Posted on October 07, 2014
Source: The Guardian
Across San Francisco’s hilly streets, rainbow flags are always present, shining through the city’s persistent fog, displayed outside the city’s trademark brightly colored Victorian homes – and their modern apartments packed with Silicon Valley millionaires. And now this longtime home to gay pride and technological innovation may soon become the country’s leader in the fight to eradicate Aids.
This week, city supervisor David Campos unveiled a radical plan with a single goal: to wipe out HIV in the city. The plans could rest on what some have described as an HIV miracle drug and others have described as a public health disaster in the making: Truvada.
The drug, if taken every day, has a remarkable record in preventing HIV infection, and some believe it’s as effective as condoms. Campos has introduced a proposal that would make it available to any San Franciscan – male, female or transgender – who could benefit from it. This effort is backed by fellow supervisor Scott Wiener, who on Wednesday announced that he takes Truvada.
“The Aids movement started in San Francisco 30 years ago, and it makes sense that now San Francisco is in the position to take the lead in potentially eradicating HIV infections,” Campos told the Guardian before a Thursday rally in support of his proposal.
His plan is particularly striking, because, while the World Health Organization and the US Centers for Disease Control and Prevention have endorsed the drug as safe and effective in the prevention of HIV, and most insurance plans cover it, take-up has been remarkably slow.
Truvada began as part of combination therapy for people with HIV. For people who are HIV negative, the FDA in 2012 approved Truvada as a preventive treatment, also known as a pre-exposure prophylaxis (Prep), a term used synonymously with Truvada.
It can cost between $8,000 and $14,000 per year, though the manufacturing company Gilead offers payment plans for those who can’t get it through insurance.
But take-up has not been wide. “It’s a boutique intervention at this point,” said Johns Hopkins’ Dr Chris Beyrer, who co-chaired the WHO guidelines for Prep, which were released in July. He hopes that these guidelines along with an even stronger endorsement by the CDC in July will help make the drug available in more places.
“If this is going to have efficacy as a public health intervention that can really reduce rates of new infection at population levels, we have to have a different model,” he said. Beyrer, as well as other researchers and politicians, are trying to figure out how to get Prep prescribed to more people, especially in places where people aren’t linked closely to healthcare services. New York governor Andrew Cuomo has proposed an initiative similar to Campos’s for his state.
