PrEP Pride: New York Doctors Reflect on an Important Standard of Care
When PrEP (Pre-Exposure Prophylaxis) was brought to market in 2012, the HIV prevention game dramatically changed. High-risk populations could now significantly reduce their odds of contracting the disease by upward of 92%, simply by taking one pill each day. With minimal side effects, today PrEP is widely accepted as an enormous public health asset.
PrEP works by blocking an enzyme that’s critical to helping the HIV virus replicate. To be effective, PrEP does need to be taken regularly (effectiveness is stronger and better maintained with each day you take it). In that sense, one way to think of it is sort of like a birth control pill for HIV. In fact, like birth control, people don’t need to take it forever. It’s common for users to go in-and-out of what we call “seasons of risk,” which are times in your life where you’re risking exposure. For example, if you’re single and sexually active with a number of new partners, you’d be in such a season. If you settled into a period of abstinence or a monogamous long-term relationship with someone who is HIV negative, you’d be out of your risk season and could stop taking it.
Starting on January 1, 2020, PrEP coverage without copays became mandatory for all insurance plans in New York State. New York has also been the first state to declare a PrEP Awareness Week, and it now leads the nation in PrEP prescriptions. In honor of PRIDE month, we asked four New York MDs for their thoughts on PrEP — how it’s altered the prevention landscape and what it means today.
“HIV is a preventable disease. However, transmission rates are still very high in New York City and in other parts of the country. Approximately 125,000 New Yorkers are living with HIV and up to 20% do not know they are infected. We need to educate patients and providers on how to prevent transmission of this disease. In my practice, I consider PrEP standard of care. Just telling patients they can take a pill daily to prevent HIV infection has done a lot to reduce their anxiety and opens up an important dialog about safe sex practices. It’s great to be able to offer my patients a safe and effective way to take control of their health.” -Jason Kindt, DO, Assistant Professor of Family Medicine & Community Health at Mount Sinai’s Ichan School of Medicine
“We have about 2000 patients taking PrEP in our practice. With regard to any negative stigma, it’s actually quite the opposite. Not only are patients for whom it might be indicated willing to take it, but also we have people who ask to take it who probably don’t need to. People see it as a way to get peace of mind. It’s so low-risk that if it benefits them mentally, that’s okay, too.” -Kris Bungay, MD, practitioner at Gotham Medical Group
“We’re definitely seeing PrEP prescriptions rising among gay men — they really get why it’s important — and HIV rates continue to decline in that population. A lot of credit there goes to the drug’s marketing campaign, which speaks directly to that community. Where we’re falling short in terms of awareness is among men who have sex with both men and women. Also, critically, black and Latina women who have sex with men, which are the only populations where HIV is currently going up nationwide. In that sense, there’s still considerable work to be done.” -Amy Esposito, MD, volunteer faculty at Mount Sinai’s Ichan School of Medicine
“In a few short decades, HIV has been transformed from a near-death sentence to a manageable chronic condition. PrEP has been a critical element in this transformation. It has given many people back what HIV had taken away — the freedom to explore one’s sexuality without having the looming fear of contracting a once life-threatening infection.” -Honore Lansen, MD, Galileo Health
