Their Opinion: Drug can prevent transmission of HIV
Newsday wrote on August 1:
More than three decades after the AIDS pandemic swept into New York and the nation to claim hundreds of thousands of lives, an amazing moment has arrived.
For the first time, a pill is available that can prevent transmission of HIV, the virus that causes AIDS, during sex.
Its name is Truvada -- and it's a key ingredient in the daily cocktail that has prolonged the lives of many who have already contracted the virus.
The startling news is that when those who are not infected take the pill once a day, Truvada has proved more than 90 percent effective in blocking the transmission of HIV, the Centers for Disease Control and Prevention reports. The CDC issued guidelines in May for using the drug to prevent HIV infections.
Seizing this moment, Gov. Andrew M. Cuomo recently announced a plan to use Truvada as a part of his strategy to cut new HIV infections statewide from 3,000 a year to 750 by 2020.
It's an ambitious, trailblazing plan -- and reaching the target will take an unflagging, collaborative effort.
But if that push can be accomplished successfully, officials say, the number of New Yorkers living with HIV would be reduced for the first time since the first cases were diagnosed in 1981.
Great strides have been made. In New York and the nation, HIV transmission via blood transfusions and from mother to child have been virtually eliminated, and new infections due to intravenous drug use have been dramatically reduced. With the success of antiretroviral drugs in treating HIV, the infection is no longer a death sentence. But there is no cure or vaccine. And the CDC estimates that nationally there are still 50,000 new infections a year.
New York, long the epicenter of the crisis, has a shot to become the first state to reduce AIDS to less than epidemic proportions by driving the number of new infections below the number of HIV-related deaths. It's an opportunity that shouldn't be missed.
Besides Truvada, other factors have helped fuel optimism among public health officials. Since 2010, doctors in New York are required to offer HIV testing to all patients ages 13 to 64. Since April, written authorization for the testing is no longer required. Verbal consent is enough. Doctors and health officials can now share information to find patients who drop out of treatment. And the Affordable Care Act requires insurers to cover HIV screening with no out-of-pocket cost for policyholders.
The state's plan includes identifying an estimated 22,000 people who are HIV positive but don't know it, and ensuring that the 64,000 people who know they're HIV positive but aren't in treatment get anti-HIV therapy. And it involves securing access to Truvada, a pre-exposure prophylaxis, or PrEP, for HIV-negative adults at high risk -- for example, men and women with HIV-positive partners, or who have sex with multiple partners.
The state has committed $5 million to the plan this year. The objective is to educate doctors about PrEP, and to push them to consistently offer testing. For the initiative to work, officials must communicate that this is an opportunity for an extraordinary public health triumph.
Anti-AIDS advocacy groups have been enlisted to reach at-risk people in places such as bars and clubs, where peer-to-peer conversations are the best way to spread the word about PrEP, and address unfounded concerns about side effects, which are minimal.
Medicaid and most private insurance plans cover the $1,300-a-year cost of the drug. And Gilead Sciences Inc., the California-based company that makes Truvada, has an assistance program to defray the cost if needed.
The state's bill for HIV medication will likely grow before savings from averted infections are realized. And there is a risk that the availability of PrEP could usher in a return to unsafe sex -- despite warnings that PrEP is not intended to replace prevention tools such as condoms.
But this is an opportunity to end the AIDS epidemic in New York, which not so long ago seemed an impossible dream.
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