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Ground Zero for PrEP

The impact of HIV/AIDS hit San Francisco hard in the early days. Today, we’re making history by taking the lead to end it. PrEP (pre-exposure prophylaxis) is the latest HIV prevention tool that everyone is talking about. Truvada as PrEP was approved by the FDA in 2012 and has been shown to be 99 percent effective when taken daily. In fact, as of September, 2014, there have been no reported sero-conversions among PrEP users who took the pills at the prescribed dosage. The take-home message is: PrEP works if you take it correctly!

A lot has been going on in the PrEP world in San Francisco lately. The city may very well be ground zero for PrEP. Gilead, the pharmaceutical company that makes Truvada, is located 20 miles south in Foster City.  Gladstone Institutes, a research organization affiliated with the University of California San Francisco is responsible for iPrEx, the world’s largest PrEP trial, with a total of 2,499 participants.

The PrEP Demonstration Project was started at San Francisco City Clinic back in 2012. The project was intended to see if PrEP could be implemented in a nonclinical trial setting. As one of three sites in the USA, San Franciscans were the most adherent to the drug. The San Francisco Department of Public Health and San Francisco AIDS Foundation (among others) are working hard to get information about PrEP out to the community. Kaiser Permanente San Francisco is home to the largest stand-alone PrEP clinic, not associated with a study or demonstration project (KP SF has enrolled 307 PrEP users as of July 2014).

PrEP Ground Zero has been teeming with activity in the past month. The San Francisco Department of Public Health and the HIV Prevention Planning Council sponsored a PrEP community engagement meeting on September 16. Panelists covered such topics as adherence, efficacy, navigating access, insurance plans and how to better engage the transgender community.

On September 17, openly gay San Francisco District 8 Supervisor, Scott Wiener, made public his use of PrEP. He became the first elected public official to make such an announcement, paving the way for others by raising awareness, reducing stigma and working to increase access. Another openly gay supervisor, David Campos, is ramping up efforts to promote access to all San Franciscans who want or need PrEP. On September 18, Wiener and Campos joined community members at the steps of City Hall for a PrEP Rally, announcing plans for a legislative effort that would subsidize PrEP co-pays and fund PrEP-navigator positions, which are people who assist those interested in PrEP with finding affordable options. Following the rally, the board of supervisors’ Neighborhood Services and Safety Committee met to further discuss the resolution. Health officials, care providers, activists and community members reached a consensus that PrEP works if you take it.

They also voiced concerns that PrEP is not affordable for many people who need it the most. Without insurance, the cost of PrEP can be astronomical. The $800,000 funding request seems meager when compared to the cost of having to treat an HIV positive person for life. Campos estimates that every new HIV infection prevented saves $355,000 in lifetime treatment costs. With these efforts, San Francisco is leading the way to become the first city to eliminate new HIV cases.

So what’s next for PrEP? That’s a good question! We need to improve access. That’s definitely a no-brainer. Campos and Wiener are working with the SFDPH to get this rolling. We also need to increase PrEP education efforts, as there are still so many people out there who don’t know about it.

As more and more health organizations and community members make known their approval of the large-scale implementation of PrEP as a public health intervention, more people will want to use it. As access to PrEP is improved, more people will actually be able to use it. As more people use it, new infections will go down. San Francisco will hopefully be a shining example of effective HIV prevention for the rest of the country and worldwide. But it’s not over yet.  We still have a lot of work to do. And this can change everything.

Want more information about PrEP? Check out PrEPfacts.org. For more info on Adam and is #TruvadaWhore campaign, follow him on Instagram: pup_bones. Twitter: @pupbones or join his #TruvadaWhore facebook group.