Just last week, one of Sharon Lee’s HIV-positive patients came to her with a frustrating problem that set her in action.
The man’s partner — who isn’t HIV-positive — wanted to take an HIV medication that can cut the risk of infection by 90 percent or more but couldn’t find a doctor willing to prescribe it. Other people the patient knew also had been turned down by their doctors.
“He said somebody should be doing this,” said Lee, the CEO of Family Health Care, a safety net health care center on Southwest Boulevard in Kansas City, Kan. “My patient was right.”
So beginning Friday afternoon, Lee will be holding a weekly clinic at the health center for people who want to take the drug. The clinic is among the first of its kind in the nation, Lee said.
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“We have a possibility presented to us of preventing new infections of HIV. This is one tool I think we should be using,” she said.
The HIV drug, Truvada, has been on the market four years. Two years ago the federal Food and Drug Administration approved it for HIV prevention. Several international studies found that a daily Truvada pill reduced the risk of acquiring an HIV infection by 90 percent. Even people who were less conscientious about taking the pill every day saw their risks go down.
Despite advances in treatment, new HIV infections in the United States have remained stuck at about 50,000 per year since the 1990s. Gay and bisexual men account for most of the cases, according to the Centers for Disease Control and Prevention.
But Truvada has been slow to catch on.
“Doctors are uncomfortable prescribing it,” Lee said.
Some aren’t familiar with AIDS drugs, she said. But there’s another reason for their discomfort.
“Morals,” Lee said. “Should we give people a way to protect themselves if they’re doing something we think is morally reprehensible?”
There’s also the expense. Truvada costs about $13,000 annually. Not all insurance plans cover it, but the drug’s manufacturer does offer some discounts.
AIDS activists also have been divided. Michael Weinstein, the president of the Los Angeles-based AIDS Healthcare Foundation, stirred up controversy recently by calling Truvada a “party drug.” And Larry Kramer, author of “The Normal Heart,” told The New York Times, “There’s something to me cowardly about taking Truvada instead of using a condom.”
But new research, discussed Tuesday at the International AIDS Conference in Melbourne, Australia, suggests that taking the drug does not increase risky sexual behaviors.
The research followed up on the original study proving that daily use of the drug was effective in preventing AIDS.
Some health officials had worried that taking Truvada might give a false sense of security and make men less likely to use condoms or to limit their partners. However, study participants reported no increase in these behaviors, and there was no rise in syphilis or herpes, other sexually transmitted diseases that might suggest risk-taking.
In May, the Centers for Disease Control and Prevention took the unusual step of issuing guidelines recommending that doctors offer Truvada to people at substantial risk of HIV infection, such as those in a sexual relationship with someone who is HIV-positive.
Jonathan Mermin of the CDC said this therapy, called PrEP, or pre-exposure prophylaxis, “is a powerful new tool that has the potential to alter the course of HIV in the United States today.”
Last month, Gov. Andrew Cuomo of New York announced that his state would make PrEP part of an ambitious new plan to prevent HIV infections.
Lee said she isn’t trying to “steal” other doctors’ patients by offering PrEP. Unlike her health center, the new clinic won’t be operated as a safety net service. Patients will be charged about $300 for their first visit, which includes an HIV test and physical exam. Follow-up visits every three months will cost about $140.
“Maybe this will galvanize other providers to offer this treatment,” she said.