Transmission of HIV can basically be eliminated if individuals living with the virus and those who could acquire HIV take PrEP or pre-exposure prophylaxis medication according to community health officials in Cleveland. That was the message from Dr. Lisa Navracruz, HIV primary care program director at Neighborhood Family Practice and Brittani Flory, the practice's HIV prevention nurse, who talked about their awareness efforts during the Nov. 15 episode of Sound of Ideas.
Flory said the drug prevents transmission in nearly every case.
"When taken as prescribed, it's over 99.9% effective," she said. "And so it can help someone who is negative stay negative, and they may have partners that are HIV positive, but they're protecting themselves by taking the medications to help keep them negative."
She added the medication, which was first approved for HIV prevention in 2012, can be taken as a daily pill or a shot administered every two months and is not expensive due to the various programs in place to offset costs.
"We have programs to help folks who are have no insurance get prep covered free," Flory said. "We also have copay assistance programs for folks to cover the cost of really costly injectables and name brand drugs. So they're not paying anything for that. ... Folks who are on Medicaid. It's covered at 100%. The state of Ohio also has a program called PAPI (Prevention Assistance Program Interventions), and they are able to cover the additional lab costs ... the doctor's visits, the nurse visits." PrEP "should be accessible to everybody who wants it."
Navracruz added current treatments provide those living with HIV a quality and length of life comparable to the rest of the population.
"Folks who are living with HIV, if they stay engaged in care and they stay on treatment and we reach their treatment goals, their life expectancy is just about the same as anyone who is not living with HIV ... and have their full, wonderful lives with all of the things they want to do, including childbearing and being in healthy relationships," she said.
According to Navracruz, there are around 5,100 people living with HIV in Northeast Ohio and 100 new cases per year. But she said PrEP treatments are available to prevent transmission.
"We have the tools, we can prevent this," Navracruz said.
Flory said the problem is not about medication or other treatments, but awareness, access, overcoming the stigma of the issue and mistrust of medical institutions, especially for the Black and Hispanic men who are most at risk. She added the problem is especially acute on the West Side of Cleveland in the Edgewater and Detroit Shoreway neighborhoods that have the highest rates of new HIV infections.
Flory said Neighborhood Family Practice, which has several locations in these neighborhoods, has been addressing this problem by going into the community to raise awareness of the need to be tested for HIV and to get treatment to prevent transmission of the virus.
She also goes into the community to do HIV testing during evenings and on the weekends to ensure as many people are tested as possible, while also getting medical advice on how to prevent transmission and what to do should they test positive.
"We're looking at untraditional settings where folks are disproportionately affected by new HIV diagnoses to get testing out there to make it accessible, because not everyone feels comfortable going to the doctor or they might not have insurance and know where somewhere they can go," she said. "So making it accessible and easy for folks to do is one of the big keys to get people to know their status as well."
Flory said the group is also working with community leaders to lessen the stigma of testing, rebuild trust and provide needed resources to protect their health.
"We are specifically working with organizations that are serving black and brown communities," she said. "They need the resources. There also needs to be the rebuilding of the trust in health care systems as well, because we recognize those lived experiences" that led to this distrust.
