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PrEP forum examines getting more physicians on board
by Matt Simonette

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Health-care providers, advocates and community members gathered, on Oct. 1, at University Center, 525 S. State St., to discuss both the specifics of pre-exposure prophylaxis, or PrEP, and the hurdles stakeholders face in making it more widely available to those who would benefit most from it.

The oral medication Truvada was approved for use as a PrEP intervention in 2012. Studies have shown that, with strict adherence to the prescribed regimen, chances of HIV-infection are reduced by more than 90 percent when a patient uses Truvada for PrEP. But Truvada's high cost, insurance approval difficulties, and low awareness among community members and service providers have been among the barriers to its wider use.

Many present at the forum felt that spreading the message about PrEP to medical personnel, specifically those who were not HIV/AIDS or infectious-disease specialists, stood as a key to its eventual success in significantly reducing new infections. Persons interested in PrEP—especially if they are not comfortable speaking to their primary care provider ( PCP ) about sexual health—will often seek out another physician or institution well-versed in PrEP, or get referred there if their PCP isn't comfortable writing the prescription. But any physician or nurse practitioner can prescribe PrEP, said Jim Pickett, director of prevention advocacy and gay men's health for AIDS Foundation of Chicago.

"If [patients] have a PCP, they can get PrEP," he added.

Kristin Keglovitz Baker, chief operating officer at Howard Brown Health Center, emphasized that implementing a PrEP program for a patient requires just a small level of commitment on the part of a primary care physician: confirming that the patient is indeed HIV-negative when they start the treatment, and testing for Hepatitis C and normal kidney functions. Patients must undergo regular blood tests once they start taking Truvada as well.

Community buy-in for PrEP has been most prevalent from middle-aged gay men, but they are not the demographic that is hardest-hit with new HIV-infections right now. Among those groups advocates think might benefit from the intervention are young gay men, especially ones of color; heterosexual Black women and transgender women. But those are demographics often facing extenuating circumstances that make it difficult to stay on a continuum of prevention and care.

One audience member, a nurse at a South Side hospital, said that it was especially important to get the word out about PrEP among nurses, since they do informational intakes and spend the most time with patients. "Nurses are the true providers on the South Side of Chicago," she said.

Pickett agreed, adding, "That's the hard thing—getting it outside the HIV 'bubble.'"

Oni J. Blackstock, M.D. assistant professor in the department of medicine at Albert Einstein College of Medicine in Bronx, New York, said that physicians will be more comfortable discussing PrEP when they become more comfortable discussing LGBT-related issues in general—most medical students get about five hours of training on LGBT health.

"There's an awareness that providers need to step up, but it's going to also entail changing how we do our medical training," Blackstock noted. "There's going to have to be a paradigm shift."

Christopher Cannon, senior manager for the organizations National Coalition for LGBT Health and HealthHIV, moderated the panel.

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