Officials say a preventative drug now offered by the Jackson County Health Department has the potential to virtually eliminate new cases of HIV in the region within a generation.
Pre-exposure prophylaxis, or PrEP, is a once-a-day pill that, when used consistently, can prevent at-risk people from getting infected with HIV.
Helped by a $20,000 state grant, the health department will open a “one-stop shop” clinic next month that offers client navigation for PrEP services, including education, medication access, referral to PrEP-friendly providers and enrollment into medication assistance programs, said Paula Clark, director of HIV services with the Jackson County Health Department.
“(PrEP) has been utilized for probably three or four years in bigger cities. When it recently became more widely available, insurance companies and Medicaid started to cover it, and we just felt like it’s the right thing to do, that we really needed to try to do this,” Clark said.
CDC recommends PrEP to anyone with "ongoing high risk for acquiring HIV infection." Groups that might benefit from the drug include HIV-negative people with HIV-positive partners, HIV-negative women who have an HIV-positive partner and want to ensure a healthy pregnancy, men who have sex with men and who engage in unprotected sex, injection drug users and anyone with syphilis or rectal STDs.
“We case-manage HIV-positive persons and we cover the lower 19 counties, so that’s roughly Mount Vernon down to Cairo, and we have a lot of couples where one’s positive and one’s negative, so this is a great treatment for them,” Clark said.
The health department held a training in June to educate providers on the drug; 25 local clinicians agreed to partner with them and provide PrEP. Since then, the health department has begun referring clients out to get care. Clark estimated that about a dozen of her clients are now currently on PrEP.
JCHD case-manages about 170 people who are HIV positive and offers those clients viral suppression, which drastically reduces transmission rates and enables them to stay healthy and live to old age.
“So when you put these two things together, if you have someone who’s HIV-positive but they’re virally suppressed, and then you have the negative person that’s just on PrEP, it’s just a near-zero chance. The researchers will say, ‘Zero chance, I repeat, zero chance of transmission when one is virally suppressed and one is on PrEP,’” Clark said.
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“They are feeling like, in the next 10 years, if we could increase the PrEP uptake up to at least 40 percent of those people who are at risk taking PrEP, and that if we can increase viral suppression, those two things together will equal zero new cases,” Clark said.
Nationwide, anywhere from 35 to 45 percent of HIV-positive people are virally suppressed, Clark said. Of the clinic’s 170 clients, 93 percent are virally suppressed.
“That’s because our case managers are on it. They’re really educating them and keeping on the clients and letting them know how important it is to take their meds and how much good health they are going to gain by practicing good treatment adherence,” she said.
Regional HIV rates are difficult to pin down, but the health department has seen a steady increase of HIV cases, Clark said. It currently has a record-high caseload.
“We normally see anywhere from 12 to 24 (new) cases each year in our area … that is a lot of new cases for us,” Clark said.
Jackson County Health Department’s HIV-positive clients range from people in their young teens to a patient in her 80s.
“They’re coming in younger, and they’re coming in a lot more sick, which means people aren’t being tested regularly like they should be,” Clark said. “If they test regularly and catch it early, we can get them into viral suppression and healthier a lot quicker — it takes a real toll on the body.”
“We’re reaching out to those who have tested negative for HIV and who we think would be good candidates for it, and then we’re also contacting the partners of our HIV-positive clients,” Clark said.
Clark said HIV is behavior-related, just like the most causes of death. She compared PrEP to prescribing medication to people who make unhealthy choices.
“So this is really no different than if you go into the doctor and the doctor says, ‘Hey, you’ve got high blood pressure, you’re overweight. I need you to start limiting your trips to McDonald’s and I need you to get off the couch and exercise a little bit.’ … And you come back in and you haven’t lost any weight and your blood pressure’s still really high, and you’re like, ‘Well, I couldn’t make those changes. I really just don’t want to do that.’ And he’ll say, ‘We’re going to have to put you on blood pressure medication and cholesterol medication or you’re going to have a stroke.’ It’s a pill to help prevent a disease, just like those are pills to help prevent a disease,” Clark said.
CDC recommends regular HIV testing for people who are continually putting themselves at risk.
“I’ve been doing HIV for 25 years. This is the most exciting thing that has happened as far as prevention in the life of it. We still don’t have a cure, but we have a chance to get near zero chance of transmission,” Clark said.
For more information about PrEP or about HIV testing, call 618-684-3143 ext. 155.