Los Angeles resident Gabe Zichermann says for gay men, the risk of contracting HIV is a near-constant source of anxiety.
“You were taught that if you’re gay you’re going to get AIDS and you’re going to die,” he said.
But the game changed in 2012 with the introduction of pre-exposure prophylaxis — also known as PrEP — a drug regimen proven to effectively prevent HIV infection.
“After a lifetime of being under this cloud, that bad things would happen to me, PrEP has been a tremendous emotional release,” Zichermann said.
Though the drug has been available for years, advocates say it can be difficult to access due to insurance barriers and a lack of knowledge on the part of physicians and patients.
That’s why a bill moving through the California legislature aims to make limited amounts of PrEP available over the counter, without a prescription. It would also apply to post-exposure prophylaxis (PEP), which can lower the risk of contracting HIV if taken within 72 hours of a potential exposure.
The U.S. Centers for Disease Control states that PrEP, when taken daily, reduces the chances of getting HIV from sex by about 99 percent. But less than 10 percent of Americans considered at-risk for HIV are taking Truvada, the primary drug used for PrEP, according to data from the International AIDS Society.
Advocates and patients say some people who need PrEP don’t know it exists, or are unsure about how to talk to their doctors about it. Many physicians aren’t educated on what PrEP is or when to prescribe it, said Courtney Mulhern-Pearson, senior director of policy and strategy for the San Francisco AIDS Foundation, which is sponsoring the bill.
“[The pharmacy] is a more accessible access point for a lot of people,” she said. “It wouldn’t require an appointment, and they’re in every community. So for all pharmacies that are willing to participate in this, we potentially have a broader reach of access points than we have currently.”
Zichermann said he had to be his own advocate when it came to PrEP, and that it took months to get a prescription for the treatment. When he switched doctors, he said he had to start the process all over again. And his insurance plan put up additional barriers.
“It was like pulling teeth,” he said. “They rejected it multiple times … I’m glad that legislators in California are looking to make it easier, because it’s just going to save a lot of lives.”
The bill would also ban prior authorization for PrEP and PEP, a process by which doctors have to get special approval from health plans before writing the script.
Mulhern-Pearson said this poses a challenge, especially for patients who need urgent access to PEP, which is only effective in the first 72 hours after a potential exposure.
Some medical groups are concerned about allowing pharmacists to dispense this medication, which is taken daily and can have side effects such as headaches, kidney problems and liver problems.
According to a legislative analysis, the California Medical Association stated that dispensing PrEP, “demands a high degree of safety and consideration that cannot be achieved at a pharmacy.” The AIDS Healthcare Foundation, a nonprofit group that has come under fire for voicing concern about PrEP’s potential harms, opposes the part of the bill that allows pharmacists to furnish it without a prescription.
In California, the number of new HIV diagnoses increased by 0.8 percent between 2013 and 2017. Gay and bisexual men, particularly those who are African American and Latino, are disproportionately affected by HIV, according to the San Francisco Department of Public Health.
Bill authors and advocates say PrEP and PEP access should parallel birth control, which has been available over the counter in California since 2016.
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