The Los Angeles County Board of Supervisors voted nearly unanimously for a proposal that will allow the county to begin offering PrEP. The vote was four out of five in favor of the proposal with one voter abstaining.
L.A. County is the second largest epicenter of HIV infections, but has hesitated in utilizing PrEP as a way to reduce infection rates. Los Angeles currently has an estimated 60,000 people living with HIV and about 1,800 new infections a year.
PrEP is already a prominent prevention method in San Francisco and New York state, where earlier this year Gov. Andrew Cuomo launched a PrEP assistance program that would help cover the costs associated with the medication.
"If you have a tool that could help people not get HIV, it's completely immoral not to use it," said Supervisor Sheila Kuehl, who brought the proposal to the county. Combatting HIV and AIDS was part of Kuehl's platform when running for the Board last year.
Two amendments were added before voting, one to make sure that outreach is culturally relevant and the other to look into whether the program could be implemented in the county jail system.
Part of the reason Los Angeles has been slow to move towards PrEP, Kuehl told the Los Angeles Times, has been political pushback from the AIDS Healthcare Foundation, which is based in L.A..
A recent Buzzfeed article accused AHF of preventing a vote on such a proposal, though no one representing AHF spoke at the vote on Tuesday. According to Buzzfeed, critics claim that AHF has an outsized voice in HIV prevention policy, as they have an annual budget of $1 billion and serve 421,000 patients in 36 countries, with 8,000 patients in L.A. County alone. (For comparision, GMHC, which is often called the largest AIDS service organization in the U.S., serves 9,000 clients in New York City but has no reach abroad.)
AHF has also come under fire for its litigious history, filing 12 lawsuits since 2000, seven of them over HIV-related contracts, which some critics have claimed has had a chilling effect on the county and other HIV service providers.
Michael Weinstein, president of AHF, is a vocal critic of PrEP, once calling Truvada a “party drug” and claiming that it encourages condomless sex and that people will fail to adhere to the strict daily pill regimen. Weinstein told Buzzfeed that AHF had no plans to try to block the distribution of Truvada so long as the county went through a regular bidding process. AHF sent a letter to the board of supervisors warning that the program would be under close scrutiny and that using any federal funds meant for HIV treatment would be unlawful.
In a statement to Karen Ocamb of Frontiers magazine, Weinstein defended AHF’s position, claiming that the county should focus instead on identifying the estimated 24,000 HIV-positive individuals out of care or with unknown status.
“Truvada costs about $13,000 a year per patient. Virtually no Ryan White funding can be used for PrEP, nor any of the County’s own ‘Maintenance of Effort’ funds that Ryan White requires — those funds are to be used expressly for services for people living with HIV/AIDS,” he said. “‘Treatment as Prevention’ would be a far more effective HIV prevention strategy for the County to pursue.”
The proposal will target low-income populations and will have an estimated cost of $1 million, according to Mario Perez, director of L.A. County’s HIV prevention program. Part of the cost will be covered by state and federal government programs, Kuehl said, adding that no funds for current HIV programs would be diverted to fund PrEP.
Public health officials now have 30 days to come up with a plan for implementation and report back to the county board of supervisors.