AIDS United Public Policy Committee (PPC), the largest and longest-running national coalition of community-based HIV/AIDS organizations, is calling for the scale-up of pre-exposure prophylaxis, or PrEP. PrEP involves a once-daily medication that when taken as directed, reduces the risk of HIV infection by upwards of 90 percent.
Lifelong, a member of PPC, is committed to promoting PrEP as a critically important prevention tool for people faced with substantial risk of HIV infection. Currently only a few thousand individuals are using PrEP nationwide, though the CDC says that at least 500,000 people could benefit from using it.
“PrEP is an important tool in meeting the goal of reducing infection rates outlined in the U.S. National HIV/AIDS Strategy,” said Randall Russell, CEO of Lifelong. Russell is a Leadership Circle member of the PPC and an AIDS United board member. “It is one of the many HIV prevention tools that exist to reduce the risk of HIV infection. Other strategies include increasing healthcare access, supporting HIV-positive individuals in their treatment adherence, encouraging regular HIV testing, supporting anti-stigmatization campaigns, and increasing HIV prevention education in at-risk communities.”
The response comes on the day of the four-year anniversary of the iPrEx study ― the first randomized controlled trial that found PrEP effective in reducing HIV infection risk. Two years later in 2012, the Food and Drug Administration approved Truvada as PrEP. Earlier this year, the Centers for Disease Control recommended the use of PrEP for those at substantial risk of HIV infection. Furthermore, preliminary findings from two ongoing studies of PrEP in Europe, PROUD and IPERGAY, both bolster the growing evidence for the effectiveness of PrEP. While not appropriate for everyone, it is clear that, when taken as directed, PrEP can significantly reduce new HIV infections. Time for debate on the effectiveness of PrEP is over.
For many, a barrier to taking PrEP is the out-of-pocket cost. Even with the Affordable Care Act, many people find it difficult to afford the co-insurance. In Washington State, the Department of Health’s PrEP Drug Assistance Program (PrEP DAP) covers the cost of the medication for eligible individuals interested in using it to reduce their chance of HIV infection as prescribed by their doctors, regardless of whether they are insured. Washington State is leading the nation in access to PrEP through this program.
“The accessibility of PrEP through programs like PrEP DAP gets us even closer to ending AIDS in Washington State once and for all,” states Russell. “Forty-five thousand people become infected with HIV each year, 518 in Washington State. This is a number that has been on the decline for a decade. Fully scaling up PrEP is an opportunity to continue the momentum.”
While the body of science showing PrEP to be effective has grown, it remains unknown and underutilized by people most likely to benefit from it. An August 2014 study by the Kaiser Family Foundation found that 80 percent of gay and bisexual men knew “only a little” or “nothing at all” about this important HIV prevention tool. To make an informed decision about PrEP, people most at risk for HIV infection need to be made aware that this tool in the HIV prevention toolbox exists.
Lifelong and fellow AIDS United PPC Members are moving beyond debate as to whether PrEP should be supported, and are now focusing on how to scale up its use. Local efforts going forward include raising awareness among our consumers of the benefits of PrEP, reducing financial barriers through connection to the PrEP DAP and other insure programs, and promoting use of PrEP to the HIV negative community through education and outreach.
The PPC invites other AIDS service organizations and HIV advocates to share their experiences, barriers, and perspectives about what will be required to fully scale-up PrEP using the social media hashtag #PrEPWorks.
“People need all the facts to make informed decisions about their sexual health. PrEP is not a perfect solution for all people, but it may be just what some people need. AIDS United and our PPC member organizations are committed to increasing awareness and working to eliminate barriers to access for all people who could benefit from this important prevention tool. PrEP will be part of ending the HIV/AIDS epidemic—but only if we can implement it widely,” said Michael Kaplan, President and CEO of AIDS United.