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PrEParing to
Decrease HIV Risk
By Dianne Pettis, CRNP
The Truth Contributor
The first cases of what has become known as HIV (Human
Immunodeficiency Virus) were reported in June of 1981. This
viral illness that causes the dreaded AIDS (Acquired Immune
Deficiency Syndrome) became a worldwide epidemic.
In those early days, a diagnosis of HIV was known as
a certain death sentence. Today, there is still an
epidemic, but there is treatment for those who become
infected; and medication available aimed at preventing
becoming infected with HIV.
With these advancements, a patient being diagnosed
with HIV is treated similarly to patients being diagnosed
with any other chronic disease: like heart disease, diabetes
or lung disease. Life expectancy is not much different from
that a person who does not have HIV if the person remains on
their daily medication and maintains good lifestyle habits –
like those other chronic diseases.
We know much more now about the cause, treatment and
prevention of HIV than we did in the 1980’s. Though stigma
and fear continue, it exists at a much lesser degree. HIV
used to be thought of as a gay male disease; and the number
of cases are in fact highest in the gay male population,
especially African-American gay males. No one is immune,
though. The disease affects all races, ages and sexual
orientations.
Statistics from 2015 report that there are 1.2 million
people living with HIV in the US. Racial disparities
continue with this disease, as with other chronic illnesses.
African Americans make up 12 percent of the population, yet
are 45% of those diagnosed with HIV. Hispanics are 18% of
the population, and make up 24 percent of those with HIV.
Sexual orientation continues to matter. Gay and bisexual
males make up 82 percent of those infected; of which
African-American gay males are the largest group. This group
is followed by white gay and bisexual males.
Between 2005 and 2014, HIV infection decreased in
white gay males, increased in Hispanic gay males, and
leveled off in African-American gay males 25 years and
older. A disturbing statistic is that HIV diagnosis has
risen 87 percent in young African-American gay males, ages
13-24.
During this same period; rates have decreased in
women, all heterosexuals and in injection drug users.
Another disturbing statistic is that 13 percent of the
population is positive, but they don’t know it. They haven’t
been diagnosed yet, and are out there having unprotected sex
and sharing needles – thus continuing to spread the virus to
others.
Geographically, the highest rates of HIV diagnoses are
in the South. In 2015, rates of HIV per 100,000 were 9.5 in
Ohio, 10.7 in Pennsylvania, 8.7 in Michigan, and 11.5 in
Indiana.
The good thing, is that of the 1.2 million people
living with HIV; 55 percent are virally suppressed. This
means that the ‘viral load’ in their systems is
‘undetectable’. ‘Undetectable’ means that HIV is still
present, but it is so low that the risk of infecting someone
else is very low. That is the goal of the antiviral
(antiretroviral) medications; to suppress the ability of the
virus to be spread, and heal/preserve the functioning of the
person’s immune system. So, what about prevention?
Despite the education about safe sex, safer sex and
abstinence – especially if one has a sexually transmitted
disease; HIV continues to spread. Since sex is not likely to
stop; there must be another way.
After much research, in 2012 the FDA approved the use
of two of the HIV medications to be used as HIV prevention.
PrEP was born. PrEP is short for Pre-Exposure Prophylaxis.
The two medications are combined into one tablet –
Truvada, taken once per day. When taken consistently every
day, AND with correct and consistent condom use; the chance
of becoming infected with HIV is lowered by over 90. Truvada
works by blocking an enzyme that prevents HIV from making
more copies of itself and establishing infection in the
body. It should be noted that Truvada (commonly known as
PrEP) does not protect against other sexually-transmitted
infections.
Who may benefit from taking PrEP? Keep in mind the
statistics I just reviewed. Men who have sex with men (MSM),
including transgender women is the largest priority group.
Other high-risk groups are people who inject drugs, those
involved in prostitution, heterosexual men and women who
have partners who are at high risk for becoming infected
with HIV, and anyone who self-identifies a need for taking
PrEP. PrEP is also an option for those couples who want to
have children, but one partner is HIV positive.
PrEP can be obtained by prescription by your Primary
Care Provider (PCP), but not all PCP’s are knowledgeable
about the management and follow up required. Search on-line
for PrEP providers or clinics in your area. PrEP is
expensive, but with insurance or special programs for the
uninsured; it is accessible.
You need have initial blood work to make sure you do
not already have HIV, and screening for kidney function,
Hepatitis C, other sexually transmitted diseases, pregnancy,
and bone density. Follow up will need to take place every
three months initially.
Begin with a discussion with your intimate partner
and your PCP. Though science has made tremendous strides,
HIV is still nothing to play with. The bottom line is that
other than abstinence the greatest protection from HIV will
come from combining prevention strategies like consistent
and correct condom use, plus PrEP.
Contact Dianne Hart Pettis, CRNP
Family Nurse Practitioner
724-375-7519
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