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New York State's governor puts weight behind HIV prevention pill

New York State's governor puts weight behind HIV prevention pill


Cuomo's backing of Truvada could bring it into the light

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New York State governor Andrew Cuomo did something unexpected last Sunday: he announced that he was backing Truvada — the controversial HIV prevention pill — in an effort to drastically cut the rate of new infections in the state. The pill was officially endorsed by the CDC in May for use by any HIV negative person who may be at risk for infection (not just gay men who might be having sex with HIV positive partners) but this is the first time that a high-level elected official has recommended its use, reports The New York TImes.

six years to reduce the number of new infections from 3,000 to 750

Currently about 3,000 new HIV infections are reported in New York state each year, but Cuomo wants that number reduced to 750 by 2020. To do so, he has introduced a three-prong strategy. The first two parts are rather traditional, as they rely on performing more HIV tests, and getting more people with positive tests to see physicians. But it’s the third part, the part that includes Truvada, that has the potential to cause a stir, because some people think it promotes lower rates of condom use. That statement, however, isn’t supported by a recent scientific study that looked into the matter.

Moreover, in terms of preventing HIV, Truvada’s track record is pretty good. Recent reports state that it cuts infection rates by more than 90 percent, and people who take the drug every day are 99 percent protected from HIV. Furthermore, despite its $13,000-a-year price tag, the drug is covered by most insurers. So, its continued obscurity appears to have more to do with marketing than anything else. In truth, many people who are at risk for HIV still aren’t aware of the drug’s existence. And despite the CDC’s recent backing, its manufacturer, Gilead, has yet to market the drug for HIV prevention (Truvada is also used as part of a post HIV-exposure regimen).

99 percent protected from HIV infection

This is why Cuomo’s announcement is so important. By backing the drug formally, and encouraging physicians to get the word out, he might actually bring it into the light and curb HIV infection rates. Of course, the announcement probably isn’t just about reducing infections. The pronouncement, which took place during Pride Weekend, is likely also an effort to win votes from members of the LGBTQ community. But when The Times' Josh Barro asked a top administration official about Cuomo’s decision to back the drug, the official answered in a surprisingly insightful — yet anonymous — manner about the issues at hand. "Some people use condoms, some people don’t," the official told Barro. "You can’t offer condoms to people who don’t want them."

improved access to something people might actually use

That shouldn’t be seen as a sign that New York is abandoning its pro-condom strategy in favor of Truvada, however, since state guidelines make it clear that people who take the drug should still use condoms. But given the recent decline in condom use among teens of all sexual orientations, it’s likely that people will chose to take Truvada following Cuomo’s endorsement and who currently don't use condoms will continue to expose themselves to other STIs. So, the difference here is that although they might still become infected with treatable STIs, such as gonorrhea or chlamydia, they will have improved access to an effective, alternative form of HIV protection — one that they might actually use.

Beside the Truvada endorsement, the state is also set to start enforcing a 2010 law that requires doctors to regularly offer HIV testing to patients between the ages of 13 and 65. And the state recently repealed a law that asked doctors and nurses to obtain written consent from patients before performing HIV tests, because the requirement acted as a barrier to testing.

Yet, as The Times points out, the most notable aspect of the state's rejuvenated approach to combating HIV isn't Truvada, but the combined economics of the strategies involved. None of these methods should lead to increased spending because they don't include new medical breakthroughs. In fact, the state will probably end up saving money if everything goes as planned, because every prevented HIV case saves about $400,000 in medical costs.