San Francisco is expected to become the first city in the country to offer gay men an anti-HIV pill that has proven successful in stopping transmission of the virus that causes AIDS.
Officials with the National Institutes of Health and San Francisco public health officials are close to finalizing an agreement to launch in early 2012 a demonstration project for usage of pre-exposure prophylaxis or PrEP. The combination pill contains tenofovir and emtricitabine (Gilead Science’s Truvada) and has proven to be highly effective during clinical trials studying its efficacy.
Under the contract, up to 300 men who have sex with men at high risk for contracting HIV would be enrolled in the pilot study. City Clinic would administer the program while Magnet, the gay men’s health center in the Castro, would help identify suitable participants for the study.
"We are anticipating we will be the first municipality to implement a PrEP demonstration project and things are moving forward toward that goal," Dr. Grant Colfax, the city’s director of HIV prevention, told the Bay Area Reporter this week. "We are hoping the demo project would be implemented in the first quarter of 2012."
The exact funding amount for the National Institutes of Health Implementation Science Study is still being determined. And San Francisco is expected to partner with counterparts in Miami on the study to see if gay men want to use PrEP, and if so, how to safely administer the medical prevention technique.
"We don’t know if people want it," said Colfax.
The rollout of PrEP has been highly controversial, with some HIV prevention officials worried gay men will use it in order to engage in risky sexual practices. Others are concerned about having gay men take powerful drugs every day and what impacts that may have on their health later in life.
"Certainly, there are a lot of questions about it. I think the real question is once it is on the ground, and we have a program actually offering PrEP, what is the experience of the community for the demand? What is the level of interest in the gay community in using PrEP to prevent HIV?" asked Colfax.
Magnet Director Steve Gibson told the B.A.R. that, so far, few of the clinic’s patients have asked about the HIV prevention tool or its availability. Those who have, he said, either took part in the iPrEx clinical trials, known locally as PREPARE, or are HIV-negative men who have HIV-positive partners.
"We have had a handful of guys asking about PrEP," said Gibson. "These are guys trying to figure out what the result of the iPrEx study might look like for them and how they manage their HIV risks on a day-to-day basis."
Some of the questions Gibson said he hopes the demo project will answer are not only how gay men adopt using PrEP but also how to ensure lower income gay and bi men and men of color have access to it.
"We’ve proven the concept can work. Now the question is how can we make it work and be most relevant for gay men in San Francisco," sad Gibson. "Then my concerns are about equity. In San Francisco how do we make it equitable for gay men in lower socio-economic status or fearful of health care providers."
City Clinic medical director Dr. Stephanie Cohen will be updating the HIV Prevention Planning Council about the status of the PrEP demo project at its meeting this afternoon (Thursday, September 8).
In a brief interview with the B.A.R. this week, Cohen said city leaders felt it was important to update council members about the project even though the contract has yet to be signed.
"We just want to keep them in the loop," she said. "There is a really good chance for it to go forward, so having people’s feedback is ideal."
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