WASHINGTON — Although studies have shown that a preventive treatment for HIV is highly effective, experts are concerned that the drug is still not being used enough. HIV infection rates remain high, especially among African-American gay people.
The treatment, called pre-exposure prophylaxis (PrEP), is an antiviral pill taken once a day. Combined with safe-sex practices, doctors say, the drug reduces the risk of HIV infection.
Supporters of the treatment recently met and discussed its benefits at the National Black PrEP Summit, organized here by the Black AIDS Institute.
The anti-HIV drug is called Truvada, manufactured by Gilead Sciences in Foster City, Calif. The Centers for Disease Control and Prevention (CDC) advises HIV-negative people at substantial risk of infection to take this treatment.
However, critics argue that the drug would foster careless and risky sexual behavior among HIV-infected people.
Anthony Mills, executive director of the Men’s Health Foundation, which is part of a national network funded by the CDC to implement HIV-prevention strategies, said that studies have proven that the use of this pre-exposure treatment does not tempt people to change preventive behavior.
“If people come into a trial using condoms, they often continue to use condoms. If they come into a trial not using condoms, let me tell you something: they are not going to start using condoms,” Mills said.
A recent study conducted on 657 men in the Kaiser Permanente San Francisco Medical Center found that pre-exposure prophylactic treatment prevented new HIV infections. The study, conducted over two-and-a-half years, was recently published in the journal Clinical Infectious Diseases.
The U.S. health care system, however, has yet to catch up. The HIV prevention pill is not covered by insurance in many states.
African-American gay men still find it hard to obtain this type of HIV treatment because they fear they will be stigmatized and because of the cost.
“If a person were to pay the full price of the medication out of pocket, which is almost never required, Truvada costs about $1,400 a month,” said Dawn Smith, epidemiologist in the division of HIV/AIDS prevention at the CDC, and a speaker at the summit.
She said that Medicaid coverage for the drug varies among the states.
“There are 19 states that have decided that they don’t plan to take the federal funding to expand Medicaid,” Smith pointed out. “You will know that that includes most of the southern states, which are the states that have the highest rates of new infections, particularly among African-Americans.”
HIV diagnoses in 2013 revealed that the highest number of cases were among black people. Although they constitute only 14 per cent of the population, the absolute number of African-American gay men diagnosed with HIV was greater than the number of white or Hispanic men that year.
Blacks constituted the majority among people living with HIV and people who died of HIV at the end of 2012, according to the CDC.
“Whether we are talking about new infections, which is what we focus on when we are talking about PrEP, or whether we are talking about dealing with the health outcomes for people who already have HIV infections, our community is suffering extreme disparities, and I would argue, extreme inequities,” said Smith, who is African-American.
She said that more awareness had to be created about the types of insurance coverage available for the preventive treatment and that the drug constituted 85 per cent of the treatment costs (the rest is lab tests and clinic visits).
For low-income residents who don’t have insurance, Gilead provides an assistance program under which Truvada is offered at no cost.
The military is often forgotten in terms of this treatment, Smith said. Although there are many high-risk patients in the Veterans Affairs system, not a lot of information is available.
“We don’t know how many persons are receiving PrEP through the VA,” she said.
Ron Simmons, founder and CEO of Us Helping Us, a support-group for black gay men living with HIV, said that the HIV prevention pill was safe and that it was important to know its side effects.
Clinical studies of the HIV prevention pill has shown that early side effects could include an upset stomach, loss of appetite, or a headache, according to AIDS.gov, which is managed by the U.S. Department of Health and Human Services. But these symptoms were mild.
Simmons said that the AIDS assistance program was available in the District of Columbia and that it is best to start the treatment as early as possible after patients find out that they may be at risk of getting HIV-infection.
Maryland also has its own AIDS Drug Assistance Program (ADAP).