#BlackSexualHealthMatters: Understanding The Role of PrEP In HIV Prevention

Sep 01, 2015   ·  Black Doctor  ·  Link to Article

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For the past two months the hashtag #BlackSexualHealthMatters has been a major push of the National Coalition for Sexual Health (NCSH) and the campaign couldn’t come at a greater time. The NCSH, which consists of over 50 leading health and medical organizations, issued a call-to-action to increase the use of essential preventive sexual health care services in the Black community. Backed by the CDC and several other health organizations across the nation, the NCSH has been monitoring the newly found cases of HIV arising in the African American community and the numbers are staggering. It is estimated that 1 in 16 Black men and 1 in 32 Black women will be diagnosed with HIV yearly, yet more than a third of the African American community has never been tested for the virus.

It appears that most of the newly diagnosed are contracting the virus unknowingly from partners that are unaware of their status, but for the couple that is aware of the positive status of one partner, there is a way to prevent the spread of HIV to an uninfected partner along with condom usage thanks to the use of PrEP (short for Pre-exposure prophylaxis).

Approved by the FDA in July of 2012 as a result of rigorous testing that has proved effective in preventing the spread of HIV to an unaffected partner if used regularly along with condoms,  the pill Truvada (brand name) is a viable option for the at risk.

There is a great deal of information that the general public hasn’t yet adopted about the PrEP but NCSH member and executive director of Project Inform Dana Van Gorder has all of the knowledge down to a science. I had the chance to speak with Van Gorder about the benefits and side effects of PrEP, as well as the information one should share with their health care provider about this new form of HIV prevention.

If you are an individual at risk for HIV contraction or know someone who is at risk, take a look at Dana Van Gorder’s advice on how to prevent the spread of HIV and support the #BlackSexualHealthMatters campaign by educating yourself and getting tested.

Facts about HIV prevention and PrEP the public should be aware of:

“The world doesn’t currently have a vaccine to prevent HIV infection, although much work is being done to create one. But there are extremely effective ways to avoid getting HIV – and for HIV-positive people to pass it to others. Using condoms consistently for intercourse continues to be one proven way. HIV-negative people are recommended to use them with an HIV-positive partner, or a partner whose HIV status they aren’t 100 percent sure about.”

“Here is another way of preventing HIV:  HIV-positive people are able to greatly lengthen their lives, AND can be up to 96 percent less likely to infect their partners, if they know their status and are effectively treated for HIV.  That means taking HIV medications on a daily basis, as prescribed, and fully suppressing the virus. This is why the Obama administration is leading a major effort to make sure that everyone is tested for HIV, and that HIV-positive people are actively engaged in medical care and treatment.”

“But one other VERY exciting and effective new way to prevent HIV that all sexually active people should know about – especially black men who have sex with other men, and black women – is Pre-Exposure Prophylaxis, or PrEP. PrEP involves having an HIV-negative person take a medication called Truvada every day in order to prevent getting HIV. Studies have shown that, when taken every day, PrEP can be up to 92 percent effective in preventing HIV.”

“PrEP may not be for everyone.  But it can definitely help a lot of people who are working to stay HIV-negative.  Truvada does have some side effects, but for most people they are pretty minor. Doing it as recommended includes seeing a medical provider every three months to make sure you are tolerating it and that it is working for you.”

“It’s important to know that many public and private insurers WILL cover the cost of PrEP.  And, the company that makes Truvada, Gilead Sciences, has programs to provide free medication if someone doesn’t have another way to pay for it.”

“Another thing to know about PrEP is that people who can benefit from using it have every right to choose it. Sometimes family, friends or medical professionals argue that everyone can and should use a condom every time. But that’s not always that easy to do.  Truvada has been approved by the FDA, and the Obama administration has recommended that people at risk for getting HIV consider using it. Anyone who IS thinking about it and decides to DO it should stick up for themselves. It’s not bad to be on PrEP.”

How PrEP can benefit those who are at high risk of HIV infection:

“Most importantly, PrEP can definitely prevent an HIV-negative person from getting HIV if they take it on a daily basis. It’s not as easy as using condoms each and every time, but it is a perfectly sound option for a lot of people. Most of us aren’t at risk for getting HIV for our entire lives, but we can go through times when it is harder to be safe. During those periods, PrEP is a perfectly acceptable option to consider.”

“One really great benefit of PrEP is that it gives HIV-negative people a lot more control over HIV prevention than they may otherwise feel they have. Women and gay men sometimes have a difficult time asking or making sure their sex partners use a condom. It’s still a good idea to use condoms when on PrEP to make it even less likely that you will get HIV. But if there is any reason that a person can’t use condoms consistently, PrEP is absolutely worth considering.”

“Another significant benefit of PrEP is that many people who use it end up feeling less anxious about HIV. This can help them to think through how to make better sexual choices. So, PrEP can give you the mental and emotional space to become more proactive about your sexual health.”

On questions about PrEP for the “at risk” to ask their health care providers:

“PrEP is only for HIV-negative people.  So, the first thing to ask a provider for is an HIV test. It’s good to review possible side-effects of PrEP with a provider, and also to talk about what kind and schedule of regular check-ins are needed to monitor PrEP use. Because it is so important to making PrEP work correctly to take it every day, it can be really helpful to talk to your provider about helpful strategies to remind you to stick to a schedule.”

“Sometimes, people are concerned about using PrEP because Truvada is also a medication for treating people who are HIV-positive. But compared to getting HIV, people interested in PrEP should work this issue through.  A good medical provider will definitely help you to develop a strategy to do that.  That might include putting your Truvada in a different container, and thinking about where it’s best to store it.”

“Perhaps the most important thing to ask your health care provider about is whether he or she thinks you could benefit from using PrEP as part of taking care of your health, including your sexual health. A good provider will be willing, and even encourage you to talk to them about your sex life so that they can help you with any issues you might have. You have a right to expect your provider to have an honest conversation with you about this critical part of your health and happiness, and to be non-judgmental about it.  If they can’t, you also have a right to find a different provider.”

The persons who would benefit from the use of PrEP:

“Again, most HIV-negative people who are sexually active probably don’t need to think about PrEP.  But people who might think about using it do include black men who have sex with other men, and black women.  Both groups, unfortunately, are getting HIV at rates higher than the rest of the US population.”

“Men who receive during anal intercourse – especially if they find that condoms break or have a difficult time using them consistently – should think about PrEP. Anyone who experiences a sexually transmitted disease like gonorrhea or syphilis should seriously consider it. Also, anyone who has difficulty getting partners to use condoms when they wish to use them, or has been forced to have sex might think about PrEP. And lastly, while HIV-positive people who are effectively treated for HIV are much less likely to pass the virus on to their partners, HIV-negative people who regularly have sex with positive partners may want to consider PrEP.”

On the side effects of PrEP:

“Most people who take Truvada don’t experience side effects. But short-term side effects may include headaches, weight loss and stomach problems like nausea, diarrhea and stomach ache. These occurred in about 1 out of 10 people, and most went away after the first few weeks of taking Truvada.”

“People with current kidney disease should not use PrEP.  A few people using PrEP have had minor problems with kidney health, which got better when Truvada was stopped. Those who do use PrEP should have their kidney health checked regularly with a simple blood test. Minor bone density loss also occurred for a small number of people.”

“As for longer-term side effects, we don’t yet have data on long-term use of Truvada in HIV-negative people.  But we do have a lot of experience with Truvada in people who are HIV-positive, and it has been found to be quite safe and well-tolerated.”

Advice for partners who have potentially been exposed to HIV:

“It would also be good for people who are sexually active, and who consider themselves to be at risk for HIV, to know about something called POST-Exposure Prophylaxis, or PEP.  PrEP is done BEFORE having sex – every day, as we said earlier. PEP is something people do AFTER they think they may have been exposed to HIV from unsafe sex. PEP involves taking a combination of three anti-HIV medications to reduce the chances of actually becoming infected.  It is critical to start PEP within 72 hours of having a risky episode, and take the medications every day for a month.”
For more information about PrEP and Project Inform visit www.projectinform.org and visit ncsh guide for more information on preventative services for men and women.

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