Truvada is the big pill that forces users to think about their sex lives every day, and through one program offered by the Long Beach’s Health and Human Services Department, it’s free to certain individuals who are at high risk to contract HIV. Last year, Long Beach’s health department announced their demonstration program to offer Pre-Exposure Prophylaxis (also known as PrEP) with the medication known as Truvada. The Centers for Disease Control and Prevention (CDC) has described PrEP as “a way for people who do not have HIV but who are at substantial risk of getting it to prevent HIV infection by taking a pill every day…When someone is exposed to HIV through sex or injection drug use, these medicines can work to keep the virus from establishing a permanent infection.”
Long Beach’s program has focused on a particular group of people for their study– men who have sex with men (MSM), and they must test negative for HIV. In the program, they do discuss behaviors that place clients in danger of contracting HIV.
Deborah Collins, the director of clinical services for the city’s health department, explained that some of the risky behaviors include sex without condoms, having multiple partners and sharing sex toys. They have focused on recruiting minority participants.
The study through Long Beach is part of a collaborative program with UC San Diego, UCLA and the University of Southern California.
She acknowledged in a phone interview that providing the Truvada pills might be the draw for high-risk individuals to join the study, but she added that under other circumstances, the department may not see these individuals to help them make informed decisions. The program does stress the use of condoms and offers a comprehensive education about the risk for HIV and other sexually transmitted diseases (STDs) in addition to offering advice about taking the medication itself.
“We really stress very strongly the behavioral changes that someone needs to make to reduce their risk of HIV,” Collins said. “It’s not just about the pill. As with any kind of disease like this, it’s not just the pill.”
The CDC has reported that Truvada is 92-percent effective when taken daily.
All participants in the program are regularly tested for HIV, and they are receiving care through their medical providers. Half of the group of program participants are reminded via text to take the pill.
Of the 45 participants in the program, so far, no one has reported that they have tested positive for HIV.
Dr. Mitchell Kushner, the city’s health officer, stated in a phone interview that the main goal is to prevent new HIV infection, adding that they are also treating the behaviors that put them at risk.
“We’re also using it as an opportunity to talk about all the other STDs and try to eliminate…acquisition of the other types of infections too,” Kushner said.
The CDC has recommended that patients who use PrEP have regular follow-up with their medical provider every three months for HIV testing and receive, if necessary, counseling for STDs and assessments for side effects.
The AIDS Healthcare Foundation has criticized the nationwide focus on Truvada as the main method to prevent HIV and has expressed concerns that condom use would be de-emphasized.
Whitney Engeran-Cordova serves as the senior director of public health for the AIDS Healthcare Foundation.
He warned that the focus on PrEP versus condom use is telling gay men that “all you have to do is take a pill and everything is going to be okay….That concerns us greatly because it doesn’t protect against STDs, and the studies are very clear that…if you don’t take the pill every day, it’s not effective.”
It’s a concern that’s readily acknowledged by the health department as well as other organizations geared to the gay community like The LGBTQ Center Long Beach.
The Center does refer clients to the health department if they seek to be a part of the city’s program. Ismael Morales is the director of health services for The Center. He said that they do dig a little deeper to find out why clients might be interested in Truvada.
“What I tell my clients all the time is if they’re going to be able to commit to taking one pill every day for as long as they choose to be on the study, what’s the difference between just making the decision to wear a condom or make a better decision in terms of sex partners?” Morales said. He added that at least PrEP is starting the conversation over again to prevent the spread of HIV and STDs.
Long Beach Department of Health and Human Services