HRC Promotes Use of Truvada for PrEP

The largest U.S. gay-rights organization Saturday endorsed efforts to promote the use of a once-a-day pill to prevent HIV infection and called on insurers to provide more generous coverage of the drug.

Some doctors have been reluctant to prescribe the drug, Truvada, on the premise that it might encourage high-risk, unprotected sexual behavior. However, its preventive use has been endorsed by the Centers for Disease Control and Prevention, the World Health Organization, and many HIV/AIDS advocacy groups

The Human Rights Campaign, which recently has been focusing its gay-rights advocacy on same-sex marriage and anti-discrimination issues, joined those ranks with the release of a policy paper strongly supporting the preventive use of Truvada. It depicted the drug as "a critically important tool" in combatting HIV, the virus that causes AIDS.

"HRC does not take this position lightly," the policy paper said. "We recognize there is still ongoing debate ... and that there are those out there who will disagree with our stance."

Truvada has been around for a decade, serving as one of the key drugs used in combination with others as the basic treatment for people with HIV. In 2012, the Food and Drug Administration approved it for pre-exposure prophylaxis, or PrEP - in other words, for use to prevent people from getting sexually transmitted HIV in the first place.

"Today, there is an unprecedented chance to end the HIV/AIDS epidemic, in part through PrEP's aggressive prevention of new HIV infections," said Chad Griffin, president of the Human Rights Campaign. "There is no reason -- medical or otherwise -- to discourage individuals from taking control of their sexual health and talking to their doctor about PrEP."

The CDC says studies have shown that Truvada, when taken diligently, can reduce the risk of getting HIV by 90 percent or more. Research discussed at the International AIDS Conference in July found that use of the drug does not encourage risky sex and is effective even if people skip some doses.

As part of its announcement, the Human Rights Campaign called on insurers, regulators and Truvada's manufacturer to take steps to reduce costs, raise public awareness, and make the option available to all medically qualified individuals who could benefit from it, regardless of ability to pay.

The cost of Truvada varies widely; a New York State Health Department fact sheet gives a range of $8,000 to $14,000 per year. The manufacturer, California-based Gilead Sciences Inc., has a program that provides assistance to some people who are eligible to use Truvada but cannot afford it.

The Human Rights Campaign urged all states to emulate Washington state, which implemented a program earlier this year offering assistance in paying for PrEP. The preventive option also was endorsed by New York Gov. Andrew Cuomo when he announced initiatives in June aimed at ending the state's AIDS epidemic by 2020.

The HRC called on state insurance regulators to take action against any insurers who deny legitimate claims from patients who've been prescribed PrEP by their doctors.

A prominent provider of services to HIV-positive people, the Los Angeles-based AIDS Healthcare Foundation, remains a vocal critic of the preventive use of Truvada. In an ad campaign launched in August, the foundation says many gay men fail to adhere to Truvada's once-a-day regimen and describes government promotion of the drug as "a public health disaster in the making."

On Oct. 10, an alliance of about two-dozen HIV/AIDS organizations in New York released an open letter to the Healthcare Foundation, asking it not to extend the ad campaign to their state.

"We believe your campaign could prevent people at risk for HIV from using this potential lifesaving medication," the letter said.

The Healthcare Foundation's president, Michael Weinstein, said his organization did plan to run ads soon in New York City asserting there is data casting doubts on Truvada's effectiveness.

"Censoring the discussion is not the answer," he said.

Weinstein also noted that -- according to figures from Gilead -- only a few thousand people thus far have filled prescriptions for Truvada.

"If people really felt it was the answer, it's hard to imagine it wouldn't have spread like wildfire," Weinstein said. "It's obvious there is enormous ambivalence in the medical community."

According to the CDC, there are about 50,000 new HIV infections annually, with gay and bisexual men accounting for nearly 63 percent of them.