Tag Archives: prep

State’s HIV-infection rate edged slightly higher in 2015

Last year, 225 new cases of HIV infection were diagnosed in Wisconsin, according to the Wisconsin HIV/AIDS Surveillance Annual Review for 2015.

That number is lower than the average of 247 new cases reported per year in Wisconsin over the past decade. But it’s slightly higher than the 221 cases recorded in 2014, when Wisconsin recorded the ninth lowest HIV-infection rate in the nation.

The 2015 review also showed ongoing disparities in new infections among men who have sex with men and people of color. Men in the state acquired the infection at 7 times the rate of women last year, with 196 new cases reported among males, compared to 29 among females.

Sixty-two percent of the new cases were among racial and ethnic minorities, even though they make up only 17 percent of the state’s population. From 2011 to 2015, the HIV infection rate among black males has been 16 times the rate among white males. Hispanic males have acquired the disease at 6 times the rate of white males during the same period.

Among women, the infection-rate disparity was even higher: African-American females were infected at 25 times the rate of white women, and Hispanic women were infected at 8 times the rate.

The infection rate for men who have sex with other men was the highest of all groups, accounting for 80 percent of all new diagnoses last year. Half of the men who were infected through gay sex were under 30 years old.

“This report demonstrates the importance of continuing to focus on the still-fatal AIDS epidemic, and especially its disproportionate impact on some of the most vulnerable members of our communities, said Michael Gifford, CEO and president of AIDS Resource Center of Wisconsin, in a prepared statement.

“We’ve got the tools to turn the tide,” said Bill Keeton, ARCW vice president of government and public relations. “We’re already seeing it.”

One of ARCW’s most promising tools is its PrEP clinic. PrEP is an acronym for “pre-exposure prophylaxis.” People using PrEP simply take an anti-retroviral pill once daily to protect them from acquiring HIV infection.

The strategy reduces the infection rate among at-risk people who don’t use condoms or don’t know the HIV status of their partners.

If every HIV-negative person in an at-risk community was on PrEP, and every HIV-infected person in an at-risk community was on medications that suppress the amount of virus in their blood to undetectable levels, then the community could become free of the virus.

“It’s going to take a while for people to understand it and get comfortable with it,” Keeton said.

Currently ARCW has about 60 individuals enrolled in PrEP, although there are probably more who are receiving the treatment through private physicians.

On gay online hook-up sites in many cities across the country, men are listing their HIV status either as “on PrEP” or “undetectable.” Still, epidemiologists warn that using condoms and adhering to safer-sexual behavior is the only way to ensure that you will not become infected or infect others.

“With PrEP and unfettered access to health care, (we’re) definitely moving in the right direction,” Keeton said. “The trend is good.”

“We’ll start to see the impact of the PrEP programs in the surveillance report that comes out a year from now,” he predicted.

In the meanwhile, ARCW has its work cut out for it. More than 7,900 people in the state are living with the virus, and the overwhelming burden of HIV disease is among young men and people of color, according to Gifford.

ARCW is working to provide comprehensive wrap-around services, which includes everything from finding a job and a place.


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.

ARCW opens new ‘medical home’ in Madison

On World AIDS Day, Dec. 1, the AIDS Resource Center of Wisconsin opened a new full-service center for people with HIV/AIDS on Madison’s east side.

The new center is the product of a collaboration involving ARCW, UW Health and the former AIDS Network, which merged with ARCW about 10 months ago. 

“The main purpose is to make sure that anyone in the Madison area who either has HIV or is at high risk for HIV has a place where they can go and get whatever service they need,” says Dr. Robert Striker, associate professor at the UW-Madison School of Medicine and Public Health.

ARCW refers to its centers as “medical homes,” because of the “integrated, comprehensive model of care we provide,” says Bill Keeton, ARCW’s vice president of government and public relations. The medical homes provide the full array of services needed to properly manage cases of HIV and AIDS. 

“All of our medical, dental, mental health, pharmacy, food pantry, legal, case management and housing services are available under one roof,” Keeton explains. “And all of our staff are talking to one another to ensure our patients are successful in managing their HIV disease.”

ARCW is the state’s largest HIV health care system. It serves nearly 3,000 patients. It’s also a leading provider of prevention and testing services targeting the people most at-risk for HIV, hepatitis C and sexually transmitted infections.

ARCW’s staff has direct contact with 160,000 clients per year in its Milwaukee, Appleton and Madison centers.

The latest addition to ARCW’s system is at 600 Williamson St. It offers care five days a week to anyone, regardless of ability to pay. The Madison center benefits from a partnership with UW Health, which consists of the academic health care programs at UW-Madison, including: University Hospital and Clinics, the School of Medicine and Public Health, the American Family Children’s Hospital and the Carbone Cancer Center.

“(UW Health) has been involved in community outreach in many ways for a long time,” Striker says. “I think UW Health prides itself specifically on providing great HIV care for 30 years, now. … This is a new way to partner with an organization that shares our goals — making sure that people who need HIV care get it.”

Outreach is more important than ever in controlling the disease, Striker says. “The availability of new prevention tools means that the fight against HIV has to occur in as many different places as possible. Providing it in more locations makes it easier to reach patients who don’t realize that there’s a way to prevent HIV, or who have a hard time accessing that prevention.”

“I’ve been taking care of people with HIV since 1995, and it’s just amazing how much more we can do now to make sure that everyone who has HIV can have a normal productive life,” says Striker. “It’s a great thing to have been involved with, to see how care for HIV patients has gotten so much better.”

ARCW now also offers access to pre-exposure prophylaxis, also known as PrEP.

PrEP works by providing HIV-negative individuals who are at high risk for contracting HIV with the same medication used to help HIV-positive individuals successfully minimize the amount of virus they have in their body. PrEP has been shown to be more than 90 percent effective at preventing new HIV infections when used correctly. Combined with access to health care, regular testing and other HIV prevention strategies such as condoms, PrEP might represent a game-changing development in the fight to eradicate HIV.

Get connected

The clinic can be reached at 608-252-6540 and 800-486-6276. For more information about statewide programs, visit www.arcw.org or call 800-359-9272.

AIDS Resource Center of Wisconsin observes World AIDS Day, highlights opening of Madison medical home

The AIDS Resource Center of Wisconsin is recognizing World AIDS Day by highlighting the opening of its newest HIV medical home in Madison.

The ARCW HIV medical home provides integrated medical, dental and mental health care along with a pharmacy and critical social services to make sure people with HIV have all the tools they need to live a long, healthy life with HIV, according to a news release.

“World AIDS Day is a day set aside to remember the countless number of loved ones we have lost, to support the thousands of people living with HIV today who need access to health care and treatment and to rededicate ourselves to doing all we can as individuals and as a society to eliminate new infections from occurring,” ARCW president and CEO Michael J. Gifford stated. “The opening of new medical home in Madison and our ongoing dedication to expanding HIV prevention and testing services to all who need them everywhere in Wisconsin are just two of the ways we mark this solemn and important day.”

ARCW also is offering access to pre-exposure prophylaxis, also known as PrEP, as an integral component of its health care and prevention services. PrEP works by providing HIV-negative individuals who are at high risk for contracting HIV with the same medication used to help HIV-positive individuals successfully minimize the amount of the virus they have in their body.

PrEP has been shown to be more than 90 percent effective at preventing new HIV infections when used correctly. Combined with access to health care, regular testing and other HIV prevention strategies such as condoms, PrEP provides people with a game-changing way to stop HIV.

“Today, unlike the first World AIDS Day, we have the tools and medical science to provide patients with a long, healthy life with HIV disease and to stop new infections from occurring almost completely. What we still need now is what we needed then — the collective will from our private and public leaders to join us and seize upon the opportunity we have before us,” Gifford stated. “There is much to be excited for as we look forward to a world in which everyone with HIV has unfettered access to health care, in which new infections are truly rare, and where people with HIV no longer face the stigma that helps to drive this epidemic forward.”

Get connected

HIV patients and people at-risk for HIV who would like to learn more about ARCW programs and services designed for them can visit www.arcw.org, call 800-359-9272 from anywhere in Wisconsin or contact their local ARCW office by using http://www.arcw.org/locations/.

Want to avoid HIV? Take a pill

When Milwaukeean Josh Beck, 34, posts a profile on gay dating sites, he gets a lot of questions about his HIV status: “negative plus PrEP.”

PrEP is an acronym for “pre-exposure prophylaxis,” which means taking anti-retroviral medication to protect against acquiring HIV infection. PrEP is a growing strategy in combating HIV. It puts protection in place when at-risk people don’t use condoms or don’t know the true HIV status of their partners.

A number of online meeting sites for gay and bisexual men have begun adding the “negative plus PrEP” option to their apps, but the vast majority of primary care physicians in Wisconsin seem to know nothing about it.

Although most HIV-positive people are honest about their status, a large number of them don’t know theirs. As many as 60 percent of infected young gay and bisexual men are unaware of their status, according to a 2012 study.

Gay men cruising online and elsewhere might believe they’re negative based on their latest HIV test results. But they could have become infected since their last test without knowing it. Or they might have contracted the virus so soon before their last test that their bodies didn’t have enough time to develop the HIV antibodies that produce a positive test result.

Given these unknowns, a “negative plus PrEP” status is reassuring to prospective sex partners. “People seem much more comfortable because I’m on it,” Beck says. 

Beck learned about PrEP from an ad he saw in The Advocate and asked his doctor about it. Although his doctor had never heard of it, he looked into the treatment on Beck’s behalf and provided a referral.

Now Beck takes one Truvada pill per day, which research shows can provide him up to 97 percent protection from contracting HIV — if he takes the pill with food at the same time every day without fail. Failure to comply with the dosing guidelines lowers PrEP’s effectiveness significantly.

Truvada is a combination of two anti-retroviral drugs that are also used together to treat active HIV infections. Beck’s insurance covers the cost, which is much less than treating an HIV infection.

PrEP has been around for many years, and the U.S. Centers for Disease Control and Infection recommends it for some sexually active gay and bisexual men who are negative, as well as for some negative men whose partners are sexually active. But very few of the people who need it are aware of PrEP, according to a September 2104 survey by The Kaiser Family Foundation. The survey found that only 26 percent of gay and bisexual men knew there’s a treatment that can prevent HIV infection.

Dr. Andrew Petroll is trying to build awareness of PrEP among his peers in Wisconsin. Petroll is an infectious disease specialist with the Froedtert and Medical College of Wisconsin health network and an associate professor of psychiatry/behavioral medicine at the college’s Center for AIDS Intervention Research.

Even as he’s working to increase awareness of PrEP in Wisconsin, Petroll is conducting a survey to determine the level of PrEP awareness among physicians in the cities with the 10 highest populations of people living with HIV.

The lack of awareness concerning PrEP in Wisconsin is troublesome, because the strategy has had great impact elsewhere. In San Francisco, where both HIV-testing and PrEP are promoted aggressively, the HIV-infection rate has been coming down for the past three years, Petroll says.

He currently has about 40 Wisconsin patients on PrEP, including Beck.

“We’re seeing signs of an increase in demand for this (in Wisconsin),” Petroll says. “But people who are really interested in finding it are having a hard time getting it.”

Lack of awareness among physicians isn’t the only barrier to receiving PrEP. Some patients face discrimination from doctors when they ask about it, Petroll says. And doctors who are unfamiliar with PrEP are inclined to dismiss it due to dubious concerns.

Beck has heard many of those concerns, both from his primary care physician and from people online. “My doctor was concerned that, like with a lot of antibiotics, my system could build up a resistance to it,” Beck said.

That fear isn’t real, and it’s probably based on the way that HIV mutates into drug resistant strains, forcing infected patients to switch medications from time to time. But without HIV present in the body to mutate, the development of resistance is not a concern for HIV-negative people taking PrEP.

The major concern is side effects. The awful side effects associated with highly active anti-retroviral therapy are legendary. Truvada, however, was chosen for prevention not only because it works and is simple to take, but also because it has the fewest side effects in the anti-HIV drug arsenal, Petroll says.

There’s a 1-2 percent chance of kidney dysfunction for which Petroll monitors patients on a regular basis.

Beck says that he’s experienced virtually no side effects and there have been no indications of side effects in his routine blood work. He said people are more surprised by that than any other aspect of the treatment.

Like nearly everything else to do with HIV/AIDS, there’s also a political dimension to PrEP. Some activists believe it’s a cop-out, a shirking of personal responsibility.

Gay actor Zachary Quinto set off a firestorm on the subject when he criticized PrEP during an interview with Out magazine.

“We need to be really vigilant and open about the fact that these drugs are not to be taken to increase our ability to have recreational sex,” he said. “There’s an incredible underlying irresponsibility to that way of thinking … and we don’t yet know enough about this vein of medication to see where it’ll take us down the line.”

Petroll and Beck say the benefits far outweigh such concerns.

“It puts you in control if you’re not sure that your partner is always taking his meds or telling the truth about his status,” Petroll says.

When people are looking to have uncommitted relationships or one-night stands, it offers peace of mind if their condom slips or they’re too inebriated to use a condom, he adds.

Beck says he plans to remain on PrEP until he enters a committed relationship, and he’ll continue to educate people about it when he has the chance.

“I’m glad people ask me about it,” he says. “Every doctor I’ve talked to sees my medication list and whenever they’ve asked about (Truvada), they’ve thought it’s really cool that I’m being proactive. I’ve gotten nothing but support from people. I think the message is really starting to get out there.”

For more

To contact Dr. Andrew Petroll, visit froedtert.com and search the website’s “Find A Doctor” database.

Gay rights group endorses once-a-day pill intended to prevent HIV infection

The nation’s largest LGBT civil rights group over the weekend endorsed efforts to promote the use of a once-a-day pill to prevent HIV infection and called on insurers to provide more generous coverage of the drug.

Some doctors have been reluctant to prescribe the drug, Truvada, on the premise that it might encourage high-risk, unprotected sexual behavior. However, its preventive use has been endorsed by the U.S. Centers for Disease Control and Prevention, the World Health Organization and many HIV/AIDS advocacy groups.

The Human Rights Campaign joined those ranks with the release of a policy paper strongly supporting the preventive use of Truvada. It depicted the drug as “a critically important tool” in combatting HIV, the virus that causes AIDS.

“HRC does not take this position lightly,” the policy paper said. “We recognize there is still ongoing debate … and that there are those out there who will disagree with our stance.”

Truvada has been around for a decade, serving as one of the key drugs used in combination with others as the basic treatment for people with HIV. In 2012, the Food and Drug Administration approved it for pre-exposure prophylaxis, or PrEP – in other words, for use to prevent people from getting sexually transmitted HIV in the first place.

“Today, there is an unprecedented chance to end the HIV/AIDS epidemic, in part through PrEP’s aggressive prevention of new HIV infections,” said Chad Griffin, president of the Human Rights Campaign. “There is no reason – medical or otherwise – to discourage individuals from taking control of their sexual health and talking to their doctor about PrEP.”

The CDC says studies have shown that Truvada, when taken diligently, can reduce the risk of getting HIV by 90 percent or more. Research discussed at the International AIDS Conference in July found that use of the drug does not encourage risky sex and is effective even if people skip some doses.

As part of its announcement, the Human Rights Campaign called on insurers, regulators and Truvada’s manufacturer to take steps to reduce costs, raise public awareness, and make the option available to all medically qualified individuals who could benefit from it, regardless of ability to pay.

The cost of Truvada varies widely; a New York State Health Department fact sheet gives a range of $8,000 to $14,000 per year. The manufacturer, California-based Gilead Sciences Inc., has a program that provides assistance to some people who are eligible to use Truvada but cannot afford it.

The Human Rights Campaign urged all states to emulate Washington state, which implemented a program earlier this year offering assistance in paying for PrEP. The preventive option also was endorsed by New York Gov. Andrew Cuomo when he announced initiatives in June aimed at ending the state’s AIDS epidemic by 2020.

The HRC called on state insurance regulators to take action against any insurers who deny legitimate claims from patients who’ve been prescribed PrEP by their doctors.

A prominent provider of services to HIV-positive people, the Los Angeles-based AIDS Healthcare Foundation, remains a vocal critic of the preventive use of Truvada. In an ad campaign launched in August, the foundation says many gay men fail to adhere to Truvada’s once-a-day regimen and describes government promotion of the drug as “a public health disaster in the making.”

On Oct. 10, an alliance of about two-dozen HIV/AIDS organizations in New York released an open letter to the Healthcare Foundation, asking it not to extend the ad campaign to their state.

“We believe your campaign could prevent people at risk for HIV from using this potential lifesaving medication,” the letter said.

The Healthcare Foundation’s president, Michael Weinstein, said his organization did plan to run ads soon in New York City asserting there is data casting doubts on Truvada’s effectiveness.

“Censoring the discussion is not the answer,” he said.

Weinstein also noted that – according to figures from Gilead – only a few thousand people thus far have filled prescriptions for Truvada.

“If people really felt it was the answer, it’s hard to imagine it wouldn’t have spread like wildfire,” Weinstein said. “It’s obvious there is enormous ambivalence in the medical community.”

According to the CDC, there are about 50,000 new HIV infections annually, with gay and bisexual men accounting for nearly 63 percent of them.

On the Web…

Human Rights Campaign: http://www.hrc.org/

AIDS Healthcare Foundation: http://www.aidshealth.org/(hash)/

CDC factsheet: http://www.cdc.gov/hiv/pdf/PrEP-GL-Patient-Factsheet-PrEP-English.pdf 

New guidelines recommend daily HIV ‘prevention’ pill for some

New clinical guidelines released by the White House on May 14 say that health care providers should consider advising the use of anti-HIV drugs by uninfected patients who are at substantial risk of infection.

PrEP, or pre-exposure prophylaxis, could reduce HIV infection rates, according to the administration health officials. When taken daily as directed, PrEP can reduce the risk of HIV infection by more than 90 percent. Inconsistent use results in much lower levels of protection.

“HIV infection is preventable, yet every year we see some 50,000 new HIV infections in the United States,” said CDC director Tom Frieden. “PrEP, used along with other prevention strategies, has the potential to help at-risk individuals protect themselves and reduce new HIV infections in the US.”

The guidelines were developed by U.S. Centers for Disease Control and Prevention in partnership with other federal health agencies, public health experts and community leaders.

The guidelines say PrEP should be considered for HIV-uninfected patients with any of the following indications:

• Anyone who is in an ongoing sexual relationship with an HIV-infected partner.

• A gay or bisexual man who has had sex without a condom or has been diagnosed with a sexually transmitted infection within the past six months, and is not in a mutually monogamous relationship with a partner who recently tested HIV-negative.

• A heterosexual man or woman who does not always use condoms when having sex with partners known to be at risk for HIV and is not in a mutually-monogamous relationship with a partner who recently tested HIV-negative.

• Anyone who has, within the past six months, injected illicit drugs and shared equipment or been in a treatment program for injection drug use.

“While a vaccine or cure may one day end the HIV epidemic, PrEP is a powerful tool that has the potential to alter the course of the U.S. HIV epidemic today,” said Jonathan Mermin, director of CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention. “These guidelines represent an important step toward fully realizing the promise of PrEP. We should add to this momentum, working to ensure that PrEP is used by the right people, in the right way, in the right circumstances.”

The guidelines offer providers specific advice on how to give people the support they need to take their pills regularly.

Given the need for high adherence and the lack of complete protection from HIV with PrEP or any other single strategy, the guidelines encourage providers to promote and support its use in combination with condoms and other proven risk-reduction strategies.

Accompanying the guidelines is a supplement that includes checklists and interview guides to assist clinicians with PrEP prescribing and counseling.

The guidelines build on interim guidance issued by CDC following the release of research findings on PrEP for men who have sex with men, heterosexuals and people who inject drugs.

In 2012, the U.S. Food and Drug Administration approved the drug combination of 300 milligrams tenofovir disoproxil fumarate and 200 milligrams emtricitabine (TDF/FTC) for use as PrEP in combination with safer sex practices.

Consistent with FDA labeling, the guidelines stress the importance of HIV testing before PrEP is prescribed and at three-month intervals while a patient is using PrEP. Regular testing ensures that anyone on PrEP who becomes infected with HIV discontinues PrEP use in order to minimize the risk that the virus could become resistant to the drugs. Such patients then can begin receiving HIV treatment.

“PrEP is a new approach to HIV prevention that requires continuing collaboration between patients and providers, as effectiveness requires adherence to daily medication and regular medical visits for monitoring, counseling and testing,” said Dawn K. Smith, the epidemiologist in CDC’s Division of HIV/AIDS Prevention who led the development of the guidelines. “Individuals will have to decide with their doctor if PrEP is right for them, but for some, this may offer a much-needed strategy to help protect themselves from HIV infection.”

In addition to providing guidelines and tools to assist providers in effectively prescribing and supporting PrEP use, CDC and other organizations are conducting pilot implementation studies and demonstration projects throughout the country.

These projects aim to identify the most effective ways to deliver PrEP in community settings that can reach those at high risk for HIV infection.

The guidelines were announced in the CDC’s Morbidity and Mortality Weekly Report. The 67-page guidelines and 43-page clinical providers’ supplement are published in full athttp://www.cdc.gov/hiv/pdf/guidelines/PrEPguidelines2014.pdf.