Recently, HBO aired the documentary Larry Kramer in Love and Anger, a chronicle of the iconoclastic AIDS activist, playwright, and author who co-founded Gay Men’s Health Crisis, the world’s first AIDS service organization, and later, the legendary direct action group ACT UP. Early in the film, an archival clip from the 1980s shows Kramer shouting through a bullhorn at a street protest: “President Reagan, we are gay people who are dying. It is appalling that in the seventh year of this epidemic, nobody is in charge!”
The scene — and much of the film, for that matter — was a painful reminder of the devastating lack of leadership at nearly every level government in those early years. Though there is not yet a cure for HIV, we’ve come so far since Kramer called out President Reagan at that protest. Perhaps the most significant move was the launch, in 2010, of President Obama’s National HIV/AIDS Strategy.
An ambitious response to the on-going epidemic, NHAS laid out a five-year plan to reduce new HIV infections; increase access to care and improve health outcomes for people with HIV; and reduce HIV-related health disparities. Significant federal resources have been directed toward meeting those goals.
With last month's release of the president's National HIV/AIDS Strategy Updated to 2020, we have the opportunity to make a huge leap forward in significantly reducing new HIV infections. One of the tools highlighted in the new report holds great promise: Pre-Exposure Prophylaxis, better known as PrEP, or Truvada, which is a single pill that combines two antiretroviral medications and is taken to prevent HIV.
According to the Centers for Disease Control and Prevention, PrEP has been shown to reduce the risk of HIV infection by up to 92 percent among men who have sex with men – a group disproportionately impacted by HIV – when taken daily and as directed. PrEP studies show similiarly promising results among other high-risk populations, including trans women, injection drug users, women in Sub-Saharan Africa, and people in sexual relationships with an HIV-positive partner.
In other words, by taking just one pill a day, people who are uniquely vulnerable to HIV infection can significantly reduce their risk of contracting the virus. (Editor's note: Read more about PrEP basics here.)
Despite this, widespread adoption of PrEP has been slow. This seems due to a combination of factors, including:
- Those that would most benefit from the drug are simply unaware of it.
- Reluctance by physicians to prescribe medication to otherwise healthy people.
- Stigma – particularly among gay men – stemming from the judgment by some people that those who take PrEP are promiscuous.
- Misinformation due to lack of understanding the facts or deliberate efforts by others to mislead.
A national campaign strategy around PrEP – such as those the Obama administration has sponsored around HIV testing, reducing stigma, and the link between substance use and risk of HIV infection – will give advocates, providers, and public health officials the common tools and resources needed to ensure the word gets out about the critical role PrEP can play in reducing HIV infection. At this writing, there are a handful of city- and state-level education and awareness campaigns, such as those in Massachusetts, New York City, San Francisco, and Minnesota. There’s no question that more needs to be done to raise awareness.
Unlike the days of Ronald Reagan, we currently have an administration that is providing much-needed focus and leadership on eradicating HIV in this country. With continued coordination, I am more confident than I have ever been that we will soon achieve that goal. After nearly 35 years and more than 650,000 U.S. deaths from AIDS, it’s about time.
CARL SCIORTION is the executive director of AIDS Action Committee.