It seems almost a miracle. Taken daily and combined with condom use and basic safe sex practices, a new HIV prevention medicine called PrEP has proven to be more than 90% effective in preventing the transmission of HIV through sexual activity. Less data is available regarding needle transmission, but new studies show PrEP at least 70% effective there, as well.
“For those of us who’ve been involved in the fight against HIV for decades,” says Mike Gifford, president and CEO of the AIDS Resource Center of Wisconsin (ARCW), “this is the promise we’ve wanted for 30 years—to give our friends, families and loved ones the medicine that could prevent them from contracting HIV to save their lives. We now have that very powerful prevention tool, and we need to make sure that people in need are aware of it and get easy access to it. ARCW is very pleased to offer PrEP to anybody who is interested, regardless of their ability to pay.”
PrEP, an acronym for Pre-Exposure Prophylaxis, now comes in the form of an FDA-approved, one-pill-daily medication called Truvada. Each pill combines two drugs currently used in the treatment of people who are HIV positive. “The idea,” Gifford says, “is to provide people at high risk of contracting HIV with medicine you would typically provide to somebody living with HIV, to prevent individuals from contracting HIV in the first place.”
Dr. Leslie Cockerham, ARCW’s medical director, emphasizes the need for consistency of usage with PrEP. “I tease my patients by saying, ‘the drug only works if you take it.’ Ideally, you take it every day to maintain the level in your body necessary to prevent HIV transmission. Some of the international studies have had a lower efficacy rate, but when they went back to look at the patients, many who got HIV didn’t have the levels of the drug in their system needed to protect them because they weren’t taking it very often at all,” she says.
According to the Centers for Disease Control and Prevention (CDC), PrEP reaches maximum protection from HIV for receptive anal sex at about seven days of daily use, and for all other activities at about 20 days of daily use.
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Who should consider the medication? “There are many different reasons why people might take it,” Cockerham says. “Certainly, we know that men who have sex with men are at increased risk of acquiring HIV. Heterosexual men or women might have an HIV-positive partner, and that might be a reason they should be on PrEP. Individuals having multiple partners who don’t always know the status of their partners might choose to protect themselves. Injection drug users, especially if they share needles, would be at high risk.”
ARCW has been providing PrEP to its patients since the fall of 2015. Awareness of the medication’s existence and its benefits is slowly growing. “We’re really trying to get the word out,” Dr. Cockerham says. “There are people who don’t know about PrEP or who are not sure where to get it.” This may be in part because of stigma associated with the activities that put people at risk.
Dr. Cockerham pointed to a further complication: “Sometimes, people don’t necessarily see themselves as being at risk if they’re not engaging in what one would normally think of as risky behavior, such as having multiple sex partners. But you only need to have sex once, or have one partner who is infected, to actually get HIV. So, we’re really trying to change the assumption that you only need PrEP if you’re doing risky things or you’re ‘that type of person.’ That’s not at all the way we think. We want people to feel empowered—to have control over their sexual health and be empowered to protect themselves,” she emphasizes.
“If people have questions about its efficacy or its affordability, we’ll take the time to work through those questions and to work through any obstacles that might come up with insurance or lack thereof,” Cockerham says. “We really do try to serve everyone. It doesn’t mean that it’s always exactly free, but we try to make sure that finances are not a barrier if at all possible. The first step is to make sure people know about it and know where to go to get more information and see if it’s right for them or not.”
For more information, call the AIDS Resource Center of Wisconsin at 414-273-1991 or visit arcw.org. Additional information about PrEP itself is available on the CDC website at cdc.gov/hiv/basics/prep.
