San Francisco is poised to strengthen its efforts to eliminate new HIV cases by helping to subsidize people's use of a daily pill that can reduce their chances of being infected by the virus.
While the federal drug administration approved use of PrEP, or Pre-Exposure Prophylaxis — the brand-name drug Truvada manufactured by Gilead Sciences is the only one on the market — in 2012, few people use it. In San Francisco, it's estimated less than 1,000 take the drug.
But Dr. Robert Grant, a UC San Francisco professor who led clinical trials of PrEP, said increasing users of the medicine would have significant results.
“We should be giving PrEP to about 6,000 San Franciscans,” Grant said. “If we do that we might expect the numbers of new [HIV] infections to drop from currently 400 to less than 50.”
According to city and health officials at Thursday's Board of Supervisors Neighborhood Services and Safety Committee hearing, there are two main barriers for why there is currently low usage: awareness and cost. The cost can run up to $1,800 a month without insurance.
Supervisor David Campos announced Thursday he would introduce next week an $800,000 funding request to establish a PrEP subsidy program and pay for so-called navigators to help people gain access to the drug through their health care providers' medical or The City's health programs. Washington state recently launched a similar PrEP assistance program.
The move comes as Supervisor Scott Wiener announced a day before the hearing in an online essay that he is a user of Truvada.
“A lot of people don't know about it at all,” Wiener said. “And there are a lot of people who may have some sense of what it is but they don't fully understand how beneficial it is.”
Some critics of the drug suggest that it would lead to riskier behavior such as sex without condoms and more promiscuity. But while similar arguments have been made with other sexual health issues like birth control, Grant said researchers have seen the opposite in studies. “This is an opportunity for us to end the epidemic and it's an opportunity that's underutilized,” Grant said.
AIDS Housing Alliance Director Brian Basinger said that he has become a “big believer” in the PrEP drug and believes it could make a large difference for identified high-risk populations. “The Department of Public Health has shown that the prevalence of HIV in the sexual networks of African American gay men in the Tenderloin is the primary driver of new HIV infections,” Basinger said. “We can use PrEP to disrupt the new HIV infections in really profound ways.”
The latest statistics from the Department of Health found that in 2013 there were 15,901 city residents living with HIV. Last year, there were 359 new HIV diagnoses, which have dropped annually from 530 in 2007. The number of annual deaths from HIV is also decreasing with 327 reported in 2006 and 182 last year.