The Centers for Disease Control and Prevention have released new guidelines on using the antiretroviral medication Truvada to reduce the risk of HIV infection in uninfected individuals. The government now recommends that hundreds of thousands of people at risk of becoming HIV positive should take the medication once daily.
It would mean a 50-fold increase in the number of prescriptions for the drug, Truvada — to 500,000 a year from fewer than 10,000. The drug costs $13,000 a year, and most insurers already cover it. The guidelines tell doctors to consider the drug regimen, called PrEP, for pre-exposure prophylaxis, for gay men who have sex without condoms; heterosexuals with high-risk partners such as drug injectors or male bisexuals who have unprotected sex; patients who regularly have sex with anyone they know is infected; and anyone who shares needles or injects drugs.
Truvada is manufactured by California-based Gilead Sciences. The pill is a combination of tenofovir and emtricitabine. It's been marketed since 2004 as an HIV antiretroviral. Truvada became the first medication ever to be approved for HIV prevention in adults in July 2012. That marked a major milestone in the 30-year global epidemic.
Truvada is not a "magic" pill. It is most effective when used in a combination with condoms and other risk prevention, according to research. But the intervention is not being broadly prescribed for gay men—who are the largest risk group. "By analyzing pharmacy databases, Gilead has tried to track how many Truvada prescriptions are for the drug regimen, rather than AIDS treatment. As of last September, the company said, it knew of only 2,319 — of which 49 percent were for women."
Questions have been raised about adherence—you have to take one pill daily for a lifetime—as well as resilence and the impact of powerful antiretrovirals on a healthy immune system. But the major question: Who will pay for the drug? In the United States, Truvada can cost $36 a day or up to $14,000 a year. "Giving Truvada to the 100,000 most at-risk gay men in the U.S. would cost more than $1 billion a year," reports Bloomberg News. "The CDC said on its Web site. That sum covers only the cost of the pills, and doesn’t include marketing, HIV testing, and doctors’ visits."
"Private insurers and state Medicaid programs have thus far generally covered such prescriptions, and Gilead has a program covering co-pays and giving Truvada to the uninsured," adds the Times.
Unfortunately, those in most need of the intervention do not have broad access private health insurance: Black and Latino gay and bisexual men. Stigma, homophobia, racism and other barriers also prevent them from knowing about/asking for PrEP.
The number of new HIV infections in the United States has remained “relatively stable” at approximately 50,000 per year between 2006 and 2009, according to data from the Centers for Disease Control and Prevention (CDC) that was published in August 2011.
But there have been a soaring number of seroconversions among Black men who have sex with men. The trend has been particularly “alarming” among Black MSM aged 13 to 19, according to the CDC. New infections have increased by 48 percent between 2006 and 2009. New infections rates are much higher in some cities—such as Milwaukee, where an estimated 42 percent of Black gay/bi men could be infected. See our report for EBONY: "New Data Show Black Gay Men Face "World's Highest" Risk of HIV"
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