PrEP: World Gets 35 Years Closer to Ending AIDS

  • 11/22/2016
  • Terelle Jerricks

By Zamná Ávila, Assistant Editor

Ace Robinson

Ace Robinson is the executive director of Dignity Health St. Mary’s Medical Center’s C.A.R.E. Program. He takes PrEP to prevent an HIV infection

To say the least, Ace Robinson was a late bloomer.

“I didn’t know I was gay until the middle of undergrad,” Robinson, 38, said. “I was close to 20 years old when I figured it.”

For Robinson, the era of big hair, material girls (and boys) and MTV is a distant memory. He also was too young then to be directly impacted by AIDS, a disease that changed the way we have sex. Since 1981, the year outbreaks were first noted, millions of people have died from ailments related to the disease, many of them gay men,

Much has changed in the past 35 years since. Education and prevention efforts have helped curb the spread of AIDS. New medications are enabling people living with HIV to have much longer and fuller lives.

In fact, according to the Centers for Disease Control and Prevention, the number of new HIV diagnoses fell 19 percent from 2005 to 2014. Most people who take their medications properly and consistently can live full lives.

In the mid-1990s, Robinson was still a biochemistry undergraduate student. By that time, scientists had discovered and developed the use of HIV-protease inhibitors, which revolutionized therapy options for people living with HIV and helped turn what many considered a death sentence into a chronic condition. Little did he know that he would later be working in the field of HIV/AIDS research and public health administration.

He is currently the executive director of the Comprehensive AIDS Resource and Education, C.A.R.E., Program at Dignity Health St. Mary’s Medical Center in Long Beach.

Long Beach is one of the most HIV-impacted cities in Los Angeles County.

In 2012, the Los Angeles County Department of Public Health reported that Long Beach had more HIV infections than any other region in the county.

Recently, the Department of Public Health named the C.A.R.E. Program a Center of Excellence, awarding a $90,000 grant. The program will offer PrEP-related services to people whether or not they are insured or underinsured. That is on top of the fact that Medi-Cal, Covered California and a PrEP provision in the budget signed by Gov. Jerry Brown in June, help facilitate access to the treatment.

Let’s Talk About PrEP

Pre-Exposure Prophylaxis or PrEP is a once-a-day medication, approved by the Food and Drug Administration in 2012. People who are not living with HIV can take it to prevent HIV infection when exposed. When taken, consistently, Truvada®, the only approved drug for PrEP, has proven to have 92 percent effectiveness.

According to the CDC studies have shown that PrEP reduces the risk of getting HIV from sex by more than 90 percent when used consistently. Among people who inject drugs, PrEP reduces the risk of getting HIV by more than 70 percent when used consistently.

Truvada contains two drugs in one pill. For HIV-positive people, it slows down the replication of the virus within immune cells. For HIV-negative people, if they’re exposed to the virus, the medicine will prevent the virus from more fully infecting the immune system.

Alan McCord, director of education at Project Inform, an organization that provides up-to-date information and advocacy on HIV and Hepatitis C, explained that HIV needs to get inside immune cells and merge with their genes in order to make more HIV and cause a chronic infection. PrEP works because both drugs get into and stay inside immune cells as long as daily PrEP is taken. This way, the drugs are already in place before HIV shows up. Should an HIV transmission occur, PrEP stops HIV’s life cycle well before chronic infection occurs; and HIV eventually dies because it can’t reproduce enough to cause a chronic infection.

PrEP is also often used together with other prevention methods to further decrease a person’s risk. These include using condoms, disclosing status to partners, and treatment as prevention or TasP. That means an HIV-positive person who is on HIV treatment is very unlikely to pass the virus onto others because the medications they take greatly reduce the HIV in their bloodstream to extremely low levels.

“It’s a great tool,” Robinson said. “If you are a person who can take pills every day, you don’t have to worry about HIV.

Robinson acknowledges there still is much stigma associated with people living with HIV. PrEP conveys that a person taking the prevention tool is not bigoted toward people living with HIV.

“It takes HIV out of the conversation but it doesn’t protect against anything else such as gonorrhea,” he said. “Sex is part of the conversation but it shouldn’t be the main part of the conversation.”

Robinson is not just a public health advocate. He is a patient. The former basic and qualitative scientist is HIV negative and practices safer sex in different ways, among them, using PrEP.

“I have known about PrEP well before approval by the FDA in 2012,” Robinson said. “So I already know that it worked as long as I took it properly. And it made sense logically for me to easily add it to my healthcare strategy….  “My sexual health strategies vary based on the type of sex that I am having. I try to use whatever sexual health prevention tools make sense at the time.”

Robinson said that the vast majority of people who take PrEP, have no side effects.

“It has increased the level of intimacy that I have with other men, while also reducing any anxiety that comes with potentially contracting HIV,” he said.

However, if the drug is not taken as prescribed, PrEP is much less effective. The medication must be taken daily. It takes about seven days of regular use for it to work.

Thus far, only two people using PrEP, have been infected with HIV. But there are many factors that may account for that. The status of some of their sex partners may not have been undetectable, for example.

Being Undetectable

A person living with HIV can achieve undetectable levels of the virus after undergoing antiretroviral therapy. The level of viral load is what causes a person to be likely to transmit the disease.
As explained in The Body.com, researchers have found that people who are being treated for HIV and have undetectable viral loads pose a negligible risk of sexual transmission, 0.06 percent, close to zero.

“Once you begin therapy, you stay on therapy, with full virologic suppression you not only have protection from your own HIV … but you also are not capable of transmitting HIV to a sexual partner,” said Dr. Carl Dieffenbach, director of the Division of AIDS, National Institutes of Health in a video. “With successful antiretroviral treatment, that individual is no longer infectious.”

“Undetectable only happens if you know your HIV status, you went to the doctor, you got on meds and you stayed on meds,” Robinson said. If you have anxiety about HIV transmission, it doesn’t hurt to make it nearly impossible (to get infected by taking PrEP while having sex with someone you know has an undetectable viral load). Do you need both? No, but it would ease your mind.”

The next stage of PrEP is an injectable drug, which promises to be used with less frequency than the pills that has to be taken on a daily basis.

“We have this opportunity to really end this,” Robinson said. “It’s going to take all of us, not just some of us. PrEP is really changing conversations of how we physically love each other…. We don’t live in a bubble. As long as there are trains, planes and automobiles, we are all connected.”

 

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