Experts agree that HIV prevention is primary care.

Words by Daniel Vaillancourt

(Pictured left to right, above: Miss Rusty Waters, Thomas Deem, Dr. Jason Halperin, Dr. Oscar Mairena)

More than 100 community members accepted DAP Health’s invitation to attend moderated conversation “Next Gen Care: Innovations in HIV Prevention,” sponsored by Gilead Sciences at Hunters Nightclubs Palm Springs on Arenas Road on the evening of Tuesday, July 22. The two-hour special event was facilitated by beloved local drag artist Miss Rusty Waters.

The consensus among the trio of panelists — DAP Health Director of Specialty Services Dr. Jason Halperin, Gilead Sciences Associate Director for Community Engagement & Advocacy Dr. Oscar Mairena, and Gilead Sciences Senior Medical Scientist for U.S. HIV Medical Affairs Thomas Deem, MSN, FNP-BC, AAHIVS — is that we currently have every tool needed to end the HIV epidemic. And yet, serious (though not insurmountable) barriers remain.

“This is really a dream we’ve all had — to get to the point where we have so many options that I can guarantee prevent HIV,” said Halperin. “We have [two different daily] oral medications, we have injectable medications — some that you take every two months, newer ones now that are once every six months.”

Gilead Sciences was the first to develop PrEP (pre-exposure prophylaxis) for HIV prevention, launching its daily oral agent Truvada (now available generically) in 2012. Descovy followed in 2016. On June 18, the FDA approved the pharmaceutical giant’s Yeztugo (pronounced yez-TOO-go), the long-lasting injectable lenacapavir, which needs to be administered in a clinical setting as two bilateral subcutaneous shots just twice a year, six months apart.

Halperin said his biggest concern is the current administration in Washington placing so many barriers between patients and this wide array of tools. “Medi-Cal is a lifeline for so many of our patients to access HIV treatment and HIV prevention,” he continued. “This is not just in California, but throughout the country. So, if there’s anything I feel we should be all fighting for, it’s to not defund Medicaid, but to fund Medicaid so that we have as much access to these services as possible.”

PrEP is for everyone

Even though verifiable HIV prevention has been in existence for almost 13 years, the CDC estimates there are still 32,000 new infections annually in the U.S. That’s approximately 90 seroconversions per day.

“PrEP is for all bodies, all people, all genders, all sexual orientations. It’s there to protect anybody who’s sexually active,” said Deem. “PrEP is for everyone, no matter who you are, where you come from, or where you want to be.”

Too many individuals either don’t think PrEP is for them, or mistakenly believe its access is out of reach. Unbelievably, many others still don’t even know it exists.

“For too many people, HIV is just not something they talk about,” said Mairena. “The urgency around HIV has been lost to a [great] extent. So, we still have a lot of work to do to make HIV and HIV prevention relevant to the people who need it most.

“Because, if we look at who’s acquiring HIV, it’s disproportionately people of color. About 38% of new HIV infections are among Black individuals. About 34% are among Latino individuals. But then, if you look at who’s on PrEP, only 14% of users are Black, and only 18% are Latino. So, we’re missing the mark on who needs to be on PrEP and who should have the conversation with their providers about PrEP. And too many people just don’t see that as an option for them, or don’t see it as relevant to their life.”

Sexual wellness is primary care

The panelists agreed that today, HIV prevention is primary care — and that more providers of all stripes, including those who test for HIV, should have more frank conversations with their patients about PrEP.

With the CDC estimating that 3.4 million HIV tests are given every year in the U.S., Mairena sees that as “3.4 million opportunities to talk about PrEP at some point, unless they’re already on it … but that linkage isn’t being made. HIV testing is great and important, but it’s not HIV prevention.”

“We love our HIV specialists, I am one myself,” said Deem. “But we don’t need them for HIV prevention, for the most part. Every primary care provider in Palm Springs should be able to offer PrEP to their patients when they ask.”

“I don’t want to put that onus on the patient,” suggested Halperin. “There needs to be a change of culture in the health care system where sexual wellness is core to healthy living…. We need to do more to destigmatize the fact that people are sexually active.”

“We have to normalize [PrEP] the way we normalize birth control or reproductive health,” added Mairena. “People have options in that space, and they get to talk to any provider about it. We’re not there yet with HIV prevention, but hopefully we will get there.”

“We do a pretty good job giving people cholesterol medicine to prevent a stroke,” continued Deem. “For people with asthma, we have inhalers to help [them] not have an asthma attack. We’re doing prevention in so many different arenas of health care. We need to break down the walls when it comes to HIV and sexual health stigma to realize these are just other health conditions. Sex is a part of life. Sex is a part of being healthy and happy. Just like not having a heart attack is. And we should be able to protect everyone in the way they want to protect themselves.”

Ensuring access

For those people who understand they could benefit from PrEP, but who feel the cost is prohibitive, every expert on the panel agreed there are invaluable resources to help with access.

DAP Health has three free sexual wellness clinics (in Palm Springs, Cathedral City, and Indio) and will soon open one in Oceanside near San Diego. All of them are staffed with PrEP navigators. “We are committed to providing all of the PrEP options for whatever a patient desires,” confirmed Halperin.

“Pharmaceutical companies also have programs that provide assistance,” added Mairena. “There are so many different ways to access PrEP, and I think, unfortunately, a lot of times people don’t see it as an option for them and don’t even have that conversation. They self-disqualify, almost.”

That’s where all of us can become lifesavers, Mairena offered. “If you have that friend who should be on PrEP and isn’t doing it and isn’t having that conversation — or has some myths that need busting, help us out with that. Because peer to peer is really where a lot of that change is done.”

Final words

Near the conclusion of the program, Waters asked each panelist for their last thoughts.

“Believe in science,” said Deem, stressing what most everybody already knows: that science is under attack right now. “It’s real. It’s gotten us to this point in the epidemic, and it’s gonna get us out of the epidemic. Science and community together. But we have to have both parts.”

“From the DAP Health side … we are part of this community,” added Halperin. “We welcome anyone interested in HIV care, HIV prevention, and sexual wellness. Our red carpet is out for our community.” He added that Medicaid’s expansion has done more to ensure health equity in this country than anything else. “If we’re committed to this, we really need to fight — really fight — to ensure Medicaid is not taken away.”

“If everyone in this room talks to three people about how HIV is still a thing,” concluded Mairena. “And then, they also talk to two people about getting tested. And then they talk to one person about getting on PrEP — that’s the type of community-led mobilization we need to get to the end of the epidemic. We just can’t do it without community partners and without the community itself. We need to continue to stress that urgency around HIV prevention.”

To learn more about accessing PrEP at DAP Health, or to learn more about our sexual wellness services in Palm Springs, Cathedral City, Indio, and soon, Oceanside, please click here.