Not just a dream: the power of PrEP to prevent HIV

“PrEP is one of the greatest developments for HIV prevention. We can actually see an end to new HIV infections,” says Miguel Carreón, Family Nurse Practitioner and PrEP advocate. “We weren’t considering this possibility even a few years back. PrEP works well.”

Data analyses show that when PrEP is taken daily, it can provide up to 99% protection against HIV through sex.1 Since Truvada for PrEP was approved by the FDA in 2012, there have been three documented cases of patients seroconverting to HIV out of tens of thousands of people taking the medication. 2 However, many providers and community members remain unaware of the prevention tool. Miguel discovered this lack of awareness early on and saw it as an opportunity, focusing his doctoral research on primary care providers and their knowledge, attitudes, and prescribing practices around PrEP.

Miguel Carreon

In 2016 he joined forces with the Oregon Health Authority and the Oregon AIDS Education and Training Center to create and distribute the Oregon Statewide PrEP Assessment. Over 200 Oregon primary care providers completed the survey. Early analyses of the data showed that 63% of respondents believed PrEP was an effective way to prevent HIV, though only 42% of urban respondents and 19% of rural respondents had prescribed it.3

Nationwide, uptake of PrEP has centered in the white, gay male population, highlighting disparities in access among minority populations.4 Although women made up 50% of PrEP prescriptions in 2012, that number has dropped to 30% as the percentage of gay men on PrEP has risen substantially. In addition, “Latino & Black communities continue to be left out of the PrEP conversation. The CDC estimates that half of black gay men and a quarter of Latino gay men can potentially get HIV in their lifetime.5 [As medical providers] we need to touch on sexual history with all people of color. We also need to be having conversations with women. We can’t say PrEP is a pill that only gay men can use. It can be beneficial for a lot of people.”

As a standard part of care Miguel completes a sexual history for all clients. “I let clients know that the sexual history questions may make them uncomfortable. I’m not singling people out;it’s just part of their overall health and wellness picture.” Sometimes PrEP comes up during this portion of a visit.  While PrEP is not for everyone, “I let [patients] know it’s one of the options out there to reduce their HIV risk,” he says.

Patients who are interested in PrEP often have concerns about side effects. Some patients imagine early HIV regimens that were hard on the body and difficult to take. In reality, about 10% of Truvada patients experience side effects which tend to get better or go away within 2-4 weeks. Upset stomach and headache are the most common.

Another common concern is the risk for other STDs, as PrEP only protects against HIV. This is especially relevant if a client plans not to use condoms when on PrEP, though many providers still suggest condoms as an extra layer of protection. In addition, PrEP patients get follow-up STD testing every 2-3 months, which allows for early treatment if an STD appears.

In his medical practice, Miguel observes PrEP doing more than just preventing infection. He notes that PrEP has reduced some of his clients’ fear regarding intimacy. “The mentality towards HIV has been scary,” he says. “PrEP can help with intimacy and peace of mind, knowing that you have this extra layer of protection against HIV. At the first PrEP visit, we talk about the pros and cons of PrEP, and also discuss the personal benefits which can include not being so worried about getting infected with HIV.”

While the number of PrEP prescriptions in the US increased 738% from 2012 to 2015, much work remains.4 Forty percent of Miguel’s PrEP Assessment respondents stated that patients bring up PrEP first, and less than a third of providers feel “extremely familiar” with PrEP. “We need to make sure providers are on board, and have the training and tools to prescribe PrEP to their patients, including all the counseling, lab work, and follow-up that is needed,” Miguel says.

Miguel completed his Masters of Nursing at Oregon Health & Science University and is currently finishing his Doctorate in Nursing Practice degree. Miguel was born in Ensenada, Mexico and is a fluent Spanish speaker. He has lived in Oregon for 16 years and made Portland his home for the last 5. Miguel enjoys exploring the city of Portland and hopes to make it his home for years to come. Miguel will provide primary care including PrEP services at CAP’s Prism Health center, slated to open in May 2017. He is also producing an online training module for Oregon providers to learn about prescribing PrEP.

For more info about PrEP, contact PrEP@cascadeaids.org or 503.223.5907

SOURCES:

  1. Anderson, P. L., Glidden, D. V., Liu, A., Buchbinder, S., Lama, J. R., Guanira, J. V., & Veloso, V. G. (2012). Emtricitabine-tenofovir concentrations and pre-exposure prophylaxis efficacy in men who have sex with men. Science Translational Medicine, 4(151), 151ra125-151ra125.
  1. HIV Equal Online Magazine (2017). Third Case of HIV Infection Despite PrEP Adherence. Retrieved from http://www.hivequal.org/hiv-equal-online/third-case-of-hiv-infection-despite-prep-adherence
  1. Carreon, M, & McKimmy, M. (2017) Improving awareness, knowledge, and prescribing practices of PrEP among Oregon Primary Care Providers. Unpublished doctoral project, Oregon Health & Science University, Portland, OR.
  1. aidsmap. PrEP Use Exceeds 79,000 in US Pharmacy Survey, but some groups lagging behind. http://www.aidsmap.com/PrEP-use-exceeds-79000-in-US-pharmacy-survey-but-some-groups-lagging-behind/page/3072084/
  1. Centers for Disease Control and Prevention. (2016). Lifetime Risk of HIV Diagnosis. Retrieved from: https://www.cdc.gov/nchhstp/newsroom/2016/croi-press-release-risk.html