By John Baker Brown, Campus Life Communications

PrEP – which can reduce the risk of HIV infection from sex by up to 90 percent for individuals at higher risk – has been available to Emory students since fall 2014, according to Michael J. Huey, MD, assistant vice president and executive director of Emory’s Student Health Services (SHS), a unit of Campus Life.

PrEP is the acronym for pre-exposure prophylaxis for the human immunodeficiency virus that can lead to acquired immunodeficiency syndrome, two potentially fatal diseases known respectively as HIV and AIDS.

During summer 2014, the Centers for Disease Control and Prevention (CDC) issued guidelines for the use of PrEP in primary care. The following semester, Emory became an early adopter of the program and began screening students who were interested.

Photo credit: Tina Chang, Campus Life Communications

Today, a small but growing number are accessing the service. Student visits for PrEP consultation and/or treatment grew from 13 in 2015 to 64 in 2016. The increase is due to students’ growing awareness of the service and the professionalism of the SHS team, according to Raphael Coleman, MPH, associate director for community wellbeing.                          

“Students on PrEP have easy access to physicians who are knowledgeable about PrEP and can prescribe it on campus at Student Health Services,” he explained. “Students also appreciate the open and candid conversations they can have with our health educators about sex and sexuality.”

Good news and bad

“There’s good news and bad news when it comes to HIV nationwide,” said Huey, who has lead SHS and served as associate professor of family and preventive medicine at Emory’s School of Medicine since 2002. “The good news is that HIV infections are down and treatments are better.” From 2008 to 2014, estimated annual HIV infections declined by 18 percent, according to the Centers for Disease Control and Prevention (CDC).

“The bad news is that advances in diagnosis and treatment of HIV are leading some individuals to become complacent and less concerned with prevention,” Huey explained.

Almost 37 million adults and children are living with HIV worldwide. More than one millionlive in the United States, and one in seven, or 15 percent, of them did not know they were infected. CDC 2014 statistics for the U.S. attribute more than 12,000 deaths to causes associated with HIV and nearly 7,000 directly to the disease. Another 18,000 people in this country were diagnosed with HIV the following year.

“We all must keep in mind that HIV has many potential complications and it still kills people. Although it is treated today with growing success, currently such treatments are lifelong and potentially very expensive,” Huey said. “The bottom line is that PrEP can offer higher-risk individuals an opportunity to avoid a lifetime of frequent medical visits, financial liability, and health consequences so often associated with HIV.”

PrEP is not a silver bullet, Coleman emphasized. “It’s a system that includes daily medication, periodic testing for sexually transmitted infections (STIs), and regular consultations with a health educator to develop and implement additional prevention strategies for effective and comprehensive HIV prevention efforts.”

Are you at higher risk?

PrEP may be appropriate for some individuals at higher risk of HIV infection. The treatment can be prescribed at Student Health Services, involves a once-a-day dose of the medication Truvada®, regular condom use, and routine medical visits with lab checks, usually every three months. When implemented as directed, treatment can prevent a permanent HIV infection.

According to the Centers for Disease Control and Prevention (CDC), PrEP is for individuals who have not contracted HIV but are at higher risk, which may be broadly defined as anyone who is:

• not in a mutually monogamous relationship with a partner recently tested as HIV-negative
• in a relationship with a partner who has tested HIV positive
• a gay or bisexual man engaging in anal sex without condoms
• a heterosexual woman or man not using condoms with a partner of unknown HIV status
• a person who has injected drugs with shared needles in the past six months

What about costs?

Assistance with PrEP expenses is available. PrEP medication charges are fully covered by the Emory Student Insurance Plan. Many other plans also cover PrEP costs. For people with limited income and no applicable insurance coverage, Truvada’s PrEP medication assistance program provides free PrEP.

Additional resources 

Resources at Emory
http://studenthealth.emory.edu/hs/services/PrEP.html

PrEP information and HIV risk factors
https://www.cdc.gov/hiv/basics/prep.html
https://www.cdc.gov/hiv/risk/prep/index.html
http://www.cdc.gov/hiv/basics/prep.html 

Basic statistics on HIV and AIDS
https://www.cdc.gov/hiv/basics/statistics.html 

Medication Assistance Program
http://www.gilead.com/responsibility/us-patient-access/truvada%20for%20prep%20medication%20assistance%20program 

CDC guidelines 2014
https://www.cdc.gov/nchhstp/newsroom/2014/PrEP-Guidelines-Press-Release.html