The One Pill That Saved Thousands of Lives
The story of PrEP
“Life does not happen to us; it happens from us" - Unknown
As people, we do not know when we are born until after the fact; the birth certificate tells us the date. We do not know when we are going to die, the death certificate tells the date, which is meaningless to the person that died. I was looking at my parent’s headstone and reflected on the little dash between their birth and death. Much has been written about that dash, which signifies our goals, dreams, successes, and failures, the dash is the summation of our life. Death is imminent, no one can deny this fact. What is sad is when the time the dash represents, is cut short because of a disease. A disease that once contracted, a slow and agonizing death soon follows. The disease was and is known as ‘acquired immune deficiency syndrome,’ known to most as AIDs. AIDS became synonymous with death, that is until a miracle medication called PrEP came onto the stage. PrEP is an acronym for pre-exposure prophylaxis, a medication that gained FDA approval in October 2019.
This medication is for people at risk for HIV, which is ‘human immunodeficiency virus.’ HIV infects and destroys T cells in the immune system causing a reduction of protective cells and opening the door for the AIDS virus. In simple terms, HIV is a virus that causes AIDS by destroying large numbers of cells that help the body fight infection. The AIDS virus is the late stage of HIV infection that occurs when the body’s immune system is damaged because of the HIV virus. PrEP has been proven to prevent people from getting HIV from sex or the injection of drugs. PrEP can stop HIV from taking hold and spreading the virus throughout the body. As of this writing, two medications have been approved for PrEP, they are Truvada™ and Descovy™. The uses are as follows:
• Truvada™ is for all people at risk through sex or injection drug use.
• Descovy™ is for people at risk through sex, except for people assigned female at birth who are at risk of getting HIV from vaginal sex.
A question that is often asked is where did HIV/AIDS originate and how did this deadly disease spread so rapidly? The answer might surprise some; colonial West Africa in the 1920s, with its labor camps, prostitution, bushmeat hunting and the railroad, was considered the perfect storm for the introduction and spread of HIV. A form of the HIV virus was in animals which through bushmeat hunting was transferred to humans then spread to others by blood and other bodily fluids. The disease, known since the early twentieth century, spread to Haiti and from there, to the United States. The reason HIV did not ‘become public’ sooner than it did, was because of its long incubation period, a person could have HIV for up to ten years before the immune system would be compromised. Once compromised, HIV opened the door for AIDs. Setting all judgments aside, people contracting AIDS by sexual intercourse or blood transfusions; the sentence was the same, a slow, excruciating death.
HIV is spread by sexual contact with an infected person and by sharing needles and/or syringes (primarily for drug injection) with someone who is infected or less commonly (and now very rarely in countries where blood is screened for HIV antibodies), through transfusions of infected blood or blood clotting factors. Babies born to HIV-infected women may become infected before or during birth and through breast-feeding after birth.
The late Dr. Johnathon Mann of the World Health Organization (WHO) outlined the progression of AIDS which is as follows:
• Silent spread – 1970s – 1981
• Recognition – 1981 – 1982
• Intense discovery 1982-1985
• Global Mobilization 1986-1988
• Ending the problem by blood testing in 1984
• Public education 1986
• Anti-viral treatment 1986
• Development of a vaccine??
It can be said that we are in step seven with the Introduction of PrEP.
PreP, which is a registered trademark, is not a cure but it is a highly effective, safe, prevention of HIV. Some people experience side effects such as diarrhea, nausea, headache, fatigue, and stomach pain. PrEP may be of benefit if a person is HIV negative and had anal or vaginal sex in the last six months, have a sexual partner with HIV, have had unprotected sex or have been diagnosed with an STD in the past six months. PrEP is also recommended for people who inject drugs, have an injection partner with HIV or share needles and syringes. PrEP is only available by prescription, any provider that is license to write prescriptions can prescribe the medication. A specialist in infectious diseases is not required to write the order. A provider can be found by visiting a community health center. Currently, there are 190 health centers in 57 jurisdictions prioritizing in the Ending the HIV Epidemic initiative. As with any issue of concern, word of mouth is always an option. COVID -19 has taught us to think outside the box; there are self-testing kits for HIV to take at home as part of your ongoing PrEP care as well as telehealth appointments to limit trips to the clinic of health care provider.
Paying for PrEP can be a challenge for some people. Most health care plans cover the cost of the PrEP medications. Check with your insurance carrier, if you do not have health insurance that covers PrEP, a person may receive co-pay assistance from drug manufactures, state programs, or patient advocacy foundations. PrEP can be obtained by anyone that needs the medication.
There are other things that a person can do to augment the treatment, among those are:
• Keeping the immune system strong
• Reducing your chances of getting the infection
• Reducing your chances of infecting others
• Regular visits to the doctor to monitor your therapy
Ryan Wayne White’s dash represented nineteen years, far too short of time to experience life. Ryan was diagnosed with AIDS in 1984, he had a blood disorder that required blood transfusions. He became the national poster child for HIV/AIDS after failing to be readmitted to school because of his diagnosis. The stigmatization that Ryan faced because of the disease and his family’s subsequent fight against that mistreatment, made him a spokesperson for the fair treatment of HIV/AIDS sufferers and served to educate the American public about the disease. Could a medication like PrEP prolonged his life; that we will never know. What we do know is that PrEP is saving lives today. The time the dash represents is getting longer for many people, for that we are grateful. PrEP may be setting the stage for step eight, a vaccine.