Petrelis Files

MoJo: HIV Morning-After Pill
You've Never Heard of

Here's some news for the folks at Mother Jones: The gay press and AIDS magazines have extensively covered PEP, post exposure prophylaxis, and its ramifications, including how it is not actively promoted by the HIV prevention mafia. While it's great to see a progressive magazine report on PEP, and I really like the tone of the article, I wish this sub-head gave the gay and AIDS communities some credit for working to develop and publicize PEP:

Introducing the best FDA-approved, commercially available lifesaver you've never heard of

Um, quite a few queers have heard it actually.

That being said, it's maddening to me that years after the evidence came in showing the benefits of PEP, far too-many HIV at-risk sexually active people don't know about it. Basically, because HIV prevention mafiosi are executing 1980s-style finger-wagging campaigns out of step with 2008, HIV cases that could have been averted are allowed to develop in people, who, if they knew about PEP, might take advantage of it.

Before delving into the MoJo piece, let me call your attention to a Bay Area Reporter story last month on a town hall meeting in San Francisco with the city's HIV prevention godfather, Dr. Grant Colfax. Despite his bizarre claim that evidence is lacking, DPH has long recommended and provided PEP for occupational exposure to HIV, and in recent years making it available to sexual exposure cases. From the BAR:

As for PEP, Colfax agreed many men do not know about the four-week drug regiment or where to go to get it. But he added data is lacking to show it truly works, and with limited resources, questioned if it made sense to launch a PEP-focused campaign.

There may not be a social marketing effort or even grassroots stab at educating gay men in SF about PEP, but the DPH STD clinic does provide info about their PEP program on its site:

PEP is a 28-day cycle of drug treatment believed to be effective in preventing an HIV negative person from becoming positive after exposure to HIV. At City Clinic, we offer testing, counseling and prescription for PEP medication within 72 hours of a possible exposure to HIV. You can call (415) 487-5538 to discuss your situation with a clinician before coming to the clinic for services. Once you arrive at the clinic, you will meet with a clinician to discuss available medications, be provided counseling with a trained Health Worker, have blood drawn for HIV and STD tests, and receive a schedule for follow-up appointments at 1 month, 3 months and 6 months.

Now, let's get to the MoJo story:

. . . The side effects of debilitating nausea and fatigue were a small price to pay for its potential benefits: A study of health care workers published in the New England Journal of Medicine linked the rapid administration of the drug to an 81 percent decrease in the risk of contracting the
virus . . .

As preventative medicine, the drugs work with a one-two punch: The first intercepts the virus' initial attachment to DNA, and the second stops infected cells from spreading the virus.

Danny was lucky that California is one of the few states (along with New York, Massachusetts, New Mexico, and Rhode Island) where policies ensure that the general public—not just hospital workers who have been exposed on the job—can access the drugs. Elsewhere, the decision is up to individual hospitals, clinics, and doctors. Surveying all 50 state health departments and more than 50 ERs nationwide, I encountered STD clinicians and workers at AIDS hotlines and Planned Parenthoods who did not know PEP could be prescribed to the public . . .

"It needs to be treated like a gunshot wound or a stabbing," says Antonio Urbina, a medical director at St. Vincent Catholic Medical Center's HIV clinic in New York City . . . In a 2005-06 CDC survey taken at gay pride parades around the country, less than 20 percent of HIV-negative respondents knew about PEP. "When I tell people that I used it, they say they've never heard of it," says Danny. "You see signs about crystal meth or syphilis, but even in the gay publications, you never see ads for pep."

PEP is FDA approved, commercially available, and even often covered by insurance (though for the uninsured the drugs run upward of $1,000) . . .

But for reasons that are more political than scientific, there is no federal funding for the treatment. Some public health officials claim that public availability of pep will encourage risky behavior—the same argument used against RU-486, abortions, and condom distribution. Robert Janssen, director of the Division of hiv/aids Prevention at the cdc, explains, "Biomedical interventions raise concerns that people would feel, 'Oh, I have these pills, they will keep me from getting it.'" . . .

Peter Leone, medical director of North Carolina's hiv department, who hasn't received the necessary support to institute a public PEP program in his state, believes the benefits of pep outweigh the risks. "Nationally, there is a 'Don't Ask, Don't Tell' policy," he says. "We're okay to say it's a good idea, as long as we don't know about it and don't do anything to support it. We don't deny care to smokers or people who didn't buckle their seat belts. It says a lot about the political climate around sexuality and homophobia." For the 40,000 people infected with HIV in the United States each year, the knowledge of a lost opportunity for prevention is devastating. In Britain, an HIV-positive couple has filed suit against the government for withholding lifesaving information . . .

In consideration of the fact that national HIV infections have allegedly remained steady at 40,000 for so long, and some CDC and state officials claim that number is climbing, now would be a good time to radically rethink prevention modalities that integrate the powerful HIV drugs in new preventative ways. If only the HIV dons and prima donnas could think outside the box, we would likely see new infections come under control.