The Promise of the Pill

It's blue, and a pill. It's tied to sex, but it's not Viagra. It's Truvada. And although it's been approved by the federal Food and Drug Administration (FDA) for use as an HIV-preventative — and a highly effective one at that — since 2012, access, education and uptake is lacking in Michigan.
"We've had 10, maybe 15 calls for PrEP," said Victoria Cammarata. She's a social worker employed at the Thomas Judd Center in Traverse City. That demand, combined with possible outbreak of HIV among people who use needles to use drugs, specifically opioids, in 11 counties served by the center, has led the agency to open Northern Michigan's first PrEP clinic, called PrEVENT. It official opens on Dec. 1, World AIDS Day.
Until then, the nearest clinical practice prescribing PrEP was located in Clare county, according to data from the state of Michigan.
When the Centers for Disease Control and Prevention released prescribing guidelines for the drug in 2013, an estimated 500,000 people should have gone on the drug. Damon Jacobs, a licensed counselor in New York and founder of the Facebook group PrEP Facts: Rethinking HIV Prevention and Sex, said the most recent numbers, from the end of October, of prescriptions for PrEP released by Gilead, the drugmaker, show nationally 145,000 or so people taking the drug.
Jacobs said the drug is taking off in "little enclaves" like San Francisco, Portland, Chicago, Boston and New York City.
"And consequently a lot of these cities are reporting significant decreases in new HIV diagnoses," he said.
But those numbers reveal a more complicated issue at play in America. There is a racial disparity among those who are accessing and using PrEP, he said.
"White men don't make a significant amount of new HIV diagnoses in the US, whereas African Americans make up, I think the numbers were like 44 percent of new HIV diagnoses in the U.S.," he said. "But only 10 percent of PrEP consumers. So that's a really glaring disparity which tells us something is serious. It tells us that the information, the education, the access is not happening amongst communities and geographic regions where it really needs to happen if we're serious about the whole end of HIV thing."
State health officials were unable to provide a breakdown of the racial makeup of persons in Michigan on PrEP. However, they said from January to September of this year, 1,951 referrals for PrEP were made statewide. Wayne County agencies represented 1,044 of those referrals. Erica Quealy, a spokeswoman for the Michigan Department of Health and Human Services, said that number is almost certainly an undercount because of the way the state is currently tracking referrals.
According to information shared with the city of Lansing for a World AIDS Day resolution, one provider in Ingham County is currently providing PrEP to about 150 people. Of those, 80 percent are white, while the remaining 20 percent are about evenly split between black men who have sex with men and Asian men who have sex with men.
Katie Macomber, director of the Michigan Department of Health and Human Services HIV/STD Programs, said the state spends very little money on PrEP. It has a grant from the CDC to scale up PrEP advertising in Wayne county, which it has done for the last two years.
"We're expanding that in January to other markets in the state because we saw that it was really successful," she said of the media campaign.
But that perception is challenged by Curtis Lipscomb who is the executive director of LGBT Detroit, an African-American group focused on the same gender loving and transgender communities in Detroit.
"The average African American gay male that I come across in Detroit, Michigan, does not know the acronym of PrEP," said Lipscomb. "AIDS organizations in Detroit Michigan have no public displays of education prominent and often around that. They may see an STD clinic announcement from our health department, but PrEP and other types of treatment to prevent HIV infection is not commonly displayed."
Despite this lack of presence, Lipscomb said there is a request for "space for PrEP and test education."
Data from the state of Michigan shows that of the state's 83 counties, 11 have one or more providers offering to prescribe the once a day pill that is up to 99 percent effective in preventing a person from acquiring HIV. That data shows only 21 named medical providers who are writing the prescription in those 11 counties, with an additional three health systems recorded. According to Michigan's Licensing and Regulatory Affairs (LARA) department, over 40,000 people in Michigan have current licenses as doctors in the state.
Cammarata said her group decided the demand for PrEP was clear but the providers were not willing to prescribe the prevention drug. The Judd Center stepped into that vacuum without outside funding to create the PrEVENT Clinic. The clinic expects to serve 100 to 150 high risk individuals in its first six months of operation, she said.
"We were having people call different primary care providers who were calling us and asking if we knew anybody in the area prescribing it," she said. "Everyone was referring to the infectious disease provider, even though primary care providers can easily do it. There was this great influx of young people asking for the medication. There wasn't the response that they were looking for."
Macomber said state health officials have been working on that response by doing provider training and education with its limited resources.
The need, however, remains. And the Judd Center is stepping in.
"We felt like the rest of the state was ten steps ahead of Northern Michigan," she said. "We realized that it's a great need up in our area, that there's nothing like that up here."


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