May 6, 2014
I sit waiting at a coffee shop in the Central West End at the Washington University in St. Louis Medical School. This meeting, like most these days, are spent working on strategic planning for implementing PrEP (Pre-Exposure Prophylaxis), a one-pill-a-day drug regimen that has been shown to be up to 99% effective in preventing HIV infection. People slowly trickle into the working group and we start to address the task at hand. Who could benefit the most from access? Believe it or not, it is not those who are waging a moralistic attack on whether or not it should be used. For the most part, it is not even the people who will read this article or who are on social media. That is because the people who could benefit the most from PrEP are limited on resources. The young, black male who has sex with men or the Latino ages 13-24; that is who are falling casualty of this absurd power struggle.
PrEP provides added protection when used within a sero-discordant relationship. Recently released data from the PARTNER study showed that within a sero-discordant relationship that ensuring viral suppression of the positive partner's viral load protects the negative partner. So then who would the ideal person be that would consider utilizing PrEP? It would be those who are engaging in high-risk sexual behavior; if you are sexually active and HIV-negative then PrEP is indicated for you.
The real casualties are not the ones who are voicing their opinions in this battle of public perception that is being waged in the media and across social media. Interestingly enough, I do not see these same talking heads delivering the diagnosis to an 18 year old African American male who tests positive for HIV. I do not see Michael Weinstein working in an STD clinic consoling a young Latina who now must adjust to life as an HIV-positive woman. Although I want gay men to have access to PrEP, this is not something that should be exclusive to privileged white gay men. Thankfully, as a result of the Gilead patient assistance program (PAP), those who cannot afford the medication will get it provided to them. There is also assistance to help pay for physician co-pays for office visits.
PrEP clinics are springing up across the United States and I am proud to be working to organize the first one in St. Louis. Physicians can cure sexually transmitted infections such as syphilis with a dose of penicillin, HIV however cannot at this time be cured. We can, however, do more than simply sending a person away from clinic with a bag of condoms that may or may not be used. PrEP is included in a total risk reduction strategy which includes reducing risky behavior, regular STI/HIV screening, and as well as monitoring adherence to the medication.
As I sit in the working group I realize that the talking heads who are railing against PrEP are irrelevant, holdovers of a bygone era. The work that we are doing to provide PrEP to those who will benefit the most is marching on. You say "Michael Weinstein" and I say, "Michael Weinstein" who? My clients do not know who he is and conversely they do not care. We will continue to treat the real casualties of this PrEP battle, interestingly enough these are the same people that many seem to forget or let fall through the cracks. I am guessing that young black men and Latinos aged 13-24 weren't invited to that party.