By Lukas L. Ayers
A little over four years ago the FDA approved, for the first time, a medication used as a prophylaxis against HIV transmission. Truvada, commonly known as PrEP (pre-exposure prophylaxis), is a once daily pill comprised of two longtime medications used to treat HIV, Tenofovir and Emtricitabine. If taken daily, the pill reduces the risk of contracting HIV via intercourse by more than 90% and more than 70% via injection drug use. If someone had said five years ago that there would be a pill to prevent HIV, many would have considered this person delusional. Now, it’s here! At last we have a reliable, effective tool in preventing the spread of HIV transmission that goes far beyond what condom use alone can do. Truvada physically blocks the virus from replicating itself within an HIV-negative host, leaving the virus to die off. Why then isn’t this drug flying off pharmacy shelves? How come I repeatedly find myself explaining to non-LGBTQ focused health practitioners, heterosexual colleagues in the healthcare field and heterosexual friends and family members what Truvada is and its revolutionary importance?
In 2014, the Centers for Disease Control and Prevention reported over 44,000 individuals newly diagnosed with HIV and another 20,000 diagnosed with AIDS. Yet, that same year, there were less than 3,500 PrEP users nationwide, despite the drug being on the market for nearly 2 years already. Due to HIV disproportionately affecting gay and bisexual men, particularly Hispanic and African-Americans, it makes sense for advertisements and advocacy for the drug to be aimed at these populations. However, HIV is not a ‘gays-only’ disease. HIV does not discriminate. In fact, of those 44,000 newly diagnosed HIV cases in 2014, 24% or nearly one fourth were through heterosexual contact.
Due to the incredibly high efficacy of PrEP in protection against contraction of HIV, most private health insurers and all state Medicaid programs now cover the drug. It is exponentially cost beneficial for these health plans and government health agencies to pay for one drug as prevention rather than paying for lifetime treatment of HIV/AIDS. To increase accessibility to the drug even further, individuals insured by an employer, Marketplace or private commercial plan are eligible for copayment assistance programs that completely eliminate out-of-pocket costs to the patient. In a world where ‘Big Pharma’ can increase the price of a drug more than 400% overnight, PrEP is a welcomed and fresh example of health plans, state governments and pharmaceutical industry leaders coming together to do what they are in existence to do: help and protect the health of their consumers and citizens.
Regardless of health and economic benefits, PrEP is useless unless at-risk individuals are taking it. Despite many Americans’ views, these ‘at-risk’ individuals include more than gay or bisexual men; heterosexual men or women not regularly using condoms during intercourse with partners of unknown HIV status, people who have injected drugs in the past 6 months and have shared needles, people who work in or have participated in drug treatment in past 6 months, and HIV-negative men or women who have an HIV-positive partner. The fact is, anybody can be at risk of contracting HIV; particularly in today’s world of online dating and hook-up apps where sex is only an iPhone away.
It remains a challenge indentifying at-risk individuals until we start having consistent, open, honest conversations with each other and our healthcare providers about sexuality and sexual health. We need greater education and understanding among all medical and healthcare professionals on the uses, benefits, costs, and risks of Truvada, not solely LGBTQ-focused providers. Advertisements and outreach campaigns should not be solely aimed at the LGBTQ community, but also at heterosexual and injection drug use populations, especially in the 20-29 years of age demographic which accounted for 36% of new cases in 2014. We must continue ensuring affordability and accessibility to the drug, especially for low-income groups and those on Medicaid. We need to eliminate the stigma of PrEP users and stop attacking someone’s decision to exercise added caution and protection regarding their sexual health and wellbeing. In doing so, we have a real chance at being the generation to completely eliminate new cases of HIV/AIDS in the United States. The science and the facts are clear: Truvada can help save lives and stop the spread of HIV. But, we all need to do our part. HIV/AIDS is not a ‘gays-only’ disease; we can’t wait around for a ‘gays-only’ solution.