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No Easy Feat: Promoting The PrEP Pill For HIV Prevention Among Latinos

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LOS ANGELES – Late on a Friday night at The New Jalisco Bar downtown, a drag show featuring dancers dressed in sequined leotards and feathered headdresses had drawn a crowd — most of them gay Latino men.

Inside the bar and out, three health workers chatted with customers, casually asking questions: Do you know about the HIV prevention pill? Would you consider taking it? A few men said they had never heard of it. Others simply said it wasn’t for them.

“It hasn’t really hit the Latino community yet,” Jesse Hinostroza, an HIV prevention specialist with AltaMed health clinics, said while sitting at a table with a bowl of condoms and a stack of bilingual pamphlets about the pill. “They aren’t educated about it.”

In California, New York, Texas and elsewhere, health workers are trying to get more high-risk Latino men to use the drug, Truvada. The medication, which is used for “Pre-Exposure Prophylaxis” or PrEP, was approved by the FDA in 2012 for HIV prevention and has been shown to be more than 90 percent effective when used correctly. But health workers are encountering barriers among many Latinos.

Among them are a lack of knowledge about the drug and the stigma attached to sleeping with men or perceived promiscuity. Many Latinos also have concerns about costs and side effects.

AltaMed is conducting HIV prevention outreach at several Latino gay bars in the Los Angeles area. Latinos make up about 21 percent of new infections nationally, according to the U.S. Centers for Disease Control and Prevention. (Photo by Heidi de Marco/KHN)

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“Even for people who have heard about it, that makes them reluctant to use or hesitant to even inquire about it,” said Phillip Schnarrs, assistant professor of health promotion at the University of Texas at San Antonio and research director for the Austin PrEP Access Project.

Schnarrs, who is conducting a study with gay and bisexual Latino men in Texas, said 58 percent of those surveyed see themselves as good candidates for PrEP, compared to 82 percent of non-Hispanic whites, according to preliminary data.

In an ongoing study of 20 Latino gay couples in New York City, 37 of the 40 people had never heard about PrEP when interviewed last year, said Omar Martinez, assistant professor of social work at the Temple University College of Public Health.

Martinez said doctors and health workers need to focus on reaching young minority men at highest risk of getting HIV and transmitting it to others, including those who don’t regularly use condoms. “We need to do something,” he said. “And PrEP may be the solution.”

Latinos are disproportionately affected by HIV. They make up about 21 percent of new infections nationally, though they represented about 17 percent of the population, according to the U.S. Centers for Disease Control and Prevention. Latinos are also more likely than non-Hispanic whites and blacks to get diagnosed later in the course of their illness, raising the risks to their health and the likelihood of transmission to others.

At the same time, Latinos are less likely than non-Hispanic whites to be insured or have a regular doctor, although the Affordable Care Act has helped reduce that gap.

In California, health workers are trying to get more high-risk Latino men to use the drug, Truvada. AltaMed Health Services offered free HIV tests at The New Jalisco Bar in downtown Los Angeles on July 10, 2015. (Photos by Heidi de Marco/KHN)

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Truvada can cost up to $1,300 a month. Most insurance companies and Medicaid programs are covering at least part of that, and many local governments are also covering the pill for uninsured residents. But the high sticker price can dampen interest among patients.

Truvada, which blocks the virus from spreading in the body, is helping to significantly reduce new infections, said Robert Grant, a professor at UC San Francisco School of Medicine who leads research on PrEP’s effectiveness.

But the pill does not protect against other sexually transmitted diseases, requires daily use and can cause side effects in some patients, including kidney problems.

“It is a very valuable option, but it is only one option,” Grant said. “Condoms are still very important part of a sexual health strategy.”

As customers at the New Jalisco Bar danced to traditional Mexican music beneath a disco ball and rainbow lights, Jaime Cardenas conducted HIV tests in a mobile unit parked in front. Anyone who tested on the spot received a free drink coupon, courtesy of AltaMed and the bar.

One of the first to agree was Erik Quezada, a counselor at a Los Angeles high school.

Cardenas drew a few drops of blood from Erik Quezada’s finger for the rapid test. Within minutes, Cardenas gave him the good news: He didn’t have HIV. Cardenas quickly followed up with information about the HIV prevention pill.

“One way you can prevent yourself from acquiring HIV is by taking PrEP,” Cardenas said, offering to take down Quezada’s number so the clinic could call him later.

Quezada, 35, responded that he had heard it was like the birth control pill for gay people. He agreed to be contacted but quickly added, “I don’t know I would ever sign up for it.”

Erik Quezada, 35, says he has heard Truvada is like the birth-control pill for gay people. Quezada, a counselor at a Los Angeles high school, says he’s not sure he would sign up for it. (Photo by Heidi de Marco/KHN)

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Others were even less interested. Jose Arriola, 25, a self-described “diva,” said he didn’t want to take any medication. “It’s better to use condoms,” he said, sitting by his boyfriend at the bar.

A short video produced by AltaMed played between acts. The video featured different Latino men getting dressed: a cowboy for a night out, a day laborer for work, a buff young man for the gym. Each took the HIV-prevention pill as part of their routine. At the end of each segment, one word popped up on the screen: listo, or ready.

“We are really trying to project the message that taking PrEP can be a normal part of your everyday life,” said Dr. Scott Kim, medical director of HIV Services for AltaMed, which runs more than 40 health clinics in Southern California.

That, he hopes, will reduce stigma. Kim said health workers need to be more creative in places like East Los Angeles, where many gay and bisexual Latinos are still in the closet and aren’t getting information through traditional health-care sources. Talking about PrEP at a doctor’s office may not be as effective as doing so on social media, by text message or in a bar, he said. “There are a lot of social obstacles and challenges we have to negotiate here because it’s harder to be out,” Kim said.

AltaMed’s efforts are being paid for by Gilead, the pharmaceutical company that makes Truvada. The goal of its $80,000 grant is to help 100 high-risk gay Latino men throughout Los Angeles County get prescriptions for PrEP. The grant pays for the outreach but does not cover the cost of the medication.

Since the project began late last month, about half a dozen patients have received prescriptions. Hinostroza of AltaMed said there is more interest and more knowledge in gay-friendly Hollywood and West Hollywood. “But for East Los Angeles, where we are, it’s a struggle,” she said.

Louis Arevalo, 27, is a college student and AltaMed patient who lives in Los Angeles. He said he decided to go on the medication last month after getting scared when a condom broke. He said he uses condoms regularly and gets HIV-tested every three months, but the medication is “an extra layer of protection.”

“I’m not as anxious anymore,” he said.

But Arevalo said he understands the stigma that might prevent others from taking the drug. For years, he said, he has hidden his boyfriends from his mother, an immigrant from El Salvador. Arevalo said her church pastor repeatedly has said that homosexuality is a sin. “It’s just part of the culture, and it’s the religion,” he said.

Louis Arevalo, 27, says he decided to go on the medication last month after getting scared when a condom broke. The college student from Los Angeles says he uses the pill as an extra layer of protection. (Photo by Heidi de Marco/KHN)

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AltaMed’s efforts are just one part of a larger effort to get the word out about Truvada. The nonprofit Latino Commission on AIDS, based in New York, also recently started a campaign in five cities — Long Beach, CA; New York City; Chicago; Miami; and San Juan, Puerto Rico.

Gustavo Morales, the commission’s director of access to care services, said now is the time to educate people about PrEP — lest too many people form negative opinions about it and health workers become “like salmon swimming against the current.”

Morales said patients aren’t the only ones who need more information. When he decided to go on PrEP late last year, he went to two different doctors who didn’t know about Truvada. A third asked him why he wanted to poison himself. Finally, he got a prescription from an HIV specialist.

“I was definitely disappointed,” said Morales. “There is a lot of work that still has to be done.”

Blue Shield of California Foundation helps fund KHN coverage in California.

Source: Kaiser Health News (KHN) is a nonprofit national health policy news service.

[gdlr_icon type=”icon-camera-retro” size=”16px” color=”#999999″]TOP IMAGE: Louis Arevalo holds his Truvada pills at his home in Los Angeles, California on July 17, 2015. The drug Truvada, used to halt HIV infection, has been shown to be over 90 percent effective when used correctly. (Photo by Heidi de Marco/KHN)

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Study: Only 4% Gay & Bi Men Use PrEP

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Only 4 percent of gay and bisexual men in the United States reported using pre-exposure prophylaxis, or PrEP; this according to a new study recently published in PLOS ONE. The study also revealed that bisexual and non-urban men were less likely than gay men to use PrEP; while visiting an LGBT clinic and searching for information online on LGBT sources were associated with PrEP use.

PrEP is a pill taken daily that reduces the likelihood of being infected with HIV by over 99 percent and is recommended by the Centers for Disease Control and Prevention (CDC) for those at high risk of HIV/AIDS. Currently, Truvada, manufactured by Gilead, is the only form of PrEP approved by the Food & Drug Administration.

The study used data from the Generations Study using a national probability sample of 470 male participants from three age cohorts: 18-25, 34-41, and 52-59. Researchers examined HIV testing and use, familiarity, and attitudes toward PrEP among HIV-negative gay and bisexual men in the U.S. Participants completed the survey between March, 2016 and March, 2017.

ACCESS, FAMILIARITY & ATTITUDES

“The extremely low rate of PrEP use, while not surprising given barriers to access in various parts of the country, is disappointing,” said Professor Phillip Hammack of the University of California Santa Cruz’s Department of Psychology. Since it was approved for PrEP six years ago, the wholesale price for Truvada in the U.S. has risen 45 percent, with the list price for a 30-day supply close to $2,000.

Despite low usage, a majority of particpants — 60 percent — reported that they were familiar with PrEP, with the middle cohort, ages 34-41, reporting the highest familiarity at 79 percent. Attitudes toward PrEP were also positive among most men — 68 percent of all participants, with the younger cohort, ages 18-25, at 76 percent.

HIV TESTING

The study also showed that most men did not meet the CDC recommndations for annual HIV testing with more than 25 percent of men in the younger cohort, ages 18-25, and 8 percent of men over 25 never having been tested for HIV.

“I worry especially about younger men who didn’t grow up with the concerns of HIV that men of older generations did,” said Hammack. “The low rate of HIV testing probably reflects a degree of complacency and cultural amnesia about AIDS.”

“Our findings suggest that health education efforts are not adequately reaching sizable groups of men at risk for HIV infection,” says principal investigator Ilan H. Meyer of the Williams Institute at the UCLA School of Law. “It is alarming that high-risk populations of men who are sexually active with same-sex partners are not being tested or taking advantage of treatment advances to prevent the spread of HIV.”

The study suggests that “efforts to educate gay and bisexual men about HIV risk and prevention need to be reinvigorated and expanded to include non-gay-identified and non-urban men”.

The study was supported by the National Institute of Child Health and Human Development (NICHD) of the National Institutes of Health.

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Planned Parenthood, Black AIDS Institute Partner to Expand Comprehensive HIV Prevention Services Nationwide

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Planned Parenthood announced a multi-phase pilot program to build and expand its comprehensive HIV prevention and education efforts. Gilead Sciences, Inc, a research-based biopharmaceutical company, awarded the $900,000 grant to support and expand efforts of HIV prevention and education, including the integration of Pre-Exposure Prophylaxis (PrEP) awareness, at Planned Parenthood affiliate health centers across the country over the next 18 months. It is the first significant corporate grant of its kind awarded to Planned Parenthood, and will focus critical prevention efforts in communities hardest hit by the epidemic.

The grant work will be carried out in partnership with The Black AIDS Institute, the only national HIV/AIDS think tank in the United States focused exclusively on Black people.

“Planned Parenthood is thrilled to be launching this incredibly exciting project. Although this country has made progress toward greater health care equity, disparities in HIV rates remain a serious issue for too many people and too many communities,” said Dr. Raegan McDonald-Mosley, chief medical officer at Planned Parenthood Federation of America. “Rates of new HIV cases, along with barriers to treatment and health care access, continue to more greatly impact marginalized communities. With this grant, Planned Parenthood can implement life-saving awareness and care not otherwise funded at this scale. It furthers our mission to provide all people, especially those already facing barriers to accessing quality health care, with comprehensive and cutting-edge HIV prevention methods, including PrEP”.

PrEP is the medical practice of prescribing antiretroviral medication to prevent against HIV infection.

“The Black AIDS Institute is proud to partner with Planned Parenthood to expand comprehensive HIV prevention services to Black Women”, Phill Wilson, President and CEO of the Black AIDS Institute. “Given the disproportionate impact HIV is having on Black women and the new tools we have at our disposal, this is the right thing to do at the right time.”

The majority of the grant will directly support the efforts of Planned Parenthood affiliates to develop training and resources aimed at delivering a comprehensive program of HIV prevention, including PrEP and other methods, in health centers across the country. It will also go toward the creation of patient education materials to reach populations most at-risk for HIV, as well as capacity-building sustainable learning modules across affiliates.

“Scientific innovation has greatly improved our ability to address the HIV epidemic,” said Gregg Alton, Executive Vice President, Corporate and Medical Affairs for Gilead Sciences, Inc. “Alongside that innovation, diverse programs and partnerships are helping to ensure we can reach those most in need of treatment and prevention options. Prevention strategies, including PrEP and other methods, can have a meaningful impact on public health, offering an unparalleled opportunity to avert new infections and reduce long term costs to the healthcare system.”

Planned Parenthood provides high-quality, compassionate care in health centers across the country, including nearly 700,000 HIV tests each year. Planned Parenthood health centers are uniquely positioned to deliver HIV prevention services and education to disproportionately impacted communities, including Black women, Latinas, transgender people, young adults of all backgrounds, and men who have sex with men, especially people of color.

Dr. McDonald-Mosley added, “Training and resourcing more medical providers to provide HIV and PrEP education, with a particular focus on prevention in underserved communities, is a job for which Planned Parenthood is uniquely suited. For over 100 years, we’ve been fighting to ensure that people — no matter where they live — can access accurate, nonjudgmental preventive care and education so they can keep themselves and their families healthy.”

Despite the life-saving advances in highly active antiretroviral therapy (HAART) for treatment and prevention, HIV remains an urgent public health crisis, especially for certain marginalized communities who face barriers to affordable, quality health care. According to a 2014 Centers for Disease Control and Prevention (CDC) surveillance report, women of color, particularly Black women, are disproportionately affected by HIV, accounting for the majority of the HIV infections, women living with HIV, and HIV-related deaths among women in the U.S.

“Over 40% of people living with HIV in the U.S are Black. Nearly 50% of new HIV infections in this country are Black. and 1 in 32 black women, 1 in 16 black men, and 1 and 2 Black Gay men will be diagnosed with HIV infection in their lifetime. Yet 85% of current PrEP users are white men. What’s wrong with this picture”, says Leisha McKinley Beach, technical assistance consultant, Black AIDS Institute.

While awareness of antiretroviral medication as pre-exposure prophylaxis (PrEP) among men who have sex with men (MSM) has risen significantly, women at risk for HIV still face several challenges in getting the services and information they need, including structural and cultural barriers such as poverty, HIV stigma, and a relative lack of access to healthcare professionals trained to offer comprehensive HIV prevention, including PrEP and other methods.

As part of our mission to help people live healthy lives, Planned Parenthood works every day in communities across the country and with partners around the world so that everyone — no matter who they are or where they live — can access accurate, high-quality, compassionate sexual and reproductive health care.

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RBJ Health Center Named Leader in LGBT Healthcare Equality

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The Human Rights Campaign (HRC) Foundation, the educational arm of the country’s largest lesbian, gay, bisexual and transgender (LGBT) civil rights organization, has named Austin/Travis County Health and Human Service’s Sexually Transmitted Disease (STD) Clinic at the Rebekah Baines Johnson (RBJ) Health Center as a “Leader in LGBT Healthcare Equality”. The findings were part of HRC Foundation’s Healthcare Equality Index 2016, a unique annual survey that encourages equal care for LGBT Americans by evaluating inclusive policies and practices related to LGBT patients, visitors and employees.

The RBJ Health Center earned top marks in meeting non-discrimination and training criteria that demonstrate its commitment to equitable, inclusive care for LGBT patients, and their families, who can face significant challenges in securing the quality health care and respect they deserve. “This recognition acknowledges our commitment to create an inclusive and welcoming environment for every patient, customer, client and employee,” said Shannon Jones, Director-Austin/Travis County Health and Human Services.

The RBJ Health Center is one of a select group of 496 healthcare facilities nationwide to be named Leaders in LGBT Healthcare Equality. Facilities awarded this title meet key criteria, including patient and employee non-discrimination policies that specifically mention sexual orientation and gender identity, a guarantee of equal visitation for same-sex partners and parents and LGBT health education for key staff members.

The Healthcare Equality Index 2016 offers healthcare facilities unique and powerful resources designed to help provide equal care to a long-overlooked group of patients, as well as assistance in complying with regulatory requirements and access to high-quality staff training.

For more information about the Healthcare Equality Index 2016, or to download a free copy of the report, visit www.hrc.org/hei.

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