It sounds too good to be true: a pill that’s more than 90 percent effective in preventing HIV infection. That drug exists. But price, stigma and ignorance are keeping more people from taking this protective medication.
It’s called Truvada, a once a day pill to protect people from acquiring HIV, the virus that can lead to deadly AIDS. Truvada was approved by the Food and Drug Administration in 2012, but it’s not widely known or widely used, even after four years on the market.
"Initially we’re really targeting men who have sex with men," said Junda Woo, MD, Medical Director of the San Antonio Metropolitan Health District.
Woo said in the U.S., the chances of acquiring HIV as a sexually active gay man are pretty high, especially for men of color. "
If you’re white, it’s one in 11 over your lifetime. If you’re Latino, it’s one in four. If you’re African American, it’s one in two," she stated.
David Nakaido of San Antonio, a 26-year-old software engineer with HEB, starting taking Truvada recently. "I first started taking Truvada back in March," Nakaido said. "I started taking it because at the time, the guy I was dating was positive."
Nakaido said he pays nothing for the drug which costs $1,500 a month. Insurance picks up part of his cost. The pharmaceutical company that makes the drug, Gilead, provides a co-pay card that covers the rest.
Nakaido hasn’t noticed any side effects, and he says taking the pill gives him peace of mind. "
If you don’t want to protect yourself, that’s a choice you can make," Nakaido added. "But if it’s your life that you care about, I say why not?"
Not everyone in the gay community embraces the idea of an HIV prevention pill. Some derogatorily call the users “Truvada whores.” But medical professionals say the prescription medication is not designed to enable a risky lifestyle. It’s designed to protect health.
Nakaido agrees. "It’s not like I’m out there having sex all the time because I’m on this drug. No. That’s not it," he stressed. "For me, it’s a health thing."
Taking the pill could also be a “health thing” for intravenous drug users or heterosexuals with multiple partners.
The Centers for Disease Control said last year, only one in three primary care doctors had even heard of Truvada.
Physician assistant Amanda Miller of CentroMed is one of the San Antonio providers and an advocate. "I think it would be great if we could put everybody who’s at high risk for HIV on it," Miller said.
Patients are usually referred to Miller by other physicians. She’s been prescribing Truvada for two years. It’s also known as PrEP for pre-exposure prophylaxis.
"They like the idea that it’s an added layer of protection for HIV," Miller said of the patients taking Truvada. "In addition to condoms and other risk reduction techniques, PrEP just gives them a little bit of additional peace of mind that they didn’t have before."
Miller points to San Francisco as a city where promotion of Truvada use has actually decreased the number of new HIV infections significantly.
In Bexar County, the new HIV infection rate has stayed steady for the last decade or so, with about 350 people each year diagnosed. Most are young Latino and African American men.
There just isn’t a lot of information out there," he said.
Schnarrs point out that other Texas cities like Austin have been proactive about getting the word out about the availability of Truvada. A San Antonio HIV research coalition is working with Metro Health and existing clinics to make the drug more accessible in San Antonio.
As a health behavior researcher, Schnarrs says Truvada can help mental health as well as preventing disease.
"It walks back the stigma that has surrounded gay men and sexuality for the past thirty years," Schnarrs asserted. "It makes people less fearful of getting HIV and so it improves the sex that they’re having. And part of sexual health is this principle of having pleasure in sex. It also decreases anxiety. It decreases depression."
Schnarrs is gay and he takes Truvada. But the CDC reports just 1 percent of people who could benefit are taking it.
It’s a subject Metro Health’s Dr. Woo is passionate about. "When we know that we have a medicine that’s this effective, it's a crying shame."
Woo said doctors have a moral obligation to talk to their patients about the drug and offer it.