Roughly six months after Yale Health began offering a daily pill that prevents those exposed to HIV from getting the disease, Yale Health still has not begun any large-scale outreach effort to inform students that it is available. Campus leaders in the LGBTQ community are now calling on Yale Health to be more proactive in spreading the word about the drug’s accessibility.
Pre-exposure prophylaxis, or PrEP, is a daily prescription pill that reduces the risk of getting HIV by up to 92 percent post-exposure, if taken consistently. The Centers for Disease Control and Prevention recommends PrEP only to those who are at significant risk of being exposed to the HIV virus: sex workers, people with HIV-positive sexual partners and those who engage in risky sexual practices such as unprotected anal sex, among others. For others, the CDC recommends against the drug, as side effects, which include decreased kidney function and bone density, can be quite severe. Not all gay men are at a high enough risk of HIV to be good candidates for PrEP, but the CDC mainly recommends the drug to this population. Only yesterday, Kaiser Permanente — a health insurance provider in San Francisco — announced that not a single one of its 657 PrEP users, most of them gay men, has been diagnosed with HIV over the past two years.
PrEP’s arrival to campus came with little fanfare. In fact, many student leaders in the LGBTQ community say Yale Health is not doing enough to inform the campus population about HIV prevention methods available locally.
“It’s difficult for people to take a drug that they don’t know about,” said Yale College Council President Joe English ’17, who identifies as gay. “A great barrier right now is a lack of information.”
While PrEP was approved by the Food and Drug Administration in 2012, Yale Health began offering it late last semester. Students with Yale Health’s Prescription and Specialty Coverage plan can get the medication with a roughly $30 monthly copay. Those who are not on the full plan may have the drug’s cost be partially subsidized by other insurance providers; otherwise, they must pay the full $12,000 annual cost. In order to obtain the drug, students must make an appointment at Yale Health and answer several questions about their sexual history so that the clinician can determine if they are at a high enough risk of HIV to be prescribed PrEP.
Students who are uninsured can also apply directly to Gilead Sciences, the only company that produces PrEP, to declare their extenuating circumstances and request to have the drug for free.every Yalie who wants PrEP can obtain a prescription. Students who qualify for PrEP must commit to taking the pill every day and attend regular blood tests that screen for HIV and other sexually transmitted infections and check their kidney function.
Robert Heimer GRD ’88, professor of epidemiology and director of the Emerging Infections Program at the School of Public Health, said Truvada, PrEP’s brand name, was invented because researchers realized that behavioral changes alone, such as wearing a condom, cannot stem the tide of HIV. Trials conducted among high risk populations across the world suggest that the drug is only effective for those who consistently take the drug, he said.
Yale Health Medical Director Michael Rigsby MED ’88 declined to share any information about the benefits or risks of PrEP with the News.
“We encourage anyone concerned about sexually transmitted infections to speak to a clinician at Yale Health,” he wrote in a Sunday email.
But every student interviewed said the passive approach that Yale Health has taken is misguided because the people at highest risk of contracting HIV are generally not in frequent contact with health providers.
“People who would go to the doctor and say ‘put me on PrEP’ tend to be pretty risk averse anyway,” said head LGBTQ Peer Liaison Max Goldberg ’17.
Alex Borsa ’16, a Women’s, Gender, & Sexuality Studies and Molecular Biophysics & Biochemistry major who spent the past summer researching PrEP, said that after conducting around 28 interviews with public health providers, health professionals and people at risk of HIV, including some gay men, he was taken aback by how few people knew about the drug. He added that Yale Health’s failure to actively publicize the availability of the drug in the queer community was adding to the problem.
Borsa said that while some view the HIV epidemic as a relic of the 1980s, there is still a salient fear of the virus among the gay community at Yale.
“The specter of HIV still haunts sexuality in a lot of ways,” he said. “Even people who statistically and epidemiologically are not at great risk , according to their practices, still go on [Truvada] to escape the shackles of fearing HIV.”
He said he would like to see Yale Health do more to give students the option of not living in fear of contracting HIV, but acknowledged that Yale offering the drug at all puts it ahead of many universities.
Goldberg said he does not know why it took Yale Health so long to roll out the drug. But he acknowledged that nationwide, PrEP is shrouded with stigma, as some, including members of the gay community, think that those who take PrEP are having a lot of risky sex — the term “Truvada-Whore” arose as a way to shame people on PrEP.
There are also people who see PrEP as a perfect preventative treatment, and do not know about its side effects, he said.
Goldberg said such perceptions have arisen because there is not a campus-wide discussion about PrEP. While some people within queer social circles talk about PrEP with their friends and peers,. Rather, he thinks it is part of Yale Health’s duty to reach out to the student body and educate them on their sexual health.
“I would like Yale Health to explain to all students, regardless of their [sexual] orientation, that it is available, how effective it is and how to access it,” he said. “A full student body-wide email would go a long way.”
Maria Trumpler, director of the Office of LGBTQ Resources, said Yale Health did not inform her when they began offering the drug.
Kyle Ranieri ’18, a PL with the Office of LGBTQ Resources, only heard about PrEP before the start of this semester during PL training at Yale Health. He said the administrators present at the training, including Chief of Student Health and Athletic Medicine Andrew Gotlin, seemed to support broader awareness of the drug among students. But Ranieri said Yale Health has not communicated this encouragement to anyone besides the PLs.
“They are well-intentioned, but they could do more,” he said.
Truvada is the most effective preventative HIV pill on the market.