How health professionals in Southeast Michigan are educating the public about PrEP four years after the groundbreaking HIV prevention method emerged

(ANN ARBOR) – When David*, 32, an Ann Arbor native and current researcher in Cambridge, Massachusetts, found out that his sexual partner of over four years wanted both of them to start taking pre-exposure prophylaxis (PrEP), a prescription drug currently available to help prevent the spread of human immunodeficiency virus (HIV), he was perplexed.

Both David and his partner are gay, HIV negative, and in an open relationship. They practice safe sex by using condoms for protection from sexually-transmitted infections and openly communicate with each other when they have other sexual partners. He thought they were taking all the necessary steps to prevent the contraction of HIV from other potential partners, but was surprised to find that his partner did not have the same level of comfort as he did on the matter.

David had never heard of the drug PrEP until a year and a half ago when he heard a story about it on National Public Radio (NPR). As a researcher himself, this revelation surprised him. He said, “I couldn’t believe it wasn’t a bigger story. If this is how powerful they said it was and that it prevents HIV, I was surprised I hadn’t heard about it.”

The Centers for Disease Control and Prevention says PrEP has been available since 2012. This medication, pre-exposure prophylaxis (PrEP), is a pill taken daily that can be used to prevent HIV. The drug is for people without HIV who are at very high risk for getting it from sex or injection drug use. Although it is more commonly referred to as PrEP, the brand name of the medication is Truvada, which is a combination of two drugs (tenofovir and emtricitabine) that work to prevent HIV.

The Centers for Disease Control and Prevention estimates that daily PrEP use can reduce the risk of getting HIV from sex by more than 90% and can reduce the risk of getting HIV among people who inject drugs by more than 70%. It says that expanding testing, treatment and PrEP could prevent up to 185,000 new HIV infections by 2020.

Keith Hughes, the Lead Lab Coordinator and Prevention Specialist at Unified, an organization dedicated to serving people affected by HIV in Southeastern Michigan, is located in Detroit, MI, and he says unawareness of PrEP among the public is partially due to lack of knowledge among healthcare providers about the existence of the drug. According to the Centers for Disease Control and Prevention, 1 in 3 primary care doctors and nurses haven’t heard about PrEP.

Hughes said, “Even with individuals in the community that know about PrEP, their medical provider may not know or have any information on PrEP. They may have never heard of PrEP. That is a big issue.”

Calvin Dishmon, another HIV Prevention Specialist at Unified, works at the Ypsilanti office. It is here, in his own personal, brightly lit space that contains a large, comfortable red couch and striped puffy chair that Dishmon meets with individuals who want HIV testing, counseling, or resources for HIV prevention. In his experience, though, people are not necessarily seeking out PrEP because oftentimes they do not see HIV as a current threat. Dishmon said, “People don’t want to be involved with something until it becomes a crisis in their life.”

The Centers for Disease Control and Prevention estimates that about 50,000 people get infected with HIV each year, and that the HIV epidemic is growing. It also says HIV is highly prevalent in urban areas with more than 500,000 people. Although the Midwest has the lowest rate of diagnosis for HIV in the country, cities such as Chicago, Detroit, and St. Louis are still disproportionately affected by the disease than other areas in the region.

Hughes says about Unified’s work, “We are the only organization here in Detroit that actually has an actual PrEP program where we are providing PrEP services and also non-medical assistance for clients who may have various issues around retaining and adhering to PrEP.”

Unified’s office in Ypsilanti is approximately forty minutes away from Detroit, MI. According to Dishmon, “53% of the case management cases of HIV in the region are worked on by our team at Unified.” This means that over half of the people with positively identified HIV cases are receiving some sort of treatment or support from one of the three Unified office locations in Southeast Michigan.

Dr. K Rivet Amico, a Research Associate Professor at the Department of Health Behavior and Health Education in the School of Public Health at the University of Michigan has been researching PrEP for the last decade and is currently working to spread awareness about PrEP and HIV prevention methods as well.

Dr. Amico is especially vocal about pushing back against a common misconception people have about PrEP and who should use it. She says the Centers for Disease Control and Prevention’s definition of PrEP being only for high risk individuals is “confusing.” She says this definition excludes people who might benefit from PrEP but who are not necessarily a part of this specific group. Dr. Amico also says the high risk definition has created stigma against PrEP users in some communities of men having sex with men. Some of these critics of the drug have labeled PrEP users as “Truvada whores,” and in her opinion, this has prevented some people from becoming “advocates for their own health” and from choosing to go on PrEP because of this backlash to the drug.

Dr. Amico very passionately believes PrEP is one of the most important contributions to the prevention of HIV in years. She said, “I actually do believe that if you help people to identify if they have HIV and get them really good treatment, and at the same time, for people who don’t have it, offer them a continuum of options, one that would include PrEP (if they wanted it and if it was good for them) then you do have a shot of ending the epidemic, which frankly, has not been a realistic goal, for you know, decades.”

For Dishmon, the possibility of PrEP making serious strides forward in the prevention of HIV is an especially personal one. Recalling his life’s work, Dishmon reflects on the reason why he became an HIV prevention specialist in the first place.

“HIV started killing my friends and there was no medication. I just said – either I will chase you until you leave this planet or I’ll leave the planet and you’ll still be here, but I just made up my mind that I was going to try to contribute in some type of way, whatever way I could, to fight it.”

*Name of this interviewee has been changed for privacy reasons  

prepPictured above: HIV Prevention Specialist Calvin Dishmon explains the process of HIV testing at his office in Ypsilanti, MI

 

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