PrEP article 122115

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PrEP; HIV Prevention Within Reach
By JWCH Institute Inc. PrEP Committee

This is one of those topics that in twenty years you will ask yourself what side of the debate you were on. Whether you are opposed to Pre-Exposure Prophylaxis (PrEP) or you are a supporter, there is one fact that either side cannot deny, PrEP is here, and it’s having an impact in our community.

Beyond just condoms there has been no effective way of preventing HIV, until now. So what is PrEP? In 2012, the U.S. Food and Drug Administration (FDA) approved the use of Truvada—a medication normally used to treat those living with HIV—as part of a new regimen for HIV-prevention among high-risk individuals known as Pre-exposure Prophylaxis, or PrEP. Along with quarterly testing for HIV, STDs, and any possible side effects the drug may have on the bodies of those taking the pill, Truvada is to be taken once daily to help guard against HIV infection.

By interfering with the virus’ ability to replicate in the body after exposure, the medication prevents HIV from establishing infection. PrEP is proven safe and highly effective in preventing HIV infection; and the Centers for Disease Control and Prevention (CDC) states, “is even more effective if it is combined with other ways to prevent new HIV infections like condom use, drug abuse treatment, and treatment for people living with HIV to reduce the chance of passing the virus to others1.”

Three years after initial approval, recent real-world studies have shown PrEP’s effectiveness at upwards of 100% for those taking the drug as prescribed. While no one taking the medication as recommended has contracted HIV, the CDC estimates the effectiveness of PrEP to reduce sexual transmission of HIV somewhere between 92% and 96%, and in injectable drug users reduces risk by over 70%2. In September 2015, researchers at Kaiser Permanente Medical Center in San Francisco released results of a 32-month study in which 600 people taking PrEP daily—99% of whom were men who have sex with men—did not contract HIV3.

While PrEP has shown success at reducing the chance for HIV infection to near-zero, barriers to access still remain for many. Jonathan Mermin, the director of the National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention, reports that an estimated 21,000 people are accessing PrEP across the United States, though the CDC rolled out new recommendations that 1.2 million people should be taking Truvada4. The CDC determined that 1 in 4 gay and bisexual men, 1 in 5 intravenous drug users, and 1 in 200 sexually active heterosexual adults should be on the prevention regimen5.

According to the CDC, currently 1.2 million Americans are living with HIV, and it’s estimated that nearly 50,000 new infections occur annually. Of those living with the virus in the U.S., only 30% have suppressed levels of the virus in their blood decreasing their chances of transmitting HIV6.

HIV care providers bare unique obstacles in engaging and retaining those living with the virus in regular care, and prevention providers experience many of the same hurdles as it relates to providing barrier-free access to PrEP. Lack of insurance, stigma, or lack of basic knowledge about the method among those at-risk—and even medical providers—keeps many from obtaining PrEP, particularly those who remain without access to health insurance.

The approval for the use of Truvada as PrEP is fairly recent, and attention surrounding the drug is gaining, but the CDC reports that 1 in 3 primary care doctors and nurses have not heard about PrEP7. Luckily, governmental and non-governmental agencies across the nation are working diligently to spread greater awareness of resources and education about PrEP.

PrEP awareness is on the rise; and PrEP providers, along with access to them are also increasing in Los Angeles County. However the question remains: how do we help those who are uninsured? Accessing PrEP has become easier to the ideal clients—those that are insured, who can manage their health, navigate health systems, and who are more informed on the topic itself. The uninsured are almost always the ones that fall between the cracks, and are at times, the most in need of these services.
There are a few options out there. Gilead Sciences has a payment assistance program that helps those who are uninsured and unable to afford the cost for Truvada. Los Angeles County also provides information about no-cost/low-cost programs for individuals who do not qualify for Medi-Cal, Medicare, or Covered California plans depending on their monthly income. As we continue to move forward we can hope that the number of services to help the uninsured increases, along with everyone else who wants to take the next step in HIV prevention. As this unfolds in Los Angeles County, JWCH Institute will keep you updated about the latest health statistics, PrEP education and referrals, testing, and linkage to HIV care and treatment.
Learn more at:
JWCH Institute Inc. PrEP Education and Linkage Project at: www.jwchinstitute.org
PrEP Medication Assistance Program
www.truvada.com/truvada-patient-assistance
Los Angeles County Department of Public Health
http://www.publichealth.lacounty.gov/dhsp/PEP-PrEP.htm
1: http://www.cdc.gov/vitalsigns/hivprep/
2: http://www.cdc.gov/vitalsigns/hivprep/
3:http://cid.oxfordjournals.org/content/61/10/1601.full?sid=b8cedeb0-f4cf-4107-bef2-2bee62655316
4: http://www.cdc.gov/vitalsigns/hivprep/
5: http://www.cdc.gov/vitalsigns/hivprep/
6: https://www.aids.gov/federal-resources/policies/care-continuum/
7: http://www.cdc.gov/vitalsigns/hivprep/

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