A revolution is underway in HIV prevention, and for the first time since the start of the AIDS epidemic in 1981, many in the HIV/AIDS community, including medical providers and health officials, say that an end to AIDS could be in sight.
The revolution is called PrEP, or pre-exposure prophylaxis. It refers to the use of a well-established HIV anti-retroviral drug, Truvada, to prevent new infections in HIV-negative individuals exposed to the virus through sexual contact.
Research on PrEP estimates that the drug can reduce HIV infections by up to 99 percent, depending on adherence, condom use, safer sex counseling and other risk reduction interventions. The more adherence -- taking a pill every day -- the greater the protection.
In short, this is the first biomedical prevention pill for HIV-negative people ever, and the best news to come along in HIV/AIDS since 1996, when treatment advances transformed AIDS from a near-certain death sentence to a chronic but manageable disease for a majority of people.
Optimism surrounding PrEP is global. Both the U.S. Centers for Disease Control and Prevention (CDC) and the World Health Organization have released guidelines for administering and managing PrEP. In New York, Gov. Andrew Cuomo announced a Plan to End AIDS in June that relies in part on PrEP to reduce new HIV infections. Earlier this year, Washington state initiated a PrEP drug assistance program to help pay for the cost of the drug for those who cannot afford it. And just last month, the San Francisco Board of Supervisors approved $300,000 for community "navigators" who will help people access PrEP through their own insurance or other coverage.
Los Angeles has long been a leader in HIV prevention, but the County is lagging behind other jurisdictions in increasing awareness and access to this groundbreaking intervention, even though it accounts for over 40 percent of California's HIV/AIDS cases and reports around 2,000 new HIV infections annually.
Local politics is to blame. The County's Division of HIV & STD Programs (DHSP) could fast track PrEP programs through existing providers and STD clinics. The agency, however, is paralyzed by lawsuits from one of its main medical providers, and neither the DHSP nor the County Board of Supervisors has an appetite for more litigation. Nonetheless, the County's Commission on HIV passed a resolution in November calling on DHSP to act with all due haste to develop a PrEP program.
APLA Health & Wellness and other local providers support and prescribe PrEP. APLA Health & Wellness recently inaugurated a new PrEP program at its Gleicher / Chen Health Center in Baldwin Hills. The Pendleton / Goldman PrEP Program focuses on education and outreach to young gay African American and Latino men and transgender women -- populations severely impacted by escalating rates of new HIV infections. PrEP is covered by the state's Medi-Cal program, Medicare and by most private insurance plans. It is not cheap -- around $1,200 for 30 pills, or a month's supply. Gilead Sciences, based in Foster City, CA, manufactures the medication, and makes it available through patient assistance programs for the uninsured.
Despite conclusive evidence of PrEP's effectiveness, awareness and uptake have been remarkably low. A recent survey of gay and bisexual men by the Kaiser Family Foundation found that 80 percent of gay men say they have heard "little" or "nothing at all" about PrEP. Even worse, many seemingly knowledgeable medical providers have refused to prescribe PrEP to qualified patients, citing unsubstantiated concerns about side effects, drug resistance and concerns about sexual risk compensation.
Political will is what is most needed now. We must ramp up utilization of PrEP and make sure this groundbreaking intervention is available to the individuals and communities impacted by HIV. PrEP is clearly not for everyone. It is a highly potent medication with possible side effects -- including bone density loss and kidney problems -- that must be closely monitored. Nonetheless, for those at risk -- including gay or bisexual men, transgender populations, sex workers or the partners and spouses of people living with HIV -- PrEP is a potent tool in the HIV prevention tool box and could dramatically reduce new infections, save the state billions in health care costs for care and treatment and spare many people lifetimes of significant health challenges.
If we truly want to see this epidemic end, we need to act now and act decisively with every tool we have at our disposal.