PrEP stands for Pre-exposure Prophylaxis, protection before exposure to HIV. It’s a once a day pill called Truvada for people who are HIV negative to protect them from getting HIV. PrEP was approved by the FDA in 2012, and by the U.S. Centers for Disease Control for use in HIV prevention.
I recently attended the National PrEP Summit with other HIV prevention professionals from around the country. The two-part take away for me could not have been any clearer: PrEP works, and there are so many more people who should be using it. Throughout the country, PrEP is disproportionally underutilized by women, African Americans, and Latinos. There are many challenges in getting the word out about PrEP, especially in these populations.
I have said before, if you had told us in the 1980s and 90s that there was a pill that could have prevented HIV, people would have been falling all over each other to get it. So, why not now? Although a growing number of people are beginning to use PrEP as part of their personal HIV prevention strategy, it has not taken off as quickly as one would think. There are a variety of reasons for this, the first clinical trials showed that PrEP was only 44% effective, not all that exciting. However, when they dug deeper into the data it showed to be up to 99% effective for those in the study who actually took the medicine every day as prescribed. Now we’re talking!
Many people, especially in certain populations have still not heard of PrEP, or have not heard how effective it is in preventing HIV. There has also been some stigma related to taking PrEP (similar to birth control when it first came out in the 60s). Early PrEP users were often referred to as “Truvada Whores”. Fortunately, this has begun to wane in the Gay community, where it is now being viewed as a positive thing that a potential sexual partner has been protecting themselves from HIV. Other barriers in getting people on the PrEP bandwagon include the high cost, and medical providers who are not comfortable prescribing it.
While PrEP is very expensive, $1,300 a month, it’s covered by most health plans including Medi-Cal. There are also patient assistance programs that can help with co-payments. Although many non-HIV specific doctors are not knowledgeable, and therefore uncomfortable, prescribing PrEP (or even talking to their patient about sex), we are fortunate here in Sonoma County to have several local health centers that are eager to talk to their patients about starting PrEP. California just passed a law requiring HIV test counselors to tell every person who tests negative about PrEP.
Face to Face does the majority of HIV testing in the county. We’ve been handing out PrEP brochures, and referring people to PrEP providers for quite a while. We are strong advocates for using every tool out there to end HIV transmissions in Sonoma County, and believe PrEP is our most powerful prevention tool yet. Each time we deliver the news that someone is HIV positive, I wonder if this person had heard of PrEP, considered it, thought they didn’t need it, or couldn’t afford it. A person does not need to be at high risk for getting HIV, they just have to be at risk.
The PrEP vs condoms controversy: Can’t people just use condoms? Sure, and many people do and feel comfortable with that level of protection. However, condoms don’t work at all if they’re left in the bedside drawer, just like PrEP doesn’t work if you don’t take it. Many people have a hard time (pun intended) with condoms, and therefore don’t use them regularly. Most see PrEP as an extra layer of protection and use them in conjunction with condoms. Some choose to use PrEP only, and do not use condoms. Yes, public health folks are concerned about increases in other sexually transmitted diseases. And, while there is currently a significant spike in Chlamydia, Syphilis, and Gonorrhea in California and in Sonoma County, it has not been shown that PrEP is to blame. And remember, these sexually transmitted infections are all curable, whereas there is still no cure for HIV.
- So, PrEP is effective. There has been only one known case of someone contracting HIV while on PrEP, owing to a rare Truvada-resistant strain of HIV.
- And, PrEP is safe. Most people experience no side effects and those who do say they are mild and last less than a month.
- And, PrEP is available locally, and in most cases, affordable.
The enthusiasm and hope of ending HIV at the National PrEP Summit got me thinking about myself. I’m a single Gay man. I’m 62, and not quite as “popular” as I was in my 20’s, but couldn’t I use another layer of protection? Why not take PrEP myself? I called my doctor, got labs done to make sure I’m HIV negative, a full STD screening, checked my kidney function and bone density (all good tests I haven’t had in a long time), and now I’m ready to start my once a day pill. Who knows, maybe I’ll become more “popular” because of it, lol.
If you, or someone you know is curious about PrEP, come in and talk to one of our HIV Test Counselors. Get more information, have your questions answered, and if you’re ready, get a referral to a local provider. Test Counselors are available on a drop-in basis, Tuesday through Friday from 9:00 am to 4:30 pm at the Face to Face office at 873 Second Street, Santa Rosa.