PrEP Campaign Aims To Block HIV Infection And Save Lives In D.C.

Apr 10, 2018
Originally published on April 10, 2018 8:34 pm

A big part of Washington D.C.'s plan to get its HIV rate down is to get more uninfected people on PrEP, a two-medicine combination pill that's also sold under the brand name Truvada.

When taken daily by people who are at high risk for contracting HIV via sex or shared needles with someone who is infected, this pre-exposure prophylaxis can cut the risk of HIV infection by 92 percent, studies show.

PrEP has been around for years now, but only a small portion of those at high risk for HIV infection use it, partly because many still don't know it exists.

To cut new infections in half by 2020, D.C. health officials estimate it will need to more than quadruple the number of people in the District who are on PrEP. The department of health and community groups are pulling out all the stops to raise awareness.

"Thinking about sex? Then think about PrEP," one public health commercial says, over video clips of a woman sensually licking an ice cream cone, or a man stroking a golf club. You get the gist.

There are also social media pushes, and an ad campaign called "PrEP for Her" targeting African American women, who, along with gay and bisexual African American men, are at high risk of infection in D.C.

At a recent conference in the city on LGBTQ issues, Sarah Fleming stopped by the PrEP information table put together by Luis Felipe Cebas of Whitman-Walker Health, a community health center that focuses on providing care to LGBTQ patients.

Fleming tells Cebas she's surprised she's never heard of PrEP. She even got tested for HIV recently.

"They told me nothing about this!" she says. "I was negative — but, I feel like, it's a preventative, so you should tell people about it."

Gregorio Millett, vice president and director of public policy at the Foundation for AIDS Research, says some health care providers don't suggest PrEP because of their mistaken belief that it will increase risky sexual behavior; research hasn't shown that to be the case.

Millett adds that there are other reasons why people — especially people of color — haven't requested PrEP as much as he and other public health officials would like. Some African Americans distrust the medical community because of historical mistreatment, he says. And there's still a stigma attached to HIV, especially in some minority communities.

"In order to be prescribed PrEP you need to be 'out' to your provider," Millett says. "And we see that for African-American men, as well as for Latino gay men, they're less likely to tell their providers that they are gay or bisexual."

Several cities across the U.S. — including Seattle, Boston and San Francisco, as well as Washington — are making concerted efforts to overcome these challenges and promote PrEP as a tool for reducing HIV transmission, Millett says.

There are signs of progress in D.C. Whitman-Walker Health has seen a recent uptick in new PrEP patients, including 28-year-old Ricardo Cooper, who lives in the District.

Cooper is gay and HIV-negative. He's been taking PrEP for a few months, and says he hasn't experienced many side effects, which can commonly include headaches, nausea and cramping; according to the U.S. Centers for Disease Control and Prevention, these side effects tend to go away over time.

Cooper says taking the drug gives him peace of mind.

"It just makes me feel so much better about engaging in sexual activity," he says, knowing that he won't get or transmit HIV to a partner.

He's also found he now talks more openly about HIV, which still has a lot of stigma among his friends. He says he even walks up to people at bars and sells them on PrEP.

"The professionals can't really force PrEP on people, but I can," he chuckles. "And I've done that to my friends. It's like, 'You don't have an option.' "

Cooper says, turning serious, that he's usually a private person, but to him this is important — he wants to do everything he can to spread the word.

"If I need to be the face of PrEP for this African American community or the communities that are under-represented — to let them know that, 'It's OK, it's cool, I mean, you should at least try it,' then I'm perfectly fine with stepping out of myself and doing that," he says.

Health providers say this kind of community evangelism — along with the bus ads and sexy commercials —will be key to reaching the ultimate goal of ending the HIV epidemic in Washington, D.C.

This story is part of NPR's reporting partnership with Kaiser Health News.

Copyright 2018 NPR. To see more, visit http://www.npr.org/.

MARY LOUISE KELLY, HOST:

A big part of Washington, D.C.'s plan to get its HIV rate down is to get more people on PrEP. That's a drug which can prevent HIV infection. Now, PrEP has been around for years, but only a small portion of those at risk for HIV use it. And that is partly because many people still don't know it exists. NPR's Selena Simmons-Duffin reports on what the district is doing to get the word out.

SELENA SIMMONS-DUFFIN, BYLINE: To cut new HIV infections in half by 2020, D.C. estimates it'll need to more than quadruple the number of people on PrEP. So the Department of Health and community groups are pulling out all the stops to raise awareness.

(SOUNDBITE OF ARCHIVED RECORDING)

UNIDENTIFIED PERSON #1: Thinking about sex? Then think about PrEP.

SIMMONS-DUFFIN: There's this sexy ad. Picture a woman sensually licking ice cream, a man stroking a golf club, squirting mustard. It's pretty over-the-top. In D.C., you see ads on buses, social media pushes. There's also a campaign called PrEP for Her targeting African-American women who are at high risk of infection in D.C., along with gay and bisexual African-American men. Another outreach effort...

LUIS FELIPE CEBAS: Good morning.

SARAH FLEMING: Good morning.

CEBAS: How are you?

SIMMONS-DUFFIN: ...Grabbing bystanders at public events. At a recent conference in D.C., Sarah Fleming stopped by the PrEP table put together by Luis Felipe Cebas of Whitman-Walker Health, which focuses on LGBT patients.

CEBAS: They can protect you against HIV even if it gets into your system. That's a 99 percent.

FLEMING: Wow.

CEBAS: So yeah, it's a big deal.

FLEMING: That is a big deal (laughter).

CEBAS: Yeah, so...

SIMMONS-DUFFIN: PrEP stands for pre-exposure prophylaxis. It's an HIV drug. When people who are negative take it daily, the medicine builds up in their bodies and can ward off HIV infection. Sarah Fleming says she can't understand why she's never heard of it. She even got tested for HIV recently.

FLEMING: And they tell me nothing about this.

CEBAS: Yep.

FLEMING: Like, I was negative, but I feel like - it's preventative.

CEBAS: It is.

FLEMING: So you should tell people about it.

CEBAS: Yeah.

FLEMING: Like, just so you know, there is this...

GREGORIO MILLETT: That doesn't surprise me at all. That's something we hear all the time.

SIMMONS-DUFFIN: That's Greg Millett from amfAR, the Foundation for AIDS Research. Who knows why no one mentioned PrEP to Sarah Fleming when she tested negative for HIV. But Millett says sometimes providers don't suggest PrEP because of a belief it will increase risky sexual behavior, although research hasn't shown that to be true. Millett also says there are other reasons why people, especially people of color, haven't accessed PrEP as much as public health officials like him would like. For one, some African-Americans distrust the medical community because of historical mistreatment, he says. And...

MILLETT: In order to be prescribed PrEP, you need to be out to your provider. And we see that for African-American men, as well as for Latino gay men, they're less likely to tell their providers that they are gay or bisexual. So that's another impediment to PrEP.

SIMMONS-DUFFIN: Millett says several cities across the country - like Seattle, Boston and San Francisco - are making concerted efforts to overcome these challenges and promote PrEP as a tool for reducing HIV transmission. He's impressed with Washington, D.C.'s efforts. And there have been signs of progress. Whitman-Walker Health has seen an uptick in new PrEP patients, including...

RICARDO COOPER: My name is Ricardo Cooper. I am 28 years old.

SIMMONS-DUFFIN: Cooper is gay and HIV negative. He's been taking PrEP for a few months and says it gives him peace of mind.

COOPER: It's kind of like, I'm good. It just makes me feel so much better about engaging in sexual activity.

SIMMONS-DUFFIN: Another benefit - he's found he talks more openly about HIV, which still has a lot of stigma around it. He says he even walks up to people at bars and sells them on PrEP.

COOPER: The professionals can't really force PrEP on people, but I can. And I've done that to my friends. It's like, you don't have an option.

SIMMONS-DUFFIN: He says he's usually kind of a private person. But to him, this is important. He wants to do everything he can to spread the word.

COOPER: If I need to be the face of PrEP for this African-American community or the communities that are under-represented - to let them know that it's OK, it's cool, you should at least try it - then I'm perfectly fine with just stepping out of myself and doing that.

SIMMONS-DUFFIN: This kind of community evangelism will be key, along with the bus ads and sexy commercials, to help reach that ultimate goal of ending the HIV epidemic in the district. Selena Simmons-Duffin, NPR News, Washington.

KELLY: And this story is part of a reporting partnership with NPR, WAMU and Kaiser Health News.

(SOUNDBITE OF GARETH DICKSON'S "PING PONG") Transcript provided by NPR, Copyright NPR.