Magazine article The Advocate (The national gay & lesbian newsmagazine)

Rx: Antidote for HIV?

Magazine article The Advocate (The national gay & lesbian newsmagazine)

Rx: Antidote for HIV?

Article excerpt

In the past San Franciscans who engaged in unprotected sex had little choice but to wait with crossed fingers for up to six months to see if they had contracted HIV. As of October 1, however, they had a new option. They could head to one of two city-run sites to get a round of pills to prevent an infection from taking hold, along with counseling to stop risky behavior m the future.

Postexposure prophylaxis -- or PEP, as it is often known -- represents a breakthrough in HIV treatment. For the first time the possibility of heading off HIV infection after high-risk behavior is available on a wide scale. According to Dr. Joshua Bamberger, HIV Postexposure Project coordinator at the San Francisco Department of Public Health, people who engage in high-risk behavior will have 72 hours to get the free medications, which are being donated by their manufacturers. Administration of the three-year program has been paid for through a grant from the National Institutes of Health. While the San Francisco project is the first to supply PEP medication to the general public -- more than 500 people are expected to get the pills this year -- the use of drugs to prevent HIV infection has been going on for years. Health care workers who accidentally stick themselves with contaminated needles have regularly been put on the same regimen. The results can be dramatic. In one study AZT alone cut the likelihood of infection by 79%.

Take the case of "Bill" (not his real name), who works in the AIDS service industry. Bill says he had an unsafe sexual experience after snorting cocaine. He took a viral load test after the incident, and it showed that the virus was present. After taking antiviral medications for a month, he never tested positive. "Whether the virus is gone as a result of early intervention or the initial viral load was just a mistake, I chalk up the learning experience as something that changed my life," he wrote in a letter to The Advocate. "Five minutes of irresponsibility is not worth a lifetime of ultraresponsibility."

PEP's eventual public appearance was inevitable. Still, says Bamberger, the fact that it took years for the first project to be launched speaks to the stigma that still lingers over the disease. "It has to do with where society MM people are worth saving," he argues. "`Doctors and nurses -- let's save them,' but `gay men -- they're expendable.'"

Pat Christen, executive director of the San Francisco AIDS Foundation, says the problem is largely logistic. "There's a lot more unsafe sex that goes on in this country on a daily basis than needle-stick injuries. It's very easy to apply [PEP] in a health care setting. When you try to apply that to the context of sexual behavior, it becomes much more complicated. I can't call my doctor up and say, "I need to see you tomorrow.'"

Economics is key in determining when PEP may become available in other cities. The San Francisco study may prove difficult to duplicate. For one, the city has one of the most extensive (and, per capita, one of the most expensive) public health care systems in the country, allowing it to try new approaches even as other cities are allocating fewer resources to HIV care and prevention. Moreover, the city has always been in the forefront of HIV care; few other cities would be willing to take as pioneering or controversial a stance.

The study is perhaps more noteworthy for what it is not than for what it is. The project is not an efficacy study, set up to determine just how well the prescribed drugs work. It is not the product of protease inhibitors; most of the patients who avail themselves of the program will be given a 28-day regimen of AZT and 3TC, an older class of drugs. …

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