An official with Whitman-Walker Health, D.C.’s largest AIDS treatment and service organization, said that similar to current nationwide trends, a relatively small number of people at risk for HIV infection in the D.C. area are taking a drug approved for preventing them from contracting HIV.
Dr. Richard Elion, Whitman-Walker’s director of clinical research, told the Washington Blade that fewer than 50 Whitman-Walker clients have signed up so far for the prescription drug Truvada, a daily pill approved by the U.S. Food and Drug Administration as a pre-exposure prophylaxis, or “PrEP,” to greatly reduce the chances of becoming infected with HIV.
“So the uptake on PrEP is that the District has been sluggish at most places,” Elion said in discussing the local demand for taking Truvada as a prevention pill.
“It’s important to have a lot of educational efforts on this because this is a prevention strategy that to me has not really gotten the recognition and the press that it deserves,” he said.
Officials with at least three other local organizations that provide AIDS-related services and prevention programs targeting gay and bisexual men – Us Helping Us, SMYAL, and Metro Teen AIDS – said they, too, believe PrEP is an important new prevention strategy that should be encouraged for people deemed at high risk for HIV, especially young gay and bisexual men.
“Us Helping Us fully supports PrEP and will publicize it to our clients through meetings and social media,” said Ron Simmons, the group’s executive director. Us Helping Us reaches out to black gay and bisexual men in the D.C. area on AIDS prevention and other AIDS-related programs.
Adam Tenner, executive director of Metro Teen AIDS, and Andrew Barnett, executive director of SMYAL, each said they are encouraged over the potential PrEP has for their clients, who range in age from 13 to 21. But the two said they have yet to determine whether PrEP is appropriate for youth as young as 13 through 17.
“We are encouraged over the effectiveness of the treatment in preventing infection,” Tenner said. “But we are going to be very cautious about PrEP for adolescents. For kids 18 and older there are fewer questions,” he said.
Tenner and Barnett each said they are awaiting guidance from experts, including pediatricians, on the advisability of prescribing Truvada to people as young as 13 or 14. According to Tenner, youth of that age often are sexually active and at risk for sexually transmitted diseases, including HIV.
He said Metro Teen AIDS sponsors HIV prevention programs targeting youth in that age range but has yet to embrace PrEP for young teens without having access to more information.
The U.S. Centers for Disease Control and Prevention, which earlier this month issued new guidelines advocating the wider use of PrEP for HIV prevention, and the American Academy of Pediatrics didn’t immediately respond to an inquiry from the Blade about the advisability of PrEP for youth between 13 and 17 years old.
The Los Angeles-based AIDS Healthcare Foundation, the nation’s largest AIDS service and treatment organization, which has facilities in D.C. and Maryland, has expressed strong opposition to PrEP, saying it has the potential to discourage condom use.
Michael Weinstein, the organization’s CEO, has pointed to studies showing that large numbers of people enrolled in the studies failed to take the Truvada pill on a daily basis as prescribed, placing them at risk for HIV infection.
Weinstein told the Blade that although AIDS Healthcare Foundation opposes the widespread use of PrEP, it believes it should ultimately be up to a patient and his or her doctor as to whether to enroll in PrEP. He said his organization’s medical clinics, including the one in D.C. and Temple Hills, Md., would not refuse to prescribe Truvada to people who specifically request to go on PrEP.
Sex workers who choose to have intercourse without using a condom would be especially suited for enrolling in PrEP, he said.
Elion disputes claims by AIDS Healthcare Foundation that large numbers of people on PrEP, men who have sex with men, are likely to stop using condoms.
“In the studies that have looked at over 12,000 patients we’ve not seen an increase in STDs in any of the people on PrEP,” Elion said. “And so I think that lack of an increase in STDs is indicative that they are not doing more risky behaviors once they start taking PrEP.”
Weinstein said a lack of an increase in sexually transmitted diseases in people on PrEP doesn’t necessarily mean they aren’t engaging in risky behaviors. He said sexually transmitted diseases other than HIV are at epidemic proportions in the U.S. for gay and bisexual men or MSM.
“The baseline is already very high,” he said.