PrEP (Pre-exposure Prophylaxis):The Future of HIV Risk Reduction? Implications, Implementation & Inhibitions

Lily&Q’s say…With all the buzz in the HIV community about reducing HIV transmission rates around the world, these articles explore PrEP and how implementing it can be a start for people who are at high risk because of their lifestyles and choices.

FDA Approves First Generic Version of Gilead’s HIV Drug Truvada
Wednesday, June 28, 2017 by Alfred Itunga
Despite the growing uptake of Truvada for PrEP in the US, only a small percentage of patients at risk for HIV infection are taking the drug. While Gilead offers an assistance program for uninsured patients and a co-pay assistance program for Truvada, many have cited its cost, which is around $1,500 a month in the US, as a barrier to access.
Lily&Q’s say…A generic for this AART life-saving drug will help fuel PrEP cost reduction and therefore increase availability, Gilead still isn’t too happy about it. Go figure…Come on Gilead, haven’t you made enough money off it yet?
And then from Kenya an article shedding some light on their urgency to change people’s minds on using PrEP, cost to administer it, and who should be targeted for PrEP in the first place. By the way having a generic for Truvada will greatly and more cost effectively help their endevors, too.

Support Groups a Driver to PrEP Rollout in Kenya
28 June 2017 From: AVAC
Kenya passed a major milestone in the fight against HIV on May 4, 2017 when it launched a nation-wide initiative to bring oral PrEP (pre-exposure prophylaxis),
antiretroviral drugs for preventing HIV, to the people who need it. A team made up of LVCT Health staff and AVAC staff recently visited the implementing
sites to gather stories and collect lessons learnt as part of the OPTIONS project. We interviewed providers, adherence counselors and people using PrEP
who shared their journeys of PrEP uptake and adherence.

Lily&Q’s say…This CBS news story below, is a MUST listen to, MUST read new story! It changed what words I will use in the future to explain the necessity of PrEP, and the importance of understanding why PrEP must be implemented in a new world of HIV transmission, where complacency is fueling the new HIV transmission firestorm.
And finally, a research article on PrEP and introveneous drug use from Standford. I know from personal experience there is a huge stigma hanging around HIV/AIDS testing & treatment, but the complex issues surrounding introveneous drug use in America, makes HIV stigma look like a silly, simple “cakewalk”. America treats these users as the “low of the low” and offer little care or hope for this community. This article shows how a multi-spectrum approach will be the only way HIV transmission can be reduced in this marginalized population. Merely stemming the IDU’s addiction to the drug in the needle, won’t solve all the problems either, as you’ll see in this article.

36 years and counting AIDS in America
CBS News/ June 4, 2017, 9:50 AM
Thirty-six years: That’s how long it has been since AIDS first caught the attention of public health officials. Though modern medicine has done much to control the disease, the battle against it is far from over. Our Cover Story is reported by Rita Braver:

When 31-year old Dean Carras hits the bars, and maybe strikes up a new relationship, he has a level of confidence that wouldn’t have been possible just a few years ago. That’s because Carras, who is HIV negative, begins his day with PrEP (short for Pre-exposure Prophylaxis), which reduces the risk of sexual transmission of HIV — the virus that can lead to AIDS — by more than 90 percent.

“I don’t want to sound cynical, but I don’t have to trust somebody 100 percent, because I know for myself that I am protected,” Carras said. “I come from a generation where condom use was 100 percent; that was safe sex. If you said safe sex, that meant you used a condom.”

Though modern medicine has done much to control the disease since it first caught the attention of public health officials, the battle against HIV is far from over.

4 Methods for Reducing HIV Risk in Intravenous Drug Users
JUNE 05, 2017 by Carolyn Colwell

With the opioid epidemic looming large over the nation, physicians must identify cost-effective HIV prevention programs in order to stave off increasing rates of the virus among intravenous drug users, according to a group of Stanford University researchers.

   “Because HIV spreads relatively efficiently through the transfer of blood in shared injecting equipment, people who inject drugs (PWID) account for a disproportionate share of HIV prevalence and incidence in the US,” the Stanford researchers said in a recent study.

They found that over a 20-year period, nearly 43,400 HIV infections among PWID could have been prevented if at least 50% of the people eligible participated in a combination of prevention programs, including opioid agonist therapy (OAT), needle and syring exchange program (NSEP), test and treat, and PrEP (pre-exposure prophylaxis). Participation in these programs would have also reduced the HIV prevalence among PWID by 27%, researchers said.

As a standalone, OAT was the treatment approach that would be the most cost-effective, because it would increase the length and quality of life of those treated, according to the study.

 “Additionally, we assume that individuals on OAT have higher HIV screening rates than the general PWID population and are more likely to connect to ART [anti-retroviral therapy] services,” the study explained. “OAT also provides the sole pathway by which individuals permanently cease drug use (3.6% annually) and move to a lower risk population.”

OAT programs involve using drugs such as methadone and buprenorphine to block opioid craving. The major costs for OAT include starting clinics and the long-term costs of the therapies, which the study found to be relatively low.

Implementing these programs is not necessarily easy, the study explained. Often there is neighborhood opposition to methadone clinics. Also, for reasons the study did not explain, a reported 60 percent of the people on methadone do not receive sufficient doses. “If barriers to OAT access were lowered and treatment offered at international evidence-based standards, our analysis suggests that the value of this already cost-effective intervention could increase,” researchers wrote.

In combination with OAT, NSEPs – programs where PWID trade used needles and syringes for clean ones – would be especially effective, and could prevent 40,000 HIV infections over the next 20 years, the study said. By themselves NSEPs have a much lower delivery cost than the other programs.

There are obstacles, however, to increasing the availability of NSEPs. Currently there is a ban against federal funding for NSEPs despite the fact that an earlier study reported no significant relationship between crime and the location of treatment centers…Go to link to read entire article.
Lily&Q’s say…PrEP is here to stay and getting informed on how to implement it, to whom and when PrEP is most valuable are all questions to be answered. Stigma is the LARGEST & last hurdle to overcome, and that is so with all health concerns in our communities that others percieve are unlawful, disgusting, not tolerable, or at the very least not Godly. Once we see all Americans as worthy many of our social and health ills could be irradicated. Party-N-Play responsibly, know your body and take responsibility for YOU! Get testing and know your options when it comes to risk reduction-No matter who you are or what you choose to do, WE are here to better inform you, & offer our 2-cents-worth!