Beam: Increasing awareness of HIV prevention drug

By Amanda Beam

It's been called a game changer, this little blue pill that when taken daily can decrease the risk of contracting HIV by as much as 92 percent.

But why aren't more people in Louisville aware of it?

Groups around Kentuckiana are answering just that as they strive to bring PrEP to the forefront of HIV prevention efforts while trying to save lives in the process.

A pre-exposure prophylaxis, PrEP, known also by the brand name Truvada, continues to gain acceptance in the medical community as one of the pillars of HIV prevention. People who are HIV negative take this medication before coming into contact with the virus to decrease the chance of infection. In 2014, the CDC recommended the drug for those at greatest risk of acquiring HIV and set up protocols for its use.

Using PrEP as directed can decrease the possibility of acquiring HIV by as much as 92 percent for men who have sex with men (MSM) and between 25 and 75 percent for heterosexual couples. Other forms of safer sex protections, such as condoms and dental dams, should also be used while taking the oral medication.

"When I heard about something that can help prevent people from getting infected with HIV, I was like this is a great idea. Anyone who wants this should be able to have it," said Sister Alma Badhabits, a member of the Derby City Sisters.

The local organization promotes LGBTQ rights as well as safer sex awareness. While the Sisters as a group do not have a stand on PrEP, the 37-year-old educates others about the preventative measure.

"The greatest statement about PrEP that you can make is that people are taking responsibility for their health," Badhabits said. "If you know you're in a risk category, why not take the precaution?"

As the co-director of the southeast region of the American Academy of HIV Medicine, HIV specialist Dr. Karen Krigger understands the value of PrEP well. For more than 20 years, the family doctor and University of Louisville professor has been at the forefront of HIV prevention and treatment in Kentucky. She now instructs health care providers in PrEP procedures and has scheduled an upcoming PrEP Summit in Louisville on Nov. 12 for both physicians and the public.

PrEP is "a piece of our armamentarium against HIV," she said. "The World Health Organization predicts by 2030, if we do the things we're supposed to do like identifying those with HIV and linking them to care, making sure they have non-detectable viral loads thereby reducing transmission, and providing those at risk with PrEP, we will have eradicated HIV on the globe. You'll still have positive people, but you won't be having new infections by 2030."

Hitting this goal will require an extraordinary effort. Recognizing those PrEP can help is just a piece of it. Expanding the number of family practitioners and other doctors who feel comfortable writing scripts for the medicine also will be needed. According to the 2015 World AIDS Day Morbidity and Mortality Report, one-third of primary care physicians don't know about the benefits of PrEP.

"Primary care physicians are on a learning curve for PrEP. There are very few people in this city who are actually writing for PrEP, and so they're learning how to do it, and we need to be encouraging of that," Krigger said. "And the public needs to know that it's out there. That one pill a day can reduce the risk of HIV acquisition, not stop it, but reduce it."

Several vulnerable populations fall under these at-risk designations. Couples where one partner is HIV positive and the other HIV negative should inquire about the prescription, as do MSMs who don't use condoms or have had an STD in the prior six months. People of all sexual orientations with multiple sexual partners, those unsure of their partner's monogamy, sex workers and IV drug users and their partners also have a greater chance of contracting the illness.

"If someone is MSM or having a lot of unprotected sex, we want to make sure they are knowledgeable and can access PrEP," said Marshall J. Kellner, program manager for the Volunteers of America's Kentuckiana S.T.O.P. Program, an initiative designed to prevent the spread of HIV in the community.

At their Goss Avenue office, the team provides free and confidential HIV testing, safer-sex supplies and post-test counseling and referrals, including alcohol and drug assessments.

In addition, discussing PrEP with clients who may benefit from the drug has become a priority. While they do not prescribe Truvada from their office nor have resources to fund the medication, S.T.O.P counselors direct those interested to appropriate medical providers as well as to sites that offer financial assistance.

"A lot of times being knowledgeable walking in the door and knowing what you're getting into can really go a long way in building that trust and helping access it," Kellner said.

But the drug remains expensive, especially for those without insurance or Medicaid and Medicare subscribers who enter the coverage gap known as the "donut hole".Gilead, the maker of Truvada, started offering co-pay and cost assistance to increase the drug's availability. Those interested may phone 1-800-226-2056 for more information.

Even with the price of PrEP, prevention still costs less than an HIV diagnosis.

"The cost of Truvada is about $1,700 a month, but that's still cheaper than providing the cost of an HIV-positive patient, which can be up to $80,000 a year," Krigger said. "So it's cost effective to take care of the need for PrEP."

PrEP, though, isn't for everyone. Side effects do occur, and continued monitoring and additional testing after receiving the drug is part of the regimen. At the end of the day, the benefits must outweigh the risks. A good doctor will help patients access these before writing a prescription.

But for those who do qualify, PrEP offers more than just a prevention strategy. It can also give peace of mind.

"We've lived for 35 years now as gay men equating sex with something that could kill you. That's always been in the back of probably every gay man's mind," Badhabits said. "And to be able to take a simple pill every day and have that specter that has been moving over everyone for 35 years, for a lifetime for people, go away is really liberating."

Amanda Beam writes a social justice column that appears every other Sunday in the Courier-Journal's Forum section. Feel free to let her know your thoughts and column ideas by emailing her at adhbeam@icloud.com.