The good news is, there is a pill that can prevent the transmission of HIV. It is safe and effective when taken as prescribed. The bad news is, a key high-risk subgroup isn’t getting enough information about it. Truvada, the brand name for the first pre-exposure prophylaxis pill, is available to the general public. This is not a hoax or an urban myth. Black women carry the burden of having the second highest number of new HIV infections in the District. Yet the marketing surrounding this drug is conspicuously aimed at gay men. Local community activists and the DC Department of Health are working to include black women in the conversation. Will they go for it?
First, Do No Harm
Truvada, also known as PrEP, has been approved by the US Food and Drug Administration since 2012. It is “as safe as Tylenol.” When used as prescribed, it can lower the risk of getting HIV from sex by more than 90 percent and from injection-drug use by more than 70 percent. The side effects are very few if any for most users (mild nausea, headaches). It’s one pill, taken daily, similar to a birth control pill.
PrEP acts as a blocker that keeps the HIV virus from duplicating. PrEP is effective in men or receptive anal sex partners after it’s been taken for about seven days. For vaginal sex partners (women), insertive anal sex partners, or injection-drug users PrEP becomes effective after about three weeks. It is covered by most health insurance plans, and some manufacturers offer it at no cost to those who qualify.
Persuading people to believe that they are at risk is the first hurdle in HIV education. HIV doesn’t have a “look,” and many people go on with their lives unaware of their infection. At The Women’s Collective (TWC), a female-focused health and HIV advocacy organization on Pennsylvania Avenue in Southeast, the goal has three parts. They are trying to raise awareness about HIV, about the drug, and about how to get the drug. Martha Sichone-Cameron, director of prevention at TWC, says that some DC neighborhoods are more at risk than others. “If you get off the Metro at Anacostia station you are more likely to hook up with someone who is HIV positive than if you get off at Dupont Circle. How do you communicate that to someone who doesn’t think they are at high risk? Just by your living in some particular areas you might want to protect yourself.”
Next is advising women to take advantage of a drug that they’ve never heard of to prevent a virus that they don’t have. Sichone-Cameron explained that black women aren’t so easy to impress. “We pulled together some focus groups. The feedback was quite surprising. These were women of color and their automatic reaction was suspicion. ‘Really? Is it true?’ Then it moved from suspicion to anger: ‘Why are we always the last to know about this?’ We really had to move through those conversations first. We had to tell the health department, ‘Look, people are just hearing about this for the first time.’ Some of them are associating it with an HIV drug so they are worried about side effects. And some of them are generally worried. Lots of questions needed to be answered.”
If you think cajoling people to use condoms is hard, try telling them to take a pill daily. Health advocates and physicians alike say that it’s a struggle to get people to take medication for common health problems such as blood pressure or cholesterol. PrEP is a pill that needs to be taken daily in order to be effective. Missing a dose can result in lowering the amount of the drug in a person’s system and possibly allowing an HIV infection.
Why Physicians Won’t Prescribe PrEP
Why wouldn’t a healthcare provider prescribe a medication that could potentially save the lives of patients? Simply put, they aren’t aware of its existence or which patients to prescribe it to. A survey done by the Center for Disease Control in 2015 found that 34 percent of physicians and nurses were not aware of PrEP. Several women have reported to TWC that their doctor told them they don’t need PrEP.
Michael Kharfen, senior deputy director of the HIV/AIDS, Hepatitis, STD, and TB Administration, stated in a previous interview that they are working on getting more physicians on board with PrEP. “We’re working even further with women’s health providers, OB/GYN, adolescent health providers for young women to provide more educational opportunities. We’re also going to get more input from the community on how we can get the message out in better ways. In particular, when we’re talking about a health opportunity that is not very well known we have to make that message as authentic and strong as possible. This is also an important part of Mayor Bowser’s plan toward ending the HIV epidemic in the District.”
The DC Department of Health has launched one of the first campaigns to educate black women about PrEP. The #PrEPForHer drive has been spotted around the city on billboards, in doctor’s offices, and on Metro.
Two Points to Consider
Although Truvada has been pushed for gay men to use, women stand to benefit generously for two important reasons. First, it removes condom negotiation. If a woman suspects that her partner is unfaithful or misleading about his sexual history, she can discreetly take the pill for protection. It also removes a potential trigger in relationships where domestic violence plays a role. Second, it can help sero-couples (one partner is HIV positive and the other is negative) conceive a baby. PrEP is safe enough to be taken while trying to have a baby. More importantly it puts reproductive power back into the hands of the woman.
Getting black women on board with PrEP will be an uphill push for a while, requiring sustained collective efforts. For more information about #PrEPForHer visit dctakesonhiv.com. The Women’s Collective is located at 3230 Pennsylvania Ave. in Southeast.
Candace Y.A. Montague is the health reporter for Capital Community News.
Five Tips about PrEP
- It must be taken daily in order to be effective. Missed doses can result in HIV infection.
- Following up with your doctor is imperative – every three months.
- PrEP does not prevent other sexually transmitted diseases. Although PrEP is quite effective for HIV you still need to use barrier protection such as male or female condoms to prevent other infections that are transmitted through sex.
- PrEP will not prevent Hepatitis B or C or blood-borne pathogens transmitted from sharing needles.
- It is not effective after exposure to HIV. For that you would need to use post exposure prophylaxis (PEP) within 72 hours of exposure.