Newswise — People at risk for contracting HIV from HIV-positive sexual partners or through intravenous drug use can reduce their risk of infection by up to 90 percent when they take a daily pill as directed.
Pre-exposure prophylaxis (PrEP), which is sold under the name Truvada, is an antiretroviral medication that health authorities call essential to ending the AIDS epidemic. But obstacles such as lack of education, access to health care and insurance, and stigma are often barriers to those who need the treatment the most.
On Dec. 7, the Rutgers School of Public Health and the Rutgers School of Nursing will tackle these challenges to delivering care during “Prepping for PrEP,” a World AIDS Day commemoration that emphasizes awareness of and access to PrEP and features health experts, researchers, PrEP users and community organizers.
Conference organizers Perry N. Halkitis, dean of the School of Public Health, and Suzanne Willard, director of the HIV Doctor of Nursing Practice Program at the School of Nursing and a nurse practitioner with one of the largest PrEP practices in the state, discuss the importance of this treatment and the challenges of delivery.
How can PrEP help stem the AIDS epidemic?
Halkitis: It was a remarkable breakthrough when the U.S. Food and Drug Administration approved Truvada as the first – and still only – drug for PrEP in 2012. Finally, there was a technology besides condoms that could be used to stop HIV transmissions. It has been known for some time that HIV-positive people who adhere to their treatment regimen can suppress the levels of virus in their blood to undetectable levels, which means they cannot transmit the virus, even in the absence of a condom. While not cures, treatment as prevention for HIV-positive people coupled with PrEP for HIV-negative people are the tools we have to bring an end to AIDS.
Willard: It’s important to note that since PrEP does not guard against sexually transmitted diseases, such as gonorrhea and syphilis, it should not be used as a substitute for condoms. In fact, use of a condom in conjunction with PrEP lowers the risk of HIV transmission even more.
Who should be using PrEP?
Halkitis: People who engage in sex without the use of condoms, who have an HIV-positive partner or who are unclear of their partner’s status should be on PrEP. Populations that are most at risk for acquiring HIV are trans and cisgender women, sex workers and gay men – especially young black and Hispanic gay and bisexual men.
Willard: Women also can find themselves in situations where sexual negotiation is challenging, which places them at high risk. PrEP is a method that women can use to keep themselves healthy.
What is preventing people at risk from seeking this treatment?
Willard: People often feel their health care provider is either not comfortable with assessing the need for PrEP or prescribing PrEP. For their part, patients say they feel they cannot discuss their sexual activities with their primary care providers. PrEP also is not part of the package of services in health care settings, including family planning clinics.
Since PrEP requires a prescription and laboratory monitoring every three months, access to health care and co-payments can be obstacles. Many patients may either have no or inadequate health insurance coverage for the lab studies or the medication. Gilead Sciences, the makers of Truvada, offers a PrEP medication assistance program for those who qualify.
This is why this conference is so important: We need to have open and clear discussion on how to get PrEP in the hands of those who are most at risk.
Halkitis: My research shows that young gay men have a high level of knowledge about PrEP but do not pursue prevention. There are many factors behind this, including misconceptions about PrEP, concerns about its ability to protect, reluctance to taking a daily pill and mistrust of the medical community and pharmaceutical companies. We also have found that gay men would prefer an injectable PrEP, which is in development.
What might the future of PrEP look like?
Willard: PrEP needs to be available to patients in the same way as other resources for sexual health like birth control and STD treatment. We need not fragment care but keep it patient-centered. Family planning programs, Federally Qualified Health Centers and primary care offices all need to be familiar with the use of PrEP. Schools of nursing, medicine and public health should work together to ensure that their students – the future of health care workers – are well versed in all methods aimed at keeping patients healthy.
Halkitis: HIV disease is as much a social phenomenon as it is a viral phenomenon. We still have a lot of work to do around societal realities, such as stigma surrounding HIV patients and communication with health care providers. Antiquated HIV criminalization laws, which seek to prosecute HIV-positive individuals, also need to be addressed. I envision a time when people can go to their local Walgreens – which is now prescribing PrEP in its in-store clinics in certain metropolitan areas nationwide – annually for their flu shot and PrEP shot.