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Why PrEP Is Essential to Safeguard Black and Hispanic MSM and Transgender Women

July 7, 2014

L. Jeannine Bookhardt-Murray, M.D.

L. Jeannine Bookhardt-Murray, M.D., is the chief medical officer of the Harlem United Community AIDS Center, a community- based health organization serving people living with, and impacted by, HIV and homelessness. Harlem United offers health care, housing and prevention services.

We are failing our young, black and Hispanic men who have sex with men (MSM) and transgender women. Each year in the U.S., we see nearly 50,000 new HIV infections. New York City remains the epicenter of the country's epidemic. Black MSM and black women, including transgender people, remain deeply impacted.

On the heels of National HIV Testing Day and LGBT Pride Month, we are in a position to recommit to combating the transmission of HIV aggressively. Routine testing, connection to care and mental health services are important, but there is room for valuable interventions like post-exposure prophylaxis (PEP) and pre-exposure prophylaxis (PrEP). While some in the medical community know about these interventions, many community members are not aware of them, or don't know where to access them.

PrEP consists of a pill (brand name Truvada) containing the two drugs tenofovir and emtricitabine that is taken once a day by individuals who believe they are at risk for becoming infected with HIV.

It's true: Condoms are safe and inexpensive. Why subject a healthy person to the potential adverse reactions from treatment to stay healthy? What about the potential risk of becoming infected with resistant virus should an individual seroconvert while taking the pill? Will this approach burden our already fragmented and strained health care system? How can we ensure that it is taken every day as prescribed? Will all have access or will there be a disparity?

Each is a legitimate question, however, PrEP is here and it is an essential part of our available HIV prevention options.

Ending HIV and AIDS requires a multifaceted approach. We need to do more to stop transmission up front rather than after the fact. And to that I say, "Why not PrEP?" It may not be the right choice for everyone, but it is an option for all. In studies, PrEP reduced the risk of HIV infection for people who took it every day by more than 90%. People in those same studies experienced mild side effects for the first few weeks, but those side effects went away. More serious side effects, such as effects on the kidneys and bones are not as common, but must be monitored with regular testing.

Truvada as PrEP is taken by mouth once a day with or without food. It's helpful to take it at the same time every day to establish a regular routine and to ensure doses are not missed. As challenging as remembering to take medicine may be, the right support from a provider, family and friends can help. The most effective prevention is PrEP used in combination with condoms. PrEP does not protect from other sexually transmitted diseases (such as chlamydia, gonorrhea, syphilis, herpes and human papillomavirus [HPV]), but using condoms can protect an individual from many of those infections.

Some private insurers cover PrEP. If your patient or client is denied this coverage, speak with the individual's insurer, challenge the decision and try again.

Medicaid covers PrEP in New York state.

Finally, Gilead, the pharmaceutical company that makes the drug, has a patient assistance program for those who cannot afford the drug. Call 1.866.290.4767 for more information.

Harlem United's own survey of more than 1,300 men revealed that less than half of respondents reported having heard of PrEP. Our black and brown communities need education about HIV, HIV transmission and HIV prevention.

PrEP is a promising and powerful option.

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