HIV in the Age of PrEP

At first it was heralded as a medical miracle-the news that a daily single dose of the drug Truvada protected sexually active people from contracting the HIV virus. The news became headlines around the world in July 2012, when the US Food and Drug Administration approved Truvada as a pre-exposure prophylaxis (PrEP) for those who actively pursued condomless sex.

Not only aimed at gays, the FDA tossed its net wide and included "heterosexual men or women who do not regularly use condoms during sex with partners of unknown HIV status;" all those who had "injection of illicit drugs with sharing of equipment;" as well as "discordant heterosexual and homosexual partners where one partner is HIV-positive and the other HIV-negative." Leave no stone unturned.

That only made common sense, of course, since everyone seemed to know that both straights and gays have unprotected sex at one time or another in their lives. It just seemed that the word on the street suggested that gays had it far more often than the rest of mankind in general-which is why HIV was much more likely to infect gay men, at least in the United States.

Unfortunately, what was true in 2012 is still true to this day. There are currently 1.2 million people living with HIV in the US (and 1 in 9 don't even know they have the disease). Even so, there is genuine progress being made in the fight against the disease. From 2005 to 2014, HIV diagnoses have declined 19 percent. No small victory.

The good news ends, however, with today's youth. Black gay and bisexual men between the ages of 13 and 24 had seen an increase in HIV infection by 87 percent in the past several years. Clearly the word is not reaching this group-or youth in general for that matter. Regardless of race, of all age groups, those between 20-29 have the largest increase in infection rate in this country.

Of that group, less than two percent have been taking Truvada as PrEP. In fact, even as the drug has gained in popularity as a pre-exposure prophylaxis, current data from its manufacturer Gilead Sciences suggests just 49,000 prescriptions of the blue pill have been filled across the country.

Cost is one reason. In the United States, the average price of Truvada is $1,564 per month. And while Gilead Sciences does have programs in place to make the drug available for low income patients, the shear cost of the drug is prohibitive to most working class adults. Insurance rarely helps to cover PrEP, since using Truvada as a prophylaxis is not treating a medical condition. (Note: When used to treat an existing HIV infection, Truvada must be prescribed in combination with another HIV drug, bringing the combined cost to well over $3,000 per month.)

But cost isn't the only reason that Truvada and PrEP have hit some stumbling blocks. There is also the on-going protest over PrEP's use by the AIDS Healthcare Foundation (AHF) and its president Michael Weinstein. Weinstein is concerned that those on PrEP will not take Truvada consistently, thereby giving a false sense of protection. Additionally, Weinstein feels that PrEP advocates, including the Center for Disease Control, are not being completely honest to sexually active adults by suggesting that PrEP is an effective tool for the masses. Weinstein feels that only the wholesale use of condoms will accomplish that.

"If you have multiple partners or your partner has multiple partners, the most effective protection for yourself, your partners, and our community is a condom," Weinstein states. "Mass PrEP administration is a dangerous experiment that is not supported by medical science and is currently resisted by doctors and patients alike."

And then there are the name callers. Oh yes. Take PrEP and proclaim it loudly or often enough, and you are likely to be labeled an "HIV slut" or a "Truvada whore." In case you've missed the theory here, the common thought is that if you have access to the big blue pill, you will be more prone to throw caution to the wind and behave even more dangerously during sex. Exactly what you might do is limited only by your imagination, but certainly other drugs are among your options here, including but not limited to Tina (otherwise known as crystal methamphetamine, krank, tweak, or ice).

But mere name calling is a minor point when compared with HIV, the disease, is concerned. While the virus doesn't appear much in the news these days, it may be making a sudden and ugly resurgence. The source has nothing to do with PrEP or other pharmaceutical advances, and everything to do with the American Health Care Act as currently being proposed by the Republican led Congress and President Donald Trump.

AIDS United, the largest and longest running national coalition of community-based HIV/AIDS organizations, has just announced its opposition to the suggested replacement for the Affordable Care Act. "This is the biggest attack to the health care system as we know it and the stakes are critical," AIDS United vice president of policy and advocacy Ronald Johnson said. "Millions of people gained access to [health] care through the Affordable Care Act-many for the first time. And these gains are at risk.

"This isn't an improvement to the Affordable Care Act. This is a hack job that puts tax cuts for wealthy people above the health needs of people.

"The serious changes contemplated by this Act will directly undermine the goals of providing treatment and care for people living with HIV as well as the goal of ending the epidemic. AIDS United strongly opposes this Act. We encourage our partners and advocates to contact the House Ways and Means Committee and House Energy and Commerce Committee to oppose this bill."

PrEP, Truvada, and government health plans. You be the judge.