How Important Is Access to PrEP for People at High Risk of Contracting HIV?

Segment Description: W. David Hardy, MD, adjunct professor of medicine in the Division of Infectious Disease at Johns Hopkins University, discusses how important access to pre-exposure prophylaxis (PrEP) is.

Interview transcript (modified slightly for readability):

Contagion®: How important is access to PrEP for people at high risk of contracting HIV?

W. David Hardy, MD: Access to PrEP is really the most important thing that I think people first of all have to establish before PrEP can really be useful. PrEP was approved by the FDA in the summer of 2012, and it really didn’t take off for probably about 4 years after that. Why did that happen? There were a lot of different conflicting reasons, but I think part of it was the fact that there were just questions about what was going to happen in terms of someone taking the medication to prevent a viral infection like HIV. The questions of resistance, the questions of increased sexual or high-risk activity, the questions of toxicity were all lingering after 2012.

But, as more data became available, all of those questions were answered. And so there’s really very little reason that persons should not take PrEP. Access is something that is really based upon money. How do the people pay for this medication which, if they had to pay for it out of their pocket, would cost them $1,500 a month? So the access question is: Is there some sort of government-sponsored or private health insurance plan that will cover that medication cost? Not only is the medication cost necessary but an every-three-month doctor visit is required as well, or clinic visit to make sure the person is staying HIV negative and that sexually transmitted infections (STIs) are being screened and treated if necessary. For women, it’s important also to be tested for pregnancy before and during taking PrEP because what we’re seeing is that condom use is decreasing while PrEP is being used because of the fact that people are looking at it as a way to stop HIV infection.