But a new preventive drug is poised to make an enormous difference. And APHA members are on the ground making it happen right now, in spite of the barriers.
Pre-exposure prophylaxis, or PrEP, is a preventive strategy that lowers the risk of HIV infection by up to 92 percent among people who adhere to its guidelines, according to the Centers for Disease Control and Prevention. The strategy includes regular HIV screenings, medical monitoring, sexual health consulting and daily intake of Truvada, a drug approved by the U.S. Food and Drug Administration in 2012.
The bad news is that many obstacles stand in the way of people gaining access to PrEP. The good news is that Chicago’s public health workforce is demonstrably fixing the problem, as evidenced during a Wednesday morning session on “Keeping PrEP’s Promise: A Windy City Approach to a New HIV Prevention Paradigm.”
“We’ve enrolled over 200 patients to date,” said Sybil Hosek, PhD, of the John Stroger Hospital of Cook County in Chicago, which opened a PrEP clinic in April. “Our ultimate goal is to provide PrEP to whoever needs it whenever they need it.”
It’s not possible for the hospital to do this right now for a variety of reasons, such as electronic health system shortcomings, lack of staffing, physician availability and even insufficient hours of operation (the clinic closes at 4 p.m. each day). However, Hosek told session attendees that the hospital is aggressively creating solutions, with dedicated medical staff and doctors creating time and space to treat previously unmet patient needs.
Two other challenges have emerged in the early days of PrEP treatment: access and inequity. PrEP is covered by most insurance and Medicaid programs, but “it is very confusing,” according to Jim Pickett of the AIDS Foundation of Chicago, and many early PrEP patients are insured, employed and don’t mirror the typical demographics of patients who use public safety-net hospitals.
Pickett said that awareness and education among vulnerable communities — notably, young gay black men, transgender women and black cisgender heterosexual women — may be the foremost challenge. The foundation, along with the Chicago Department of Public Health and others, recently began a five-year plan to eliminate HIV in the city.
A citywide social marketing campaign is scheduled to launch in 2016, with a focus on “making sex positive,” according to Pickett.
“Love, lust, intimacy, pleasure — we’ll use these words because we want people to enjoy sex without fear, anxiety or shame,” Pickett said. “And … without HIV.”
To learn more about PrEP, check out this article from The Nation's Health.