Pride and PrEP
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 upwards of 92%, simply by taking one pill each day. With minimal side effects, today, PrEP is widely accepted as an enormous public health asset. In fact, Governor Cuomo distinguished himself as one of the first high-profile US politicians to advocate for PrEP’s use when he made it a key part of his plan to end the state’s HIV epidemic by 2020.
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. In honor of Pride month, we asked three to New York MDs for their thoughts on PrEP — how it’s altered the prevention landscape and what it means today.
“We have about 1361 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 Clinic and chair of the Clinical Care Committee of Callen-Lorde Community Health Center.
“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, Medical Director of the Oscar Center and Assistant Professor in Internal Medicine at Mount Sinai Hospital.
“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, One Medical and Weill Cornell Medicine Voluntary Faculty Member
