An Important HIV Prevention Option

Re: Supervisor Scott Wiener's blog, "Coming Out of the PrEP Closet," published September 17, 2014

The California Department of Public Health (CDPH), Office of AIDS commends San Francisco Supervisor Scott Wiener for publicly sharing his choice to consult his physician and take HIV pre-exposure prophylaxis (PrEP) to further protect him from acquiring HIV. By sharing his personal choice, he has raised community awareness about this important HIV prevention option.

PrEP uses some of the same anti-HIV medications used by people living with HIV to prevent HIV infection before exposure to the virus. The medication currently approved by the federal Food and Drug Administration for PrEP is called Truvada. The pill can reduce the risk of HIV infection by up to 99 percent when consistently taken once a day as prescribed. PrEP has been extensively studied and found to be effective for gay men, transgender women, other women at high risk of HIV acquisition, and persons who inject drugs. As Supervisor Wiener points out, PrEP does not replace, but rather augments, other risk reduction behaviors, including consistent use of condoms, reducing the number of sexual partners, and avoiding other sexually transmitted diseases.

The concept of using HIV medication to prevent HIV infection has been used successfully since the early '90s to prevent HIV transmission from an infected mother to her newborn child, leading to the virtual elimination of this mode of HIV transmission in California. Just as heterosexual women have multiple pregnancy prevention options available and are encouraged to discuss with their medical provider which option or combination of options will work best for them, the Office of AIDS encourages men and women at high risk of HIV acquisition to discuss HIV prevention options, including PrEP, with their medical provider and choose a method or combination of HIV prevention methods that will work best for them.

Individuals taking PrEP work closely with their medical provider to monitor their HIV status and receive support for adherence to the daily medication, reducing risk, and accessing other prevention methods. The use of PrEP has not been shown to promote riskier sexual behaviors. PrEP has been incorporated into public health approaches endorsed by both the World Health Organization and the Centers for Disease Control and Prevention. Both Medi-Cal and an increasing number of insurance companies cover the cost of Truvada for use as PrEP, and the drug manufacturer has a program to assist those both with and without health insurance who otherwise may not be able to afford PrEP.

Approximately 5,000 Californians become newly infected with HIV every year -- almost 14 every day. These HIV infections are preventable using tools that we currently have available, and PrEP is one of these important tools. Learning about PrEP and discussing options to avoid HIV infection is a critical step. Supervisor Wiener has successfully increased awareness through sharing his choice to use PrEP. The CDPH Office of AIDS applauds Supervisor Weiner and supports the use of PrEP as an effective method of HIV prevention.