Baton Rouge, Louisiana, had the third highest rate of HIV diagnoses among U.S. cities in 2016, which is an improvement from 2014, when it led the country in HIV diagnoses. However, the Louisiana capital has been among the top four cities for new HIV diagnoses every year this decade, and any progress in the local fight against the epidemic has been achieved without the full muscle of the college town's mightiest entity: Louisiana State University (LSU). LSU First, the school's primary insurance policy, which covers about 70% of LSU enrollees, excludes coverage of the HIV-prevention medication known as pre-exposure prophylaxis (PrEP).
PrEP is the common name for the preventative form of Truvada (FTC/tenofovir disoproxil fumarate), a drug that has been used in combination with other drugs since 2004 to treat people living with HIV. The Centers for Disease Control and Prevention (CDC) says that using Truvada as PrEP virtually eliminates the possibility of acquiring HIV, and PrEP has been widely heralded as a breakthrough due to its potential to help curb the epidemic. LSU First covers Truvada, but only for those already diagnosed with the disease.
"Coverage for Truvada would require a diagnosis of HIV and/or a known suspected possible exposure to the HIV virus (if it is initiated within 72 hours of exposure)," LSU media relations director Ernie Ballard said in a statement to TheBody. "There are several other drug assistance programs offered, but like LSU First, most programs require a diagnosis of HIV."
Ballard also noted the availability of co-pay assistance programs funded by the drug's manufacturer, Gilead Sciences. However, for some LSU students and alumni, by referring its employees to drug assistance programs or community-based organizations, LSU is abdicating its critical role in addressing Baton Rouge's health crisis.
"There are not enough services in Baton Rouge to meet the demand that this city has with PrEP," said Kelvin Dandridge, an LSU graduate who works as a harm reduction navigator at the non-profit Open Health Care Clinic (OHCC). "I'm very surprised to find that PrEP is not being offered through LSU because LSU is such a leading entity in this area, given that I know that they know the statistics and they know what we're being challenged with. We have a multitude of clients who are either employees of LSU or students of LSU, and we've found out the particular insurance that LSU uses does not cover Truvada unless the patient has been diagnosed with HIV."
Since 2016, OHCC has partnered with Baton Rouge's HIV/AIDS Alliance for Region Two (HAART) to link the area's HIV-negative population to PrEP.
"I don't know how aware the health care professionals at LSU are of PrEP," said "Chris," a current LSU student who asked to be identified by a pseudonym to avoid any retribution for criticizing the school. "[M]ost of the folks that I know are aware of PrEP, but … the people I know that take PrEP get it from HAART. Although these amazing resources exist in the community, LSU can also be a resource."
In response to follow-up questions from TheBody, LSU spokesperson Ballard said the university offered coverage of PrEP in five of the eight insurance policies it offers. And, while fewer employees are enrolled in the plans that include PrEP coverage, Ballard said, "[I]n some instances, the [alternate insurance] plans offer a lower deductible than LSU First."
"The initial response was only in reference to LSU First, but we should have provided info on all the plans at that time," Ballard said. "As part of their full-time employment, LSU employees have eight health plans to choose from. Each health plan offers members different coverage options and out-of-pocket costs. Employees are encouraged to choose a health plan that best fits the needs of themselves and their family members."
LSU AWOL in Fight Against HIV?
LSU's somewhat fickle response to whether it offers PrEP is not surprising to Dandridge, who said that the university's commitment to fighting the disease was unclear when he was a student.
"I can remember being 18 and fearing I had been exposed to HIV, and wanting to get an HIV test, and I went to my infirmary that's located on campus," said Dandridge, who added that he was worried about getting an HIV test through his parents' insurance plan. "I wanted to get a completely anonymous test, and I could not get that test done at LSU. It was through a friend that I was referred to the company I'm working for now."
LSU has about 12,000 employees and more than 31,000 students on its main campus, giving it an outsized presence in the town of over 225,000 residents. With Baton Rouge perennially atop the country in HIV/AIDS statistics, Dandridge said LSU remains conspicuously absent from public efforts to fight the epidemic.
"To be honest, I cannot think of any campaigns that they've enacted," Dandridge said. "I know that there are clinics that are under the LSU umbrella, but I'm not sure if they offer PrEP."
Even the problem that Dandridge encountered as a freshman in 2007 persists, he said.
"There aren't even any testing sites where you can go to get tested for HIV," Dandridge said. "I think I can probably count on two hands how many testing sites [in Baton Rouge] test for HIV at no cost, where you can just walk in and receive a test for HIV or other [sexually transmitted infections], for that matter. There are probably five to seven entities that do that. None are directly affiliated with the university."
As part of the school's effort to combat the HIV/AIDS epidemic, Ballard referred to the LSU Health Science Center's Comprehensive Alcohol Research Center (CARC), which conducts "cutting edge basic research on alcohol and HIV that can be translated into effective community-based interventions," but does not offer health services to clients. Nevertheless, Ballard said LSU takes seriously its commitment to the health of its employees and the surrounding community.
"The problems of Louisiana are the problems of LSU," Ballard said. "LSU researchers work each day to help solve the state's problems, whether that is health-related issues being researched at one of LSU's two health sciences centers, the obesity epidemic being researched at LSU's Pennington Biomedical Research Center, or the eroding Louisiana coastline that is being researched daily at the flagship campus in Baton Rouge."
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Lack of PrEP Coverage Could Lead to "Vicious Loophole"
TheBody reached out to all 14 schools that comprise the Southeastern Conference (SEC), LSU's direct competitors in athletics, faculty recruitment, and campus life. All six of the schools that responded -- Auburn University; Mississippi State University; and the universities of Florida, Kentucky, Mississippi, and Missouri -- indicated they include coverage of PrEP in their insurance policies. Representatives for Texas A&M University; Vanderbilt University; and the universities of Alabama, Arkansas, Georgia, South Carolina, and Tennessee did not respond to questions about PrEP coverage.
Chris, the current LSU student, said it is "frustrating" that LSU lags behind many of its peer institutions in covering PrEP, and that, "LSU's insurance should offer it flat out."
Men who have sex with men are the demographic most closely associated with both the HIV/AIDS epidemic and the dawn of PrEP as a barrier to the disease, and Dandridge wonders whether that linkage contributes to LSU not battling the disease with the same vigor that it displays towards athletics.
"People in Baton Rouge think that HIV is a gay man's disease, particularly a gay black man's disease, and unfortunately, that's not true," Dandridge said. "I think that it's a mis-education issue, which is one of the reasons the epidemic in this area is so high. People think that they are not susceptible; they feel as though HIV is not something that affects them. If you're sexually active, you have a possibility of contracting HIV. So, being tested and being given preventative measures is not something for gay men or gay black men, but is something for everyone."
LSU has taken steps to address the needs of LGBTQ students, including designating about 70 bathrooms across campus gender neutral and expanding the school's Safe Space program, but the school "doesn't do nearly enough" to recruit and retain LGBTQ students and faculty, Chris said.
"LSU has improved a lot, even over the past two years, and that's because the faculty here who are queer, and some of the students, both graduate and undergraduate students, do a lot of laboring and pushing the university to respond to us, to respect us, and to support us," Chris said. "There's no one person that is dedicated to queer folks. The position that's dedicated to queer students is a graduate position. We've been pushing for there to be a center for years, and there needs to be a director of that center."
Ballard denied that LSU's position on PrEP was in any way related to the drug's association with gay men.
"Gender and sexual orientation are not criteria that are considered when determining if a member would qualify for coverage for Truvada," Ballard said.
However, an LSU employee who does not have access to PrEP through LSU First could have difficulty trying to obtain the drug from outside sources, Dandridge said.
"If you are a working individual with insurance, it becomes a lot harder, because they don't waive certain labs that need to be done; they also don't waive the prescription of the medication," said Dandridge, who added that there are limitations to the Gilead co-pay program that has provided PrEP to many for little or no cost.
"The co-pay card has a limited amount, and we've found that we're running out of money on that co-pay card before the end of the year is up and it's renewed, and we have to seek outside entities like private organizations, the majority of which are out of state, and we have to seek their help to make it to the end of the year," he said. "We've found where some insurances will not let them use the co-pay card with their high-deductible plan -- meaning they have to meet that deductible out of their pocket, and [the insurance company] won't allow Gilead or any other private entity to come in and help them reach that deductible, which is another barrier to care."
Facing the decision of whether to pay a three or four thousand-dollar deductible or take care of basic necessities, such as utilities or car insurance, some Baton Rouge residents have had to go to extreme measures to protect themselves from HIV, Dandridge said.
"It's seriously a vicious loophole that they get trapped in, and we're using every effort we can to rectify the situation and get them the medicine," Dandridge said. "We've been successful with a lot of cases; however, there are some individuals that we've had to consult with clinics in Canada to try to get a generic form of medicine sent down because they just can't afford it, and their insurance is not allowing them to meet their deductible."
Jean Redmann serves as director of prevention at CrescentCare, another community-based organization in Baton Rouge that operates a PrEP clinic. While she was careful not to comment about LSU's policies, Redmann deemed PrEP a critical tool in Baton Rouge's fight against the epidemic.
"There are multiple barriers for people to access health care, not just PrEP," Redmann said. "We do our best to find ways to overcome those barriers so our clients can get the services they need. As an agency that has long been on the forefront of the battle against HIV/AIDS, we follow the science, and that science clearly shows that we now have the tools to end the epidemic."