BTL Editorial: An Epidemic Solution After 30 Years Should Be Embraced

Let's be perfectly clear: The announcement last week expanding who should be able to access the HIV prevention technology PrEP (Pre-Exposure Prophylaxis) is a watershed moment in the history of this epidemic. Not only did the CDC put on the full court press, but even the White House got in on the messaging, sending out the CDC's press release. The White House doesn't release information unless the White House is behind it 100 percent, and the Obama administration is absolutely spot on to stand behind this.

PrEP is using the incredibly effective drug Truvada, originally designed to treat HIV infection, to prevent infection with the virus in the first place. The drug is taken daily, and if taken daily, can be 90 or more percent effective in preventing infections. That is more effective than any other prevention option – other than complete abstinence – that we know of.
PrEP has the potential to change how we discuss HIV, and more importantly, it could literally help end the epidemic that continues to disproportionately impact the gay community – even after 30 plus years. PrEP is a revolutionary game changer, and the new CDC guidance places that reality squarely in the hands of our community.
How revolutionary? Well, BTL thinks the science is so strong and the evidence so clear on the efficacy of PrEP that we joined nearly 70 other groups across the country praising the new CDC guidance, and told the naysayers to take a seat.
How revolutionary? The Michigan Department of Community Health had consistently refused to adopt PrEP as a recognized risk reduction option since its approval by the FDA in July of 2012. But on the day after the CDC released the new guidance, MDCH announced it would follow the guidance and encourage medical and health partners across the state to do the same. The move came literally a week after the state health officials told BTL there was no chance the department would endorse PrEP in the near term, even though the low income health program Medicaid would cover the prescription for patients.
That's a revolution. It's a game changer. It's an attitude changer. MDCH officials have often been the brunt of criticism on these pages, but this time, we are incredibly proud to call them our partners. We are also pleased that they saw the science, realized that PrEP could benefit the lives of Michigan residents and changed their public stance. That takes guts. That takes leadership.
And as fantastic as that policy shift is from MDCH, we are also cautious. State officials say they are exploring how best to share this information with doctors and medical providers in the state. We know from experience how important policy guidances from the state health department is. When an investigation found that access to post exposure prevention drugs was dependent on where a person in Michigan lived – and that the state had no policy on that intervention in the five years after it was created by the CDC – it still took MDCH 18 months to conceive of and release policy and guidance. Such communications reach every health care provider in the state of Michigan – no small feat. It is incredibly important to put everyone in the state on the same page when it comes to PrEP. There is not time, nor any excuse, for a months long delay from the state in issuing the PrEP guidance to medical providers.
BTL is watching. This is a lifesaving option and any delay is unacceptable.
While this news is certainly welcome, PrEP is not necessarily going to be readily embraced by healthcare providers. We've heard horror stories about medical professionals who lack basic cultural competency when it comes to LGBT health and that often translates into moralizing judgments about what care and treatment members of our community can have access to. That is unacceptable. If your doctor refuses to prescribe PrEP, find a new doctor.
If you are a medical provider in Michigan who is willing to prescribe PrEP, contact BTL today so we can include you in a database of medical professionals willing and able to provide this revolutionary and lifesaving option to transgender women, as well as gay, bisexual and other men who have sex with men.
Several months ago, we challenged this community to take HIV on as the serious crisis facing us that it is. PrEP is part of embracing the challenges and rewards of battling HIV in our community. Together, we can end HIV. Are you going to join us?