Media Coverage: Effort to provide preventative treatment for HIV set back by pandemic
This piece was originally published by PBS NewsHour on Oct. 5, 2022
Three years ago, the Trump administration laid out a plan to drastically reduce new HIV infections. While cases are on the decline, the effort has faced significant setbacks due to the COVID-19 pandemic. Special correspondent Dr. Alok Patel reports in partnership with the Global Health Reporting Center.
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Judy Woodruff:
Three years ago, then-President Trump's administration laid out a plan to drastically reduce new HIV infections. While cases are on the decline, the effort has faced significant setbacks.
Special correspondent Dr. Alok Patel reports, in partnership with the Global Health Reporting Center.
Tommy Williams, 1917 Clinic: This is Tommy from UAB Outpatient.
Dr. Alok Patel:
Tommy Williams helps to coordinate patient care at the 1917 Clinic at the University of Alabama at Birmingham, one of the longest-running HIV clinics in the country.
Tommy Williams:
Much all we do actually is around HIV care, which includes treatment and research, community engagement. We also do HIV testing in this clinic as well.
I will ask see you when you get here, lovely.
Dr. Alok Patel:
It's Tommy's job to connect patients with all the services at the clinic, including PrEP.
Tommy Williams:
PrEP is a preventative measure for individuals who have a negative HIV diagnosis, and their interest is keeping it that way.
Dr. Alok Patel:
PrEP, or pre-exposure prophylaxis, is a remarkably effective way of blocking HIV.
When taken as prescribed, about 99 percent of people on PrEP remain uninfected. It is antiviral medication very similar to the combination that's used for HIV treatment.
Dr. Latesha Elopre, University of Alabama Birmingham School of Medicine: And if you're taking this medication and you're exposed to virus, essentially, you have enough of this concentrated medication into wherever you have been exposed to prevent the virus from being able to go into your cells and replicate.
Dr. Alok Patel:
PrEP is the backbone of the U.S. government's strategy to meet its stated ambitious goal, a 90 percent reduction in new cases by 2030.
Tommy Williams:
How you been?
Corey Oden, PrEP Client:
I have been doing good.
Dr. Alok Patel:
And yet Tommy Williams knows that PrEP can be a tough sell.
Corey Oden:
I have been seeing somebody. It'll be a year in June. So…
Tommy Williams:
I love that. You deserve that. You deserve…
Corey Oden:
Thank you.
Tommy Williams:
I have always said you deserve to be happy.
Dr. Alok Patel:
Corey Oden was a holdout, until Tommy convinced him to start the medications four years ago.
Corey Oden:
I was really against PrEP, but I think I was more against the mentality I thought PrEP made people have.
So I was sexually active with people. And those people were like, oh, well you're not going to have sex with me with a condom now, because I'm on PrEP, but, baby, I'm not.
(LAUGHTER)
Corey Oden:
You know, so what about me? What about me? So I hated that.
Tommy Williams:
Oh, my goodness.
Corey Oden:
I hated that.
Dr. Alok Patel:
CDC guidelines say PrEP should be taken by anyone who is sexually active and at high risk for infection. But, nationwide, fewer than one in four of these people has a prescription.
And amid the other longstanding challenges, the COVID pandemic landed like a ton of bricks.
Dr. Monica Gandhi, University of California, San Francisco: Prior to the COVID pandemic, we were actually doing really well.
Dr. Alok Patel:
Dr. Monica Gandhi oversees HIV care at San Francisco General Hospital.
Dr. Monica Gandhi:
And I was seeing very few barriers to hopefully by 2030 getting to the end of the epidemic in San Francisco. Essentially, our homeless population increased. And so did substance use.
Lance Toma, CEO, San Francisco Community Health Center:
COVID, I know, everywhere, there were some setbacks.
Dr. Alok Patel:
Lance Toma is CEO of the San Francisco Community Health Center, which offers PrEP, HIV care, and other services to some of the city's most vulnerable residents.
Lance Toma:
With HIV, we were trying to build community. We're trying to break isolation. And so, when COVID hit and we had to actually support people to isolate and even quarantine at times, this had dramatic impact.
Person:
Which way should we go?
Person:
Eddie.
Person:
Eddie? OK.
Dr. Alok Patel:
When COVID arrived, the center had to adapt, and fast.
Miguel Ibarra leads one of its outreach teams.
Miguel Ibarra, San Francisco Community Health Center:
We developed these mobile teams that would go out and vaccinate people twice a week.
Dr. Alok Patel:
Once that was in place, they began to expand the services.
Miguel Ibarra:
And we provided rapid syphilis testing, rapid HIV testing, rapid hep C testing to people. And if they wanted to get on PrEP, for example, we could provide that service in that moment, and then do a lot of follow-up.
Dr. Alok Patel:
It's almost like it took COVID to get people to unify and pay attention to health care access, awareness, preventative measures, and to get people to finally focus on it. Is that what you're kind of feeling?
Miguel Ibarra:
Yes. I mean, it's true, because I think, initially, there was some chaos that happened, which it just forced us to coordinate better amongst different providers and actually, like, be more engaged with people and go leave our sites and actually go to them and find them and hang out with them and stay with them and make sure that they had everything that they needed.
Dr. Alok Patel:
But then last month came a new hurdle. A federal judge in Texas struck down a requirement, part of the Affordable Care Act, which says all private health insurance plans have to cover PrEP.
If the ruling stands, many people will face a sticker price of about $2,000 a month.
Lance Toma says there would be a ripple effect, not just for people on private health plans.
Lance Toma:
And if we start to chip away at what's guaranteed, whether it's in employer-based coverage or in Medicare, that erodes trust in all of these prevention efforts.
PrEP, we know, works. We know HIV treatment works. It's just — it's infuriating.
Dr. Alok Patel:
Insurance hassles and cost are just two of the reasons that PrEP coverage remains low from California to Alabama and nearly everywhere in between.
The decision to start on PrEP is deeply personal. For many, bringing it up with a doctor is hard.
Tommy Williams:
There's a lot of stigma attached to PrEP, because it's like, why are you taking that? Like, are you gay? Is that why you are taking PrEP?
Dr. Latesha Elopre:
The idea that you're in a rural community that is oftentimes extremely conservative, highly impoverished, everyone knows each other. And so they said, I would never feel comfortable accessing PrEP.
Person:
It's Truvada for PrEP.
Dr. Alok Patel:
Even with widespread advertising from companies like Gilead, there's still a lack of awareness, especially among young people.
Tommy Williams:
I believe one of the many reasons that the kids aren't accessing PrEP is because either they don't believe it or not know about it. They — and if they know about it, they don't really understand it, or they are not, like, accurately identifying their level of risk.
Dr. Alok Patel:
But, in some ways, the prospects are looking better.
And, according to Dr. Latesha Elopre, one big reason is a new medication, a new longer-lasting formulation of PrEP.
Dr. Latesha Elopre:
Did you have any questions about long-acting, the cabotegravir injection?
Dr. Alok Patel:
The new version is given as an injection, rather than a daily pill. Patients only need to come for a shot every two months, making it far easier to stick with the regimen.
Person:
Do you want to remain on the injectable PrEP or go back to the daily pill?
Bobby Christon-Walker, Long-Acting PrEP Client:
The injectable.
Person:
OK.
Bobby Christon-Walker:
And then now it's like, OK, I know I have gotten my shot. I'm good for my shot until my next appointment. So I don't forget to take the pill.
Dr. Alok Patel:
The FDA approved widespread use of these injections late last year.
Dr. Latesha Elopre:
I'm hopeful — and we always have to be hopeful — that there's going to be these advancements and they're going to improve some of the disparities that we see.
Dr. Alok Patel:
Even longer-lasting versions are under development, a step towards protection that patients barely have to think about, maybe inching us closer to the end of HIV in America.
For the "PBS NewsHour," I'm Dr. Alok Patel.
Judy Woodruff:
And you can learn more about the fight against AIDS by watching "NOVA"'s "Ending HIV in America." That's later tonight here on PBS and on the PBS video app.