May 14 should have been PrEP’s big coming out moment. That’s when the federal government issued new guidelines urging doctors to adopt the use of PrEP -- a powerful tool that when used daily is over 90% effective in preventing new HIV infections. But for most gay Americans, the news hardly registered.
As a longtime HIV/AIDS advocate, I was puzzled. After all, these guidelines represent a huge victory for HIV prevention advocates who have championed PrEP’s wider use since its initial FDA approval in 2012. The U.S. Public Health Service and the Centers for Disease Control and Prevention recommended the treatment be prescribed for a number of at-risk populations, including men who have sex with other men who have practiced condomless sex, people whose partners are HIV-positive, and people whose partners are at high-risk for infection.
Daily use of PrEP (or pre-exposure prophylaxis, consisting of taking the pill Truvada) is safe and has few side effects. In combination with traditional prevention techniques, it can be an amazing tool in our fight against HIV/AIDS.
And cost doesn’t have to be an issue. Most private insurers and many Medicaid programs now cover PrEP.
But still, if you scour the websites of leading LBGT or HIV organizations, you’ll find there is little information on how and where to actually access PrEP. It’s one of the best-kept (and therefore tragic) secrets in the gay community.
So what’s keeping PrEP in the closet?
Unfortunately, skepticism and even outright disapproval of PrEP persists among many in the LGBT community. Some raise questions about “unknown side effects.” Others have condemned the government’s decision, arguing it is a “party drug” that will encourage more people to engage in condomless sex. And a few get nastier, dubbing users of the drug “Truvada whores,” accusing them of immaturity, cowardice or worse.
Of course, HIV prevention advocates must continue to encourage practicing safer sex and using PrEP. But with new infection rates stalled at 50,000/year nationally, and rising among low-income communities of color, we need to use every tool at our disposal. These tools include PrEP, non occupational post exposure prophylaxis (nPEP) and condoms. nPEP can be used to prevent HIV infection if taken within 72 hours after a person believes they were exposed to HIV.
So rather than keeping PrEP & nPEP tightly-guarded secrets, shaming those who use them or ignoring the epidemic’s continued reach, our community’s political, faith-based and entertainment leaders should be using Pride Month and every opportunity they can to tear this closet door off its hinges and promote PrEP and nPEP’s use.
We know from the early days of AIDS that we cannot expect our mainstream hospitals and healthcare providers to rapidly adopt PrEP and nPEP, though the CDC’s announcement is helpful. Our own LGBT health care providers and health centers must lead the way with endorsements of PrEP and nPEP and clear pathways for access. And we must aggressively press to ensure that every insurer cover PrEP – and insist that state and federal governments make it readily available to all who are at risk.
Can you imagine how quickly we would have embraced a pill for prevention that was over 90% effective in the 80’s and even the 90’s? How many lives we could have saved?
By preventing needless infections, PrEP and nPEP can help curb the epidemic in the US for good – and reduce the burden of HIV/AIDS on our healthcare system. It is already a key part of New York State’s vision for ending the epidemic by 2020 by bringing new infections below 730 per year. We also know that prevention of HIV is significantly less costly to the healthcare system than hundreds of thousands more people becoming HIV positive for the rest of their lives. And no matter what skeptics might say, a Truvada pill a day while at risk for getting HIV sure beats a lifetime of HIV treatment.
It’s time to bring PrEP and nPEP out of the closet.
Kelsey Louie is a native New Yorker and the new CEO of GMHC ((formerly Gay Men's Health Crisis), the nation’s leading provider of HIV/AIDS prevention, care, and advocacy.