Legislation Proposed to Make Preventative HIV Drugs More Accesible

San Francisco Supervisor David Campos introduced legislation today that would allocate about $800,000 to not only assist San Franciscans who can’t afford preventative HIV/AIDS drugs but would also pay health navigators to increase education about the effectiveness of the drug.

“The day has finally arrived that so many of us in the LGBTQ community have been dreaming about,” Campos said today as he presented the legislation to the Board of Supervisors for consideration.

The pre-exposure prophylaxis (PrEP), often referred to by its brand name Truvada, is the first drug approved by the U.S. Food and Drug Administration, World Health Organization and Centers for Disease Control and Prevention for preventing the spread of HIV.

Truvada was created by Foster City-based Gilead Sciences and was approved by the FDA in 2012.

Campos said that despite studies showing PrEP’s effectiveness in preventing new HIV infection, there are barriers that are limiting the number of people who are prescribed the drug.

He said that PrEP is expensive and without insurance can cost individuals up to $1,800 per month.

Even insured individuals may still not be able to afford the prescription, because PrEP isn’t fully covered by many insurance plans, Campos said.

He also said many physicians remain hesitant to prescribe PrEP due to a lack of familiarity with the treatment.

According to the drug’s website, Truvada is designed for HIV-negative people who want to protect themselves from contracting the disease.

Truvada makes it harder for HIV-1 to multiply by blocking a particular enzyme in the body, thus helping lower the viral load and thereby decreasing the amount of HIV in the blood.

Serious side effects can include excessive amounts of lactic acid in the blood, liver problems, and other issues, according to the Truvada website.

Last week, following a rally by supporters outside San Francisco City Hall, Campos held a hearing of the board’s Neighborhood Services and Safety Committee with Supervisors Eric Mar, Leland Yee and Scott Wiener to learn how San Francisco could become the first city to provide the preventative drugs to HIV-negative residents who can’t otherwise afford them.

Campos said PrEP could be the “game changer” needed get to zero new infections in San Francisco and that the city has the chance to be the first city in the country to make PrEP available to everyone.

At the hearing, Supervisor Wiener said that he is currently taking PrEP. He noted that one of the reasons he chose to take the drug is to increase public awareness around it and to help destigmatize the drug.

Of the roughly 3,000 people who have been prescribed the drug worldwide, about 1,000 of those people are San Francisco residents, according to Wiener.

He said today that he finds it “perplexing” that a stigma could exist around something that could save lives. Wiener said there is a dramatic decrease in the risk of infection to those who take it daily.

He previously has said he is shocked to learn how few people are on PrEP, despite how “very effective” it is.

He likened the stigma to the pushback against the HPV vaccine and efforts to expanded access to birth control, which some critics say encourages bad behaviors.

At the hearing last week, Wiener said “shaming” people will not produce good behavior and that blocking access to public health only means that people are going to be less healthy.

Among those who spoke at the hearing was Dr. Robert Grant, who conducted the clinical trial at the Gladstone Institutes in partnership with the University of California at San Francisco that was the first to demonstrate the value of PrEP in the prevention of HIV infection.

Grant, who now serves as chief medical officer at the San Francisco AIDS Foundation, urged the Board to stop the spread of HIV in the city by funding PrEP use for all residents in need.

He said in addition to his clinical trials, other trials have found the drug to be safe and effective.

Grant said there is “at least one new HIV diagnosis in San Francisco every day” and that the drug is underutilized.

Grant said that about 500,000 people across the nation could benefit from PrEP.

Dr. Susan S. Philip, deputy health officer at the San Francisco Department of Public Heath who also works as an infectious disease physician at San Francisco General Hospital, said that there is a high level of demand among San Franciscans for the drug, but due to limited health insurance coverage many people are not able to start taking it.

For those concerned about the high cost of providing the drug to every San Franciscan who needs it, Campos said that for every HIV infection prevented, the city saves about $355,000, which would have been spent on providing lifelong HIV care and treatment.

“So many of our brothers and sisters didn’t make it to see this day,” Campos said as he introduced the legislation today.

Hannah Albarazi, Bay City News

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