Taking Control with PrEP

107091581truvadacropThree months ago I started the steps of claiming further control over my health and my life by starting on PrEP (pre-exposure prophylaxis). I had been discussing my interest and intent to start with friends, family, and co-workers for a while. Before calling to schedule my appointment, I was made aware that I could qualify for co-pay assistance through Gilead, via truvada.com. Since I already had insurance I could apply for the HIV Co-pay Assistance Coupon Card, but if I didn’t I could still apply for the U.S. Advancing Access Program.
Scheduling my PrEP intake appointment with the AIDS Resource Center Ohio Medical Center was simple enough. First I met with a PrEP counseling intake specialist, in which I underwent a risk measure assessment. Basically, I covered past medical history, family history, social history (including sexual activity, any drug/alcohol use, etc.), and current medications being taken. I then moved on to meet with the physician who gave me a brief physical and prepared me for the labs I needed to have done. The rest of the visit was listening, answering questions, talking about Truvada and the risks specific to HIV, emphasizing the importance of medication adherence, along with connections to other related services. And then the waiting game for my lab results and medications began. A friend suggested to me to make sure I asked if a 90-day supply was available rather than a standard 30-day supply, as a way to potentially save a couple hundred dollars in the long run.

There’s a lot more to PrEP than just taking one pill of Truvada every day. PrEP would allow me to have sex without fear for the first time in my life. It would remove that month long hangover of psychological anguish after sex, worrying about whether or not I might have put myself at risk of HIV and looking for the slightest sign. If I get a cold or a rash my mind will instantly jump to conclusions because of the anxiety I have around HIV.

I know it’s a completely irrational fear in many ways. Even when I know there’s been no risk and I know the statistics, I should feel comfort but don’t. Even though I use condoms I still have anxiety. For me, wanting to use PrEP isn’t about not wanting to use condoms, it’s about wanting to have that extra layer of security, both physically and psychologically, to not have to worry about it for the next month, which is what I tend to do.

The entire gay community is affected by this kind of anguish and it only fuels the epidemic because when people feel anxious they don’t talk about it. When I try to talk about PrEP, people make assumptions about me and try to turn the conversation into a moral debate about personal responsibility, but doing this won’t stop the HIV epidemic. Empowering people to take control of their HIV risk with a range of tools is what’s going to help.

While condom usage remains the gold standard of HIV prevention, this shouldn’t stop us trying to understand that people might struggle with them. I think a lot of the concern around PrEP comes from the thought that “well you’re taking PrEP to have sex without a condom,” which people see as a problem. But really I think that’s missing the point; you don’t need PrEP to have sex without a condom—people do this all the time. The only reason to take PrEP is to prevent HIV infections. And that’s a pro-health choice at its core.

For anyone on the fence I ask:  If you were a woman would you take birth control pills to prevent pregnancy? If we had a vaccine for HIV, would you take that? You may not be at risk for pregnancy, and we may never have a vaccine, but for now we have an effective bio-medical strategy that reduces risk of HIV by up to 99 percent if taken daily. If you feel it’s for you, talk with your doctor.

-Evan Robinson

BREAKING THE SILO – BENDING THE CURVE.

This is the year to end rationalizations and isolationism and break out of the silo.

  • The number of new HIV infections in Ohio has gone up over the past ten years.
  • The national conversation about HIV and AIDS has become muted.
  • The age group most impacted by new infections is the younger generation.
  • An HIV positive status has been criminalized for almost two decades.
  • HIV positive Ohioans now have full access to Marketplace and Medicaid managed care plans.
  • Community viral suppression will reduce the rate of new infections.

Let’s put those in perspective. HIV has been in a silo since the start of the epidemic in the 1980s. The Ryan White Care Act was enacted by Congress in 1990 to provide a safety net for individuals living with HIV or AIDS primarily because these persons had no other sources of care or support. For as long as the virus has been around, society spoke about HIV/AIDS separately from other diseases in general, as though it was something to keep apart, and keep isolated. Culturally we became so specialized, so focused on the havoc the human immunodeficiency virus can bring, that we missed the bigger picture.

The advent of highly active antiretroviral therapies changed HIV/AIDS from being a fatal disease to being a chronic disease. It also had a different effect of muting the conversation about the seriousness of the HIV and its impact on the lives of those who contract the virus; isolating both the disease and those with it even further.

The result is not surprising. Society maintained the HIV/AIDS silo, and because of that, the national number of new infections annually has stagnated at 50,000 over the past few years. When it comes to new infections, you don’t want to see stability, you want to see a decline. Individuals under the age of twenty didn’t experience the height of the epidemic in the mid-1980s until the mid-1990s and the muted dialog only served to place the younger generations at greater risk. They are now the age group with the highest rate of new HIV infections, accounting for one in four.

2014 was a watershed moment not only for all Ohioans regardless of HIV status. For the first time in history HIV positive Ohioans can now be covered by some form of insurance with Essential Health Benefits (EHB) whether through employer sponsored insurance, Medicare, Medicaid, or the Marketplace. Access to coordinated comprehensive integrated care means greater opportunities to reduce community viral load and reduce new HIV infections.

2015 will be another watershed year—a year of breaking the silo.

  • We will move forward and recognize that HIV is a disease—not a crime.
  • We will work to fully integrate HIV treatment into mainstream health care.
  • We will promote prevention interventions including pre-exposure phrophylaxis (PrEP).
  • We will work to ensure persons with HIV have fully integrated and equal access to housing and employment.
  • We will promote State Health Education Standards.
  • We will reinitiate the dialog about HIV and AIDS with the public at large.

So, here’s the thing, and there’s really no getting around it. If we’re going to really commit to ending the HIV epidemic, we need to break the silo.

Pre-Exposure Prophylaxis

Pre-Exposure Prophylaxis (PrEP) is one of the newest and most effective ways of preventing HIV, and there has been a lot of hype, excitement, and misinformation surrounding the idea of pre-exposure prophylaxis. But what really is PrEP? Who can take the pill? What are the risks, and what are the benefits?

What exactly is PrEP? To understand what PrEP is, it is important to understand what Pre-Exposure Prophylaxis means. Pre-Exposure, in this case, meaning before one is exposed to the HIV infection. Prophylaxis means to prevent the spread of a disease/infection. So in this case Pre-Exposure Prophylaxis means, to prevent the PrEP Infographicspread of HIV, before one is exposed to it. The PrEP pill is being prescribed under the brand name Truvada.  Truvada is used in two different ways: 1) To treat HIV, in combination with other medications, in those over the age of 12, and 2) To reduce the risk of contracting HIV in at risk adults.  It is important to understand that Truvada is not a vaccine, but instead works by blocking HIV replication, thus preventing the establishment of infection in the body of HIV negative individuals. Studies have shown that the use of PrEP can decrease an individual’s risk of contracting HIV by up to 99%.

But who can take Truvada for PrEP? According to the CDC, ‘at-risk’ people include “HIV-negative men who have sex with men and who are at high risk of getting infected with HIV through sex, and male-female sex partners when one partner has HIV and the other does not.” There are other situations that may make one at-risk, such as injection drug use, sex work, or having recently been diagnosed with a sexually transmitted infection. At the moment, Truvada for PrEP is only recommended for those 18 years of age or older, and that are determined to be at-risk by their doctor. You must also be HIV-negative to start a Truvada for PrEP plan. Once you have started taking PrEP you must commit to HIV, STD, as well as other tests and doctor visits every three months, to ensure you maintain your HIV negative status. The Center for Disease Control “recommends that PrEP be considered for people who are HIV-negative and at substantial risk for HIV.” (PrEP 101) The World Health Organization “strongly recommends men who have sex with men consider taking antiretroviral medicines as an additional method of preventing HIV infection (pre-exposure prophylaxis) alongside the use of condoms.” (WHO: People Most at Risk)

What are the Risks of PrEP? Many opponents of PrEP are expressing their concerns about the risks associated with taking Truvada for PrEP. A primary concern is the risk developing a resistance to Truvada, an important drug used to treat HIV; however, the iPrex study on PrEP found little to no evidence of resistance when the drug was taking as advised. A variety of side effects are possible, so be sure to discuss any potential
side effects with your doctor when deciding whether PrEP is right for you. PrEP also has a variety of benefits as well. When taking correctly and daily as prescribed, PrEP has been shown to reduce the risk of contracting HIV by up to 99%. These rates are extraordinary, but PrEP should still be used with safe sex practices, as it does not offer any protection against other sexually transmitted infections such as syphilis or gonorrhea.

AIDS Resource Center Ohio (ARC Ohio) and The Ohio AIDS Coalition (OAC) have been working diligently to promote education, research, and the use of Truvada for PrEP. Both organizations believe that with proper education, medical supervision, and the addition of safe sex practices, PrEP could be the next major step in the fight against HIV.

 

2014 International AIDS Conference Recap

The 2014 International AIDS Conference wrapped up in July in Melbourne, Australia. The week-long symposium is a gathering of the best and brightest in the AIDS field from across the world. Thousands of researchers, activists, and, AIDS professionals gathered to discuss the latest in HIV treatment, prevention, and policy. This year’s conference hot topics included PrEP and Hepatitis C, both of which OAC have been focusing diligently on.

A major topic of conversation was PrEP, one of the newest HIV prevention strategies. This pill, which OAC has been education Ohioans and promoting on behalf of, is a viable option for protection against HIV. Numerous studies about the effectiveness of PrEP were presented at the conference. iPrex discussed the importance of medication adherence while on PrEP.  The research found that while taking Truvada four or more days a week on a regular basis, men and transgender women who have sex with men were 100% protected against HIV. This same study, however, found that this strict adherence to the pill only occurred 33% of the time.  This study is the first to show results from PrEP in a real-world situation, without a randomized controlled trial where some participants received a placebo. PrEP works.  Adherence is key.

PrEP is an exciting new tool in the HIV prevention toolbox that has the potential to play a huge role within the AIDS epidemic.   The Ohio Aids Coalition will be co-hosting a community conversation on PrEP on September 24th from 6:30 to 8:30 at the Columbus Public Health Building. Professionals, consumers, and activists will be in attendance.  The program will have a brief PrEP 101, an expert panel encompassing all sides of the PrEP world to offer perspective and answer questions, and an interactive component that will engage folks in a meaningful dialogue about negotiating safe(r) sex practices in an era of PrEP, and a discussion on what PrEP means for the future.  Email Zach Reau at Reau@ohioaidscoalition.org for more information or to RSVP!

Another important topic that was routinely brought up at the conference was that of Hepatitis C, a disease that is exceptionally prevalent in the HIV community. Nationally, 25% of people with HIV are co-infected with Hepatitis C. Hepatitis C is one of the leading causes of non-HIV related causes of death for persons living with HIV. This topic was met with both a positive and negative outlook. Research studies presented at the conference showed that the drugs Sovaldi and Ribavirin are known to cure those infected with both HIV and specific strains of Hepatitis C. In a study containing 274 participants, the cure rate ranged between 83 and 91 percent. Previous Hepatitis C treatments were nowhere near as successful and are associated with some pretty bad side effects.  Sovaldi has also been shown to be successful in persons who are HIV positive.  The research was not met with complete positivity though; the Fair Pricing Coalition (FPC) as well as other activists protested the prices set on Sovaldi. Sovaldi costs about $1,000 a pill, making treatment cost between $84,000 and $168,000 for 12 weeks and six months of treatment, respectively. The FPC states that Gilead, the company producing Sovaldi, is unfairly marketing the drug at too high of a price, making it unavailable to the majority of people suffering from Hepatitis C. Gilead is still standing strong behind their prices and Sovaldi. Gregg Alton, a Gilead Vice President said “It is a fantastic drug. It’s really changing the landscape of Hepatitis C and the ability to treat hepatitis C, from a largely untreatable disease to one we can cure with a more than 90 percent rate.” Activists are stating that they don’t believe Gilead shouldn’t be making a profit, but they are simply out of touch with reality. There are currently some promising Hepatitis C drugs coming through the pipeline.  Hopefully the increased competition will help lower Sovaldi prices to reasonable rates.

The 2014 International AIDS conference brought up a variety of interesting points on the fight against HIV/AIDS. Groundbreaking research in the HIV field was unveiled to allow for the medical advancement of treating HIV, social activism played its part in fighting for patients’ rights, and the world learned a little bit more about the needs of the HIV community. Overall, the conference was a huge success and brought to light the many needs of the HIV society. We have come a long way in the past 33 years but we still have a long way to go.

The next conference is set to take place next July in Vancouver, Canada. More information on the conference can be found at IAS2015.org.