According to the World Health Organization ( WHO ), an estimated 75 million people have been infected with HIV since the onset of the epidemic. Approximately 36 million people have died. WHO notes that—as of 2012—the numbers of deaths are on the decline. It credits the increased availability of antiretroviral therapy and fewer new infections since peak numbers reported in 1997.
Two years ago, the FDA ( Food and Drug Administration ) approved the antiretroviral drug Tenofovir/emtricitabine, or Truvada, for use as a pre-exposure prophylaxis ( PrEP ) in people 12 years or older. As a preventative tool taken daily by an HIV negative person before exposure to the disease, studies have estimated that Truvada has provided reduction in risk of exposure by more than 90 percent. It does not protect against other sexually transmitted infections ( STIs ) and it cannot simply be used in a single dose the night before or the morning after an encounter.
There are still many questions people have about the drug. Is it a cure? How does it work? What are the side effects? Can it replace condoms as a preventative measure? How expensive is it? Where can people find it?
On June 10, the AIDS Foundation of Chicago ( AFC ) partnered with the Chicago Department of Public Health ( CDPH ) to hold a workshop ( "Get Ready, Get Set, PrEP" ) at CDPHs offices to answer those questions for community-based organizations, allies and city employees. By the time the workshop began, there was not an empty seat to be found.
The AFC's Jessica Terlikowski has made HIV prevention her life's work—whether advocating for the use of female condoms or ensuring that information about the AIDS Drug Assistance Program was disseminated as widely as possible.
"AFC has always been committed to expanding prevention options and advancing the types of interventions available," she told Windy City Times. "PrEP is an option we have right here, right now and it's critical that women and men learn about PrEP and that the providers serving the communities who are at risk understand it so that we can increase the number of people who will benefit from using it."
Jose Guillermo Gonzalez is a public health administrator with the CDPH. "We're talking to organizations that will be getting the word out that there's at least one more option that we didn't use to have for people to take to protect themselves," he said.
On May 14, the Centers for Disease Control and Prevention ( CDC ) released a series of guidelines on the use of PrEP for the prevention of HIV infection in the United States. "Now that those guidelines have been released, it's a really big step forward," Terlikowski said.
PrEP is not a cure for HIV. Instead it protects CD4 T-cells from attack by the HIV virus. The virus cannot enter the cells and, so, cannot replicate. The drug needs at least seven days to build up an effective defense and does not work on people who are already HIV-positive. Thus far, side effects that have been reported include nausea, loss of bone density and a slight risk of kidney problems that abate if the drug is stopped. The cost for Truvada can be more than $1,000 for a month's supply.
"I'm having a time wrapping my mind around PrEP" one attendee said. "If I say 'take PrEP,' then I hear 'then why do I need to wear a condom?' People need to wear a condom to protect against other STIs. To me, the condom supersedes everything."
Terlikowski and her team of speakers were clear that they are not telling anyone to stop using condoms in favor of PrEP or declaring it a better form of intervention than other methods.
University of Illinois at Chicago Associate Professor of Medicine and Epidemiology Dr. John Schneider explained that PrEP is not only an additional form of protection but can provide an alternative when condom use is not possible. "There are barriers to condom use," he said. "Such as in relationships where there are power dynamics. We always need to work with clients to make sure that they are safe."
As far as availability of the drug, Schneider explained that CountyCare—a medicaid program for uninsured adults in Cook County—helps cover the cost of the drug, as well as a number of insurance companies. The drug's developer Gilead also offers financial assistance.
"There is a stigma around PrEP," Terlikowski said. "A lot of that has to do with folks not being well informed first. That's why we start our training talking about oral contraceptives, needle exchange and female condoms. All of those things have had a stigma associated with them. So—by addressing them—we are able to get people to be more willing to talk about PrEP."
There is a number of other PrEP options currently in the research pipeline, including vaginal tablets, rings and rectal gels; longer-acting injections; and even a thin film polymer.
"The AFC has been advocating for vaginal and rectal microbicides which is something we still don't have but are still going to push for," Terlikowski noted. "Because women and men need as many options as possible."
For more information, go to www.myprepexperience.blogspot.com .
