WHERE WE STAND ON BIOMEDICAL INTERVENTIONS
Housing Works supports the use of the full range of HIV prevention tools available, including treatment as prevention (TASP), condoms, PrEP (pre-exposure prophylaxis), and PEP (post-exposure prophylaxis). To achieve an AIDS-FREE New York by 2020, we will need to be making use of every viable tool in the HIV prevention and treatment arsenals, and that means increasing education and awareness of each tool as well as access to them.
Biomedical Interventions: Our Strategies
- Recommend antiretrovirals (ARVs) for all HIV-positive adults and adolescents consistent with federal guidelines.
- Make PrEP available for those who need it.
- Make occupational PEP available onsite and non-occupational PEP available in pharmacies and community health clinics within two hours of exposure.
- Require combination HIV prevention care and services from all New York City and State providers—public and private—as essential service under the ACA prevention mandate.
- Fully implement comprehensive, age-appropriate sex education in New York City and State schools.
TREATMENT AS PREVENTION (TASP)
Treating HIV as soon as possible reduces both HIV-related complications and the risk of ongoing transmission to other people.With other proven prevention methods—condom use, abstinence, and comprehensive drug treatment), effective antiretroviral (ARV) treatment reduces the risk of HIV transmission by as much as 96%.
From a scientific standpoint, the evidence of the effectiveness of condoms in preventing transmission of multiple types of sexually transmitted infections (STIs) including HIV, as well as pregnancy, when they are used consistently and properly, is indisputable. As such, they will remain a critical tool in HIV prevention.
The key challenge lies in the phrase “when they are used consistently and properly.” Condoms cannot and should not be regarded as the only reliable HIV prevention tool besides abstinence, and one need only look at the disparity between their theoretical effectiveness and their actual effectiveness to see why. Simply put, condoms aren’t always used properly or consistently, and even when used, they do occasionally break. For this reason, condoms have an effectiveness rate of 97% in theory, but their actual effectiveness in practice based on usage is about 90%. Housing Works can and will continue to promote condom use, but the studies of actual human behavior suggest that achievement of 100% consistent, proper condom use is highly unlikely, and the incorporation of additional prevention tools, ideally in combination with condoms, are equally critical.
PrEP (PRE-EXPOSURE PROPHYLAXIS)
PrEP refers to a daily dose of the HIV medication Truvada that can be used by those who are HIV-negative to reduce greatly their risk of becoming infected. The risk reduction percentages vary depending on how closely the individual adheres to the daily drug regimen, but overall, research studies indicate if PrEP is taken correctly, it reduces HIV transmission risk by at least 90% and as much as 96%-99%.
In keeping with current recommendation by both the Centers for Disease Control (CDC) and the World Health Organization (WHO) (see below for more details), Housing Works supports the expanded use of PrEP as an additional HIV prevention tool, ideally in combination with condoms, but certainly for individuals who are at high risk of contracting HIV.
PrEP: Distinguishing Between Facts & Myths
PrEP has been regarded as controversial by some in the fight to end AIDS for a number of reasons. Concerns have run the gamut and include the belief that making PrEP widely available will result in an increase in promiscuous behavior and/or a decrease in condom use, that the side effects will be severe, and that the high cost renders it inaccessible as a viable prevention tool.
Thus far, evidence-based research studies on PrEP have revealed the fears about increased risky sexual behavior to be largely unfounded. As with any medication regimen, some people do experience side effects, with some reports of bone density and kidney problems among people with HIV using Truvada as part of their treatment program. For this reason, at Housing Works, we believe that 1) the decision to adopt Truvada should be an informed individual one, based on dialogue with that person’s physician, and 2) that positive and negative individuals who take Truvada should be routinely tested for bone density and kidney function. In terms of cost and accessibility, Affordable Care Act implementation is underway to expand insurance coverage, and all insurance companies including Medicaid cover Truvada, though it may require a doctor’s pre-authorization for use as PrEP. (See the CDC’s online document to help discuss PrEP with your physician and jumpstart a conversation about whether PrEP may be right for you.)
CDC & WHO Recommendations on PrEP
Condom use has been on the decline among gay men, and those who use condoms consistently 100% of the time are very much in the minority (see this 2013 CDC study for details), and new HIV infections remain startlingly high among certain groups—people of color, men who have sex with men, and transgender women.
Consequently, the CDC issued a report in May 2014 recommending that health-care professionals offer to prescribe PrEP to specific population segments: serodiscordant couples (a couple in which one partner is HIV-positive and the other is not), gay and bisexual men with multiple sex partners who occasionally have unprotected sex, male and female heterosexuals with high-risk partners (IV drug users or male bisexuals who have unprotected sex), and IV drug users. The WHO took an even stronger stance on PrEP in July 2014, recommending that gay men consider the use of PrEP for HIV prevention even if they also use condoms.
PEP (POST-EXPOSURE PROPHYLAXIS)
PEP refers to the usage of HIV medications by HIV-negative individuals within 72 hours of possible exposure to prevent infection. Along with treatment as prevention, condoms, and PrEP, Housing Works supports the expanded use of PEP as another necessary HIV prevention tool.
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