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Trends in Behavioral Healthcare: Join the Conversation – The Role of HIV Treatment as Prevention and Pre Exposure Prophylaxis PrEP

The Danya Institute and Central East Addiction Technology Transfer Center Network are pleased to present this regular series of orignal articles on trends in the field of behavioral healthcare.  In our latest article special guest author Jerilyn Schweitzer summarizes highlights from our waiting-list-only presentation “The Role of HIV Treatment as Prevention and Pre-Exposure Prophylaxis (PrEP)” .


Dr. Richard Elion of the Whitman Walker Clinic discussed a new method of preventing the spread of HIV. Pre-Exposure Prophylaxis, or PrEP, means treating people who are not infected with the HIV virus with an anti-retroviral drug to prevent them from becoming infected. (For more information, go to http://www.cdc.gov/hiv/prep/.) During a September 27, 2012 conference of healthcare providers, Dr. Elion discussed this new treatment, which was recently approved by the FDA and endorsed by the CDC. Dr. Elion said that although this method is no silver bullet that will end the AIDS epidemic, it can become part of a comprehensive toolbox of methods to reduce the spread of HIV.

Despite all of our best efforts, the HIV virus is still spreading at a rate of eight percent or 60,000 new cases per year in the District of Columbia. Even though we’ve had an HIV test for 17 years, the number of new cases shows that all of our prevention strategies are not working. By now, people know how HIV is spread. Yet they still engage in high-risk behaviors. MSM, or men having sex with men, accounts for 70 percent of new cases of HIV, and 25 percent of those who don’t know they’re infected cause 50 percent of all new infections.

Therefore, the most important message we need to get out to the public about prevention is, “Get Tested!” When people know that they are HIV positive, they are more likely to behave responsibly. We know that there are issues preventing people from getting tested and seeking treatment, and one major factor is social stigma.

We are failing to provide appropriate care because we don’t have a model that works and addresses social stigma. We have told people what to do and what not to do, and we have failed to change their behavior. Unless we find a way to deal with all those who aren’t getting testing and treatment, we won’t ever have prevention.

PrEP is a harm reduction method – since we can’t get people to stop engaging in risky sexual behaviors, we will try to make it safer. Rather than telling people what not to do, we are giving them a pill that makes infection less likely.

A recent study of PrEP using Caprisa, a gel with a high amount of tenofovir, looked at couples in which one person was HIV positive and the other was HIV negative. The study showed clearly that PrEP significantly reduced the infection rate of the HIV negative partner (see http://www.sciencemag.org/content/329/5996/1168.abstract for more information).

With strong evidence that shows that PrEP reduces the spread of HIV without increasing high risk behavior or drug resistance, it is a useful addition to our toolbox of methods to decrease the spread of HIV.

Dr. Richard Elion is the Clinical Research Director of the Whitman Walker Clinic and an Associate Clinical Professor of Internal Medicine at George Washington University. This lecture was recorded on September 27, 2012 by the Central East Addiction Technology Transfer Center, a program of the Danya Institute, and can be seen in its entirety at http://www.youtube.com/watch?v=BrrdKWFbzVc.


Jerilyn Schweitzer is a freelance writer based in Maryland.