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App to provide anti-viral drugs prompts praise, concern

A new app has the potential of broadening the use of a prescription drug that can prevent HIV infection among those at high risk.

But some HIV/AIDS activists are raising concerns because the app allows people to order prescriptions online for pre-exposure prophylaxis, commonly known as PrEP, without direct contact with a doctor.

PrEP can reduce the risk of HIV infection by 90 percent. It’s recommended by the U.S. Centers for Disease Control and Prevention for people at high risk, including sexually active gay men and people with infected sex partners.

Earlier this year, Nurx, a company headquartered in the San Francisco area, announced it would add PrEP to the prescriptions available to users of its innovative app.

The service currently has limited reach, delivering prescribed oral contraceptives to customers in California and New York. On its website, Nurx promotes its services: “If you have health insurance, Nurx is free. If you pay cash, you can get birth control from $15 per month.

“Whether you are currently on the pill or new to birth control, Nurx is for you. We always ship you three months of birth control, for your convenience.”

Most recently, Nurx announced the availability of PrEP “right from the app with our clinical team. No need to go into the doctor’s office, or to the pharmacy.”

Customers would apply online with Nurx and receive a prescription after completing a health survey and undergoing lab tests that show normal kidney function and no HIV infection.

Some public health officials see services like Nurx as a new way to help lower new HIV infection rates, especially in areas that lack HIV/AIDS services or where such services are overburdened.

However, others, such as activists with the California-based AIDS Healthcare Foundation, are concerned.

“While the goal to improve access to effective HIV prevention tools is admirable, removing any or all direct contact with a physician or medical provider is not,” said Michael Weinstein, president of AHF. The organization has taken a position against widespread deployment of PrEP as a communitywide public health strategy. In 2014, Weinstein referred to Truvada, the anti-viral medication used for PrEP as a “party drug.”

AHF does support the use of PrEP on a case-by-case basis that’s decided between a medical provider and patient.

Weinstein said STD rates are skyrocketing, particularly among young people using hookup apps like Grindr and Tinder.

“We challenge the wisdom and ethics of an app that allows people to order a drug to prevent HIV as readily as ordering pizza,” he said. “PrEP is not simply a pill taken in isolation: It is a four-part HIV prevention strategy that can be highly effective, but one that offers no protection against any other STDs. Eliminating primary contact with the physician or medical provider from this equation is really a disservice to the patient.”

PrEP primer

PrEP as a prevention strategy includes the use of Gilead Sciences’ medication Truvada to prevent HIV infection in non-infected individuals.

Truvada was first approved for treatment of HIV/AIDS patients in August 2004. The FDA approved use of Truvada as PrEP in July 2012.

Guidelines issued by the FDA for PrEP include:

• An initial baseline negative HIV test.

• Daily adherence to the Truvada medication.

• Ongoing periodic HIV testing to ensure the individual on PrEP remains HIV-negative.

• Continued use of other prevention methods, such as condoms.

In Wisconsin, a key resource for information and access to PrEP is the AIDS Resource Center of Wisconsin, which announced expanded access to health care services across the state on World AIDS Day in December 2015. ARCW is online at arcw.org. — L.N.

Learn more about Nurx.

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