OPINION: SHS has made great steps for HIV prevention, but the struggle to access HIV care isn’t over

In recognition of World AIDS Day in 2018, Donnie Denome CG ’21 wrote an opinion for TSL calling attention to the need for immediate accessibility of HIV preventative measures at the 7Cs.

For college students, HIV is often depicted as something ubiquitous, nefarious and yet not that much of a problem,” Denome wrote.

But that’s not necessarily the case anymore.

Five years later, Student Health Services (SHS) is offering a landmark treatment for student health at the 7Cs in the form of preventive medicine that can exponentially lower the chances of infection after exposure to HIV.

The newest additions to the arsenal in the fight against infection are Pre-exposure Prophylaxis (PrEP) and Post-Exposure Prophylaxis (PEP). These are key in allowing queer communities, who were hardest hit by the AIDS epidemic, to have safe sexual experiences. Both PrEP and PEP have great clinical success in decreasing the chances of infections in scenarios such as needle sticks, sexual intercourse or failures of other preventative measures.

This June marks 43 years since the start of the AIDS epidemic. Affecting an estimated 85.6 million people and resulting in the deaths of about 40.4 million, the epidemic has affected a population equal to 10 times the metro population of San Francisco. Advancements in medical science, however, have decreased infection rates and changed AIDS from the death sentence it once was to a manageable — even preventable — disease.

Despite this great step forward for the Claremont community and immense changes to the landscape of healthcare, legislature and preventative care, the greater California community still struggles to make these HIV preventative measures accessible.

When Denome wrote their opinion, Truvada — the primary formulation of PrEP medication held by Gilead Sciences — sat at a hefty $2000 for a month’s supply. This made the medication inaccessible for people without health insurance and put a strain on medical and medicare systems.

In 2020, Gilead’s existing patent (thankfully) expired, allowing generic alternatives to hit the market. This made treatment easier to obtain by reducing out-of-pocket costs for students. 

Still, despite this win for accessibility, Gilead extended their new patent —and continued to make a profit. Patent extension methods like this are frequently employed in the pharmaceutical industry and, in this case, cause vital services that predominantly support queer and minority communities to be largely out of reach.

California took massive steps of its own toward accessibility in 2019, introducing Senate Bill 159. The bill allowed pharmacists to furnish medication for both PrEP and PEP without a prescription or positive test for HIV after completion of a 90-minute online training, making California the first state to enact a law of this kind.

Senate Bill 159 removed a huge barrier to care— especially on college campuses.

Before this legislation, SHS didn’t prescribe or administer PrEP or PEP. Students were required to obtain a referral from SHS and a doctor’s appointment from an outside service before they could access medication covered by the Student Health Insurance Plan (SHIP). 

Now, students can receive a prescription, access medication on campus and have guaranteed insurance coverage.

Despite the Center for Disease Control’s recommendations for anyone at high risk to get this medication (due to the minimal side effects) only 11 percent of pharmacists in California have furnished PrEP or PEP.

On a scale that measures the ratio of PrEP users in 2022 to the number of people diagnosed in 2021 in each state, California ranks in the middle. This stat — used as a benchmark to measure disparities between a community’s demonstrated need and need met by medical professionals — should be higher considering that California has undertaken more legislative change than almost any other state in the country.

Additionally, studies of graduating medical school classes in 2021 found that 20 percent of students were unaware of PrEP and 30 percent reported low confidence in counseling patients about PrEP.

Given SHS’ limited availability of resources, it’s likely that awareness rates on the Claremont campuses aren’t much different.

SHS doesn’t currently list PrEP as a service under the sexual health section of their website, even though they provide this service. In fact, PrEP and PEP are only displayed in two places on the website: Buried deep in the list of all services provided and under a listing for appointment types shown while attempting to schedule a sexual and reproductive health appointment.

PrEP and PEP’s lack of visibility on SHS’ website is another obstacle in education about HIV preventative measures.

The medical and 7C communities have both taken great steps forward since Doney wrote their opinion highlighting the need for PrEP accessibility — but more is required to make HIV infection a thing of the past.

We live in a world where HIV can be confidently prevented as often as 99 percent of the time by a medicine that is covered by Medicare, accessible without prescription and has minimal side effects. And yet, due to a lack of knowledge, training and care for the queer and minority communities affected, infection persists.

Let’s not wait another five years to make PrEP accessible and take the necessary steps to decrease the spread of HIV.

Adam Akins PZ ’27 is a Sports Editor and photographer at TSL who was lucky to grow up with a mom who shared her passion for public health and HIV care with him.

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