Public Health in the National News – The Food and Drug Administration approval of a pre-exposure prophylaxis, or PrEP, is an exciting development in the fight to end HIV infection. The public health community working to prevent new infections now has another in a wide array of tools with which to prevent HIV transmission.
Clinical studies have shown those who start a PrEP regimen do not engage in behaviors that transmit HIV with any greater frequency than before using the drug. Despite this, some public health officials are concerned that some may engage in those behaviors more often if they are on a PrEP. Changing behavior is difficult; if someone is engaging in activities that have high potential for transmission of HIV and he or she is not likely to reduce or stop those behaviors in the near future, PrEP could be a life-saving option. For these reasons, it is important that anyone beginning a PrEP regimen also receive counseling and education around HIV prevention and be tested for HIV on a regular basis. A comprehensive approach to HIV prevention is the best scientifically justified prevention method recommended.
As with many newly approved treatments for HIV, PrEP regimens are not cheap—some estimate costs of up to $13,000 a year. It is unclear yet how insurance companies will handle the newly approved on-label use of the drug. While PrEP may be a great new tool in the HIV prevention specialist’s toolkit, it will likely not be available to many of those who most need it because of the cost. Policymakers and drug company marketers will need to take costs of the drug into account when determining how best to implement PrEP as part of a multipronged approach to HIV prevention in the United States.
For those who are good candidates for PrEP and can afford it, the once-a-day pill is not a magic bullet. PrEP doesn’t work for everyone and is not 100% effective, even when taken every day as directed. In addition, numerous side effects can interfere with daily quality of life. In addition, some major side effects could be life-threatening. It is important that those who are considering using PrEP get all the facts and be presented with all prevention options to determine what works best for them.
While we may soon be saying “HIV?! There’s a pill to prevent that,” we need to remember that prevention has never come in a magic bullet. We still need to carry out the multipronged approach to HIV prevention as outlined in the National HIV/AIDS Strategy. We need to ensure that EVERYONE is included in our prevention efforts, not just those who can afford a pill and have the sociocultural support to take it every day.
This article was written by Christopher Fisher, PhD, assistant professor in the UNMC COPH Department of Health Promotion, Social and Behavioral Health. Dr. Fisher is also director of the Midlands Sexual Health Research Collaborative and chair of the APHA HIV/AIDS Section.