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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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Studies: Transgender Hormone Therapy Less Risky Than Birth Control Pills

New research published in Men’s Health Issue of AACC’s Clinical Chemistry journal find transgender hormone therapy Is less risky than birth control pills

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Novel studies published in the Men’s Health Issue of American Association for Clinical Chemistry‘s journal Clinical Chemistry suggest that hormone therapy for transgender people increases the risk of blood clots less than birth control pills and does not increase the risk of cardiovascular disease at all. These preliminary results could help more transgender individuals to access essential hormone therapy by increasing physician comfort with prescribing it.

Obstacles to Therapy

All major medical associations agree that transgender individuals need to be able to express their gender in ways with which they feel comfortable and that this is the most effective treatment for psychological distress caused by incongruence between sex assigned at birth and gender. For many transgender individuals, expressing their gender involves physically changing their body through medical steps such as taking hormone therapy. However, transgender patients often experience difficulty getting hormone therapy prescriptions, to the point that 1 in 4 transgender women have to resort to illegally obtaining cross-sex hormones. Part of this is because existing research on transgender hormone therapy is limited and conflicting, which has led to some physicians denying patients this treatment out of concern that it could significantly increase the risk of health problems such as blood clots and cardiovascular disease.

First Study

A team of researchers led by Dina N. Greene, PhD, of the University of Washington in Seattle has now estimated that in transgender women prescribed estrogen, blood clots only occur at a rate of 2.3 per 1,000 person-years. While this is higher than the estimated incidence rate of blood clots in the general population (1.0-1.8 per 1,000 person-years), it is less than the estimated rate in premenopausal women taking oral contraceptives (3.5 per 1,000 person-years), which means that it is an acceptable level of risk. In order to determine this, Greene’s team performed a systematic review of all studies that have included the incidence rate of blood clots in transgender women receiving estrogen therapy, identifying 12 that were most relevant. The researchers then used meta-analysis to combine the results of these 12 studies and calculate a risk estimate that is based on all available evidence to date.  

“Documenting the risks associated with hormone treatment may allow for prescribers to feel more comfortable with prescribing practices, allowing for better overall management of transgender people,” said Greene. “Our data support the risk of thrombotic events in transgender women taking estrogen therapy being roughly comparable to the risk of thrombotic risks associated with oral contraceptives in premenopausal women. Given the widespread use of oral contraception, this level of risk appears to be broadly accepted.”

Second Study

In a second study, a team of researchers led by Guy G.R. T’Sjoen, MD, PhD, also conducted a systematic review of all studies that have measured risk factors for cardiovascular disease in transgender people taking hormone therapy. The researchers identified 77 relevant studies in this area and found that the majority of them report no increase in cardiovascular disease in either transgender men or women after 10 years of hormone therapy. The studies that did indicate a higher cardiovascular disease risk for transgender women in particular mainly involved patients using ethinyl estradiol, a now obsolete estrogen agent, and are therefore no longer valid.

T’Sjoen’s team does state that their results are not conclusive due to the small sample sizes and relatively short duration of the studies in this area (and Greene’s team included a similar caveat for their work). However, it is important to look at Greene and T’Sjoen’s studies in the context of transgender research as a whole. The field only began to receive National Institutes of Health funding in 2017 and is also lagging due to the fact that transgender patients often aren’t identified in medical databases that provide data for research. In light of this, these studies are significant not only because they suggest that transgender hormone therapy is safe, but also because they underscore the need for longer-term, large scale studies involving this underserved population.

Source: Press release

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Austin

Kind Clinic Launches Telehealth Service

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The Kind Clinic

Patients at Texas Health Action‘s Kind Clinic won’t have to worry about taking time off from work or figuring out how to get to the clinic. The Kind Clinic, which provides sexual health services including PrEP and PEP access, STI testing and treatment, HIV testing, and gender affirming care to Central Texans in need, regardless of race, creed, gender expression, or sexual orientation, has launched TeleKind, Austin’s first telehealth service offering quality sexual healthcare to patients through convenient and confidential video chat on a mobile device or computer.

Existing Kind Clinic patients will be able use TeleKind for follow-up appointments, prescription refills, and health care questions. TeleKind is available to all Kind Clinic patients, insured and uninsured

“Our mission through TeleKind is to ensure that sexual health is attainable for Central Texans, regardless of clinic proximity,” said Texas Health Action CEO Christopher Hamilton. “TeleKind will allow our expert providers to support our patients’ sexual wellness goals through a convenient, user-friendly platform they can access from anywhere.”

With almost 2,000 Kind Clinic patients making a significant commute to the clinic annually, video chat with the clinic’s sexual health experts ensures timely and consistent care for patients across Central Texas. “We take pride in providing our patients with a safe, supportive and empowering environment to address their sexual health concerns,” said Dr. Cynthia Brinson, Chief Medical Officer for Texas Health Action and the Kind Clinic. “TeleKind will allow us to provide that same personalized care for our patients without the commute.”

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Austin

AIDS Services of Austin Opens Moody Medical Clinic

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Ribbon Cutting for AIDS Service of Austin's Moody Medical Clinic
Ana Herrera, Joah Spearman, Kathie Tovo, Ora Huston, Paul E. Scott, Greg Casar, Jimmy Flannigan, Lloyd Doggett, and Ross Moody at Ribbon Cutting. Photo courtesy: AIDS Services of Austin

AIDS Services of Austin (ASA) celebrated the opening of the ASA Moody Medical Clinic with a ribbon cutting and tours of the new facilities for press and community supporters. In addition to ASA staff and board members, dignitaries attending included Representative Lloyd Doggett, Austin Mayor Pro Tem Kathie Tovo, City Council Members Greg Casar (District 4), Jimmy Flannigan (District 6), and Ora Houston (District 1).

ASA Moody Medical Clinic Ribbon Cutting
Paul E. Scott, Jimmy Flannigan, Kathie Tovo, and Ora Huston watch at Greg Casar reads city proclaimation at ribbon cutting. Photo courtesy AIDS Services of Austin.

Located at ASA’s main campus location at 7215 Cameron Road in North East Austin, the Moody Medical Clinic will provide primary care and HIV specialty care for those living with HIV as well as PrEP services and HIV/STI testing for those at high-risk of transmission. Clinical services will be integrated into ASA’s existing social and direct assistance programs in order to reduce barriers to care.

The ASA Moody Medical Clinic is now open! A special thank you to those that made this clinic a reality: Ross Moody, the…

Posted by AIDS Services of Austin on Thursday, September 13, 2018

“Our new ASA Moody Medical Clinic, working alongside the city and our community partners, will support Austin’s Fast-Track City initiative goals by increasing access to life-affirming care and help Austin get to zero new HIV transmissions,” says ASA Chief Executive Officer Paul Scott.

The clinic was made possible with a million dollar investment by Ross Moody and the Moody Foundation and $600,000 in community donations to support the construction, staffing, and first 6 months of clinical operations. The foundation also supported ASA’s Jack Sansing Dental Clinic.

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