from Los Angeles, home to two-thirds of Californians with HIV
A recently-released study by Kaiser Permanente San Francisco Medical Center is raising big hopes that HIV can be medically prevented by taking a daily drug regimen known as pre-exposure prophylaxis, or PrEP.
The real-world study followed more than 650 mostly gay men in San Francisco for almost three years. They all took Truvada, the first PrEP drug approved by the Food and Drug Administration.
Not a single one of the subjects on the daily regimen became infected with the virus that causes AIDS, even those who did not wear condoms during sex.
“This is a game changer in the fight against HIV,” says Vallerie Wagner, the chief operating operator of APLA Health & Wellness. She oversees three non-profit clinics in Los Angeles and says PrEP has the potential to help a variety of patients.
“Women and straight men, or individuals that are sexually active, who are engaging in sex with multiple partners, or who use recreational drug when they are engaging in sexual activity, or anyone who just feels like they would be a good candidate for PrEP,” Wagner explains.
APLA Health & Wellness started offering PrEP late last year and Wagner describes it as one of the best kept secrets in HIV prevention. She is cautious to note that the drug is not a replacement for condoms. PrEP does not prevent gonorrhea, syphilis and other sexually-transmitted diseases.
“You know, a raincoat and an umbrella, right?” asks Wagner. “Condoms have been around since the beginning of this epidemic. If condoms alone were enough we would not have an epidemic, because in the beginning it was all we had. But condoms along with a drug that has proven to be effective in preventing the transmission of HIV, why not?”
Wagner says while the Affordable Health Care act has made prescribing Truvada easier, she admits that working with insurance companies in order to get PrEP can, in her words, be “a bear.”
And that’s why the organization brought Ken Almanza onto the staff earlier this year. His official title is PrEP Navigator.
“My job is to hold their hand through entire process and really make it reasonable and not overwhelming,” he says.
Almanza knows how to get through the maze because he is on PrEP himself. “I have heard many horror stories of patents being judged by the provider,” he explains.
While insurance coverage can be one barrier to PrEP, the stigma attached to what some are calling a party drug is another.
Danny Cruz is a former licensed vocational nurse who now works as a male escort. He uses PrEP to remain HIV-negative, and says one has to be responsible for it to work, just like with birth control pills.
“A lot of people, when they hear you take Truvada, they think you’ve thrown condoms out the window, you’re just going to go be a slut, when that’s actually not the case. You’re taking this to prevent something you don’t want. And you recognize that you’re going to have to take take this pill every day, but more for personal peace of mind than a pass to go be promiscuous,” says Cruz.
Detractors of the drug say its use could wind up having the opposite effect: spreading HIV if users skip daily doses or stop using condoms.
And in black and brown communities some are reluctant to take Truvada. APLA Health & Wellness chief operating officer Wagner says many recall the decades-long U.S. Public Health Service Experiment in which black men in rural Alabama were told they were getting free healthcare, when in fact doctors were merely monitoring the untreated progression of the venereal disease syphilis.
“A lot of people have likened it to syphilis and the Tuskegee Experiment. People feel that the government is giving people HIV to test along,” Wagner explains.
Public education efforts to dispel this suspicion are underway. The challenge now is to increase awareness about the drug and its effectiveness when taken daily.
The studies about PrEP have been compelling enough that the Los Angeles County Board of Supervisors approved a plan in June to make PrEP a part of the county’s HIV prevention strategy, joining major urban centers New York City and San Francisco and the states of Florida and Washington.