The Department of Public Health has launched an ambitious campaign called Getting to Zero: zero HIV transmissions, zero deaths from HIV-related illnesses and zero HIV stigma in San Francisco by 2020.
One of the ways to achieve the goal is for people who don’t have HIV, but are at risk, to take a pill called PrEP (Pre-exposure prophylaxis), which is known by the brand name Truvada. When consumed daily, PrEP can reduce the risk of HIV transmission by 80 to 90 percent.
Sandy Close, the director of New America Media who moderated a panel on how to close the information gap on PrEP in underserved communities, called it a “break the silence issue,” referring to the stigma and misconceptions about PrEP and HIV.
Misinformation about the drug is all too rampant. Too many from communities of color believe the drug is not for them.
Jorge Vieto, a health systems navigator at the GLIDE Foundation, said that he often heard it was primarily for gay white men.
“I’m a gay Latino immigrant from Costa Rica,” he explained, describing why this belief is widespread. “I don’t see myself in the posters and advertisements.”
“We don’t see Latinos, we don’t see blacks, we definitely don’t see women and trans women as part of the imagery that’s promoting PrEP,” said Terrance Wilder of the San Francisco AIDS Foundation. “So, of course, they’re not going to think it’s for them.”
Besides including black and brown faces to be part of the PrEP campaign, communities of color should be invited to discussions and forums where confusing myths and messages can be dispelled. Though, even when invited, cultural barriers can limit access to honest conversations.
Tapakorn Prasertsith, who self-identifies as a “25-year-old nonbinary, second-generation Thai person living in San Francisco” and who works for API Wellness, said that most often they were the only Asian at the table when PrEP discussions take place. Besides not being invited to participate, Asians have a hard time discussing sex.
“I’m Thai. I have no idea how I would explain HIV to someone in my language,” Prasertsith said.
When they heard about PrEP and its effectiveness, they started outreach and often encountered anger. “Why are you doing this?” “Why aren’t condoms enough?” “I’m not one of those!” Prasertsith recalled.
The unfortunate truth is that the Asian Pacific Islander demographic is showing increasing levels of HIV infections, from 8 percent of all those newly diagnosed in 2011 to 15 percent in 2016, according to Centers for Disease Control.
The San Francisco AIDS Foundation reported The City has one of the largest HIV-positive populations, with about 16,010 people living with HIV. According to CDC estimates, in 2016, there were 223 new HIV diagnoses, a decline from previous years. Out of this group, 79 percent were gay and bisexual men; 28 percent were Latinos; and while only comprising 6 percent of San Francisco’s population, African Americans represented 15 percent of the 2016 statistic.
Perhaps equally, if not more, disturbing is how our youth are affected: Public Health data shows that the rate of HIV infection among people ages 13 to 29 is almost twice as high as older age groups.
“San Francisco won’t get to zero without young people,” said Denny David, deputy director of LYRIC, which works primarily with LGBTQQ youth, their families and allies. Bolstering his argument with the statistic that 77 percent of those living with HIV are youth of color, David described them as young men who are looking for a spiritual connection, looking to be embraced. They are disconnected from school, education and work and end up struggling, looking for other ways to connect, David said, adding that more than half had never heard of PrEP.
Even for those who know what PrEP is, the issue is one of priority and discipline. Taking the drug every day as part of a daily routine is critical to its effectiveness.
“If you’re not in a mental state, you’re not going to have the discipline to take those types of medications,” Wilder said. Since many who fall in the risk category are homeless or marginally housed, worrying about the next meal or where to find shelter next become top priorities in the struggle to survive.
The steep price of the drug adds to the information obfuscation. One month’s supply can cost up to $1,600. Medi-Cal and many private health plans cover some or all of the cost of PrEP; for those who are uninsured, Healthy San Francisco offers affordable options.
However, as Vieto mentioned, especially when it comes to the Latino community, many are “conditioned to not access any part of the public system,” for fear of being accused of taking advantage of the system.
It’s a question of awareness coupled with convenience. There exists an effective drug that can prevent the HIV virus from taking root. But there’s a jumble of information and cultural cross-talk that adds to the incoherency around PrEP.
San Francisco’s goal of becoming HIV infection-free is certainly something to reach for. What it perhaps requires is frequent rechecking, retuning and recalibrating of the PrEP message. Simply put, PrEP works!
Author’s note: This column is dedicated to New America Media and its parent organization, Pacific News Service. After 45 years as a media company, working tirelessly to profile ethnic voices in journalism, the organization is shutting its doors on Nov. 30. It is with sadness that I report on this last panel organized by NAM and its tremendously inspiring leader, Sandy Close.
Jaya Padmanabhan can be reached at firstname.lastname@example.org. Twitter: @jayapadmanabhan. In Brown Type covers immigrant issues in San Francisco.