It’s not a great metaphor, in fact it is a poor one, but there is no denying it, PrEP Fever is sweeping the nation.
If at the height of the epidemic there had been a once a day pill that was very safe, that insurance, governments, and co-payment programs covered the majority of costs for, and that was 99% effective at preventing infection when taken seven days a week and 86% effective when taken four to five days a week, our problem would have been making enough pills, not trying to raise awareness.
Today, in an era where contracting the human immunodeficiency virus (HIV), the virus that causes acquired immune deficiency syndrome (AIDS) is no longer a death sentence and where anyone who has reached and maintained viral suppression is much less likely to be infectious, the perception is that HIV is less of a risk. In lots of cases that is true. We no longer have a generalized epidemic in many areas, we have concentrated epidemics among certain groups: women of color, men who have sex with men, people who inject drugs, transgender females, commercial sex workers and their clients, and a growing number of new infections among youth.
In this era, transmissions are not equitably distributed, but continue to vary by race, income and socio-economic status. According to the Office of HIV/AIDS only 6% of the general population in Massachusetts is Black non-Hispanic, but 30% of persons living with HIV are Black non-Hispanic. This speaks more to inequitable access to medical care and health education than to anything else.
So how does advocating for PrEP awareness, access, and acceptance fit in?
For starters this is not all doom and gloom. HIV is actually very well managed in Massachusetts. When compared with other states in the nation we have been very successful at getting people with HIV connected to long-term health care, helping them remain in health care, and maintaining excellent control of their HIV. We invest a lot to solve problems that would otherwise make it easier for HIV to spread in the community, like homelessness, mental health, and addiction. From 2000 to 2011 we have seen a 44% reduction in new infections, down from 1183 to 657 documented cases per year across the state. If we stop investing in public health for HIV/AIDS however, these numbers will start to go up.
PrEP is a new tool to empower people to take action to protect themselves and their communities from the ongoing impact of HIV. Our health departments were doing well with the ability to treat those living with HIV. With testing and treatment, persons living with HIV can live a long healthy life and are very unlikely to pass on the virus to others. With PrEP, we now have the ability to treat HIV-uninfected individuals as well, and to make it very unlikely that they will become infected. That is great news and this is exactly the time to increase HIV/AIDS prevention with PrEP being a central part of that effort. By tackling stigma associated with HIV and using our tools to their fullest including PrEP, frequent testing, early treatment, and patient centered linkage engagement and retention in care, we have a real chance of driving transmission rates down to zero.
At AIDS Action Committee we are actively working with our local and elected state officials to educate them and call on them to take action to invest in this life-altering tool for public health and we encourage you to do the same.
Please stand with us and contact your local and state officials encouraging them to support re-doubling action for HIV/AIDS treatment and prevention given the advancements in prevention technology from pre-exposure prophylaxis (PrEP).
Together we will see a generation that grows up in a state free from HIV!
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