Earlier this week, New York Governor, Andrew Cuomo announced a plan to put a stop to the AIDS epidemic that has been present in New York since the 80’s. His ambitious goal is to end this epidemic by the year 2020, which translates to bringing the number of new cases down to 750 from the 3,000 reported in 2013. At its peak in 1993, the epidemic produced 14,000 new cases.
Gov. Cuomo’s announcement is significant for many reasons, not the least of which is his outward support for preventative medications given to people without HIV. The medication in question, called Truvada, is also called pre-exposure prophylaxis (PrEP) and there is growing evidence that indicates that it is quite effective in preventing the spread of HIV.
Truvada has traditionally been used to treat people who have already contracted the virus. It works by suppressing the virus, preventing it from wreaking havoc on the body as well as blocking its transmission to others. When treatment is adhered to, the virus can become virtually undetectable in blood tests. There are reported reductions in rates of new diagnoses that coincide with campaigns to get those with HIV much better access to this treatment.
Better access is a huge part of Cuomo’s plan. He is unique in his approach, though, as he is one of the first highly visible public officials to announce in a highly visible way his support of the use of Truvada to prevent transmission. The CDC backs its use, and has recommended it be given to 500,000 people in America who are at high risk for infection. However, their recommendation was not publicized. Research indicates that 75 percent of health professionals also back its use, but only nine percent have ever prescribed it to a high risk individual.
There is a some controversy surrounding this approach to preventing transmission of HIV, though most of it appears to be more stigma-based than reflective of real issues surrounding HIV-positive people and those at risk. Genuine concerns center on the necessity for a high level of treatment adherence in order for the medication to be effective. Some worry that the introduction of the medication will cause many to abandon the use of condoms, previously the main tool used to protect against infection.
Cuomo’s plan incorporates these issues. The state has already bought medication in bulk to ensure it is available to patients. Legislation has been approved that makes it easier to track those with HIV, which will help in two ways. It will ensure that those with HIV have better access to treatment, and it will help keep records accurate so that a person who moves is not being reported to the state as currently not receiving treatment. Other measures seek to make testing more available by presenting it as part of routine checkups, dismantling the stigmas, and making it less embarrassing to consent.