The National Longitudinal Lesbian Family Study (NLLFS) has been following a contingent of lesbian families since they first started to plan to have kids in the late 1980s and early 1990s. Those children are now about 25 years old, and the researchers have confirmed that they’re doing swimmingly.
Compared to their peers who were not raised by same-sex couples, researchers found no significant differences with respect to “adaptive functioning (family, friends, spouse or partner relationships, and educational or job performance), behavioral or emotional problems, scores on mental health diagnostic scales, or the percentage of participants with a score in the borderline or clinical range.”
This is one of those “good news-bad news” stories. We seldom get to witness an actual cure to a disease, but that is exactly what’s happening with Hepatitis C.
First, a very short Hepatitis C 101: “Hep C” is an ongoing challenge in our communities. It is transmitted through blood. It can be transmitted through needle sharing, sharing toothbrushes or razors, tattoos (including the ink), body piercing, through open cuts or sexual transmission where blood is present (menstrual blood, vaginal or anal abrasions). It is far more prevalent than HIV, is much more easily transmitted and is seen in a wide range of populations. Many baby-boomers are infected with Hep C. Individuals who worked in jobs or served in the military where they were exposed to blood through open cuts were often exposed to Hepatitis C. They in turn, often unknowingly, infected their wives/husbands/partners.
Folks who inject drugs and share needles are also at high risk for Hep C. The blood can be in the syringe and thus injected with the drug into the next user.
Then, of course, there is the phenomenon of tattooing and body piercing that has become a common practice for people of all ages. When tattoos and piercings are done correctly in a sanitary setting, they are perfectly safe. It’s the ones done at home in someone’s basement by their uncle’s best friend or the shop that doesn’t take proper precautions that have the potential to carry Hep C. They often use the same needles and the same ink over and over, or don’t properly clean their equipment.
One of the big differences between HIV and Hep C is that the Hep C virus (HCV) lives much longer outside the body. A study at Yale University published in 2013 showed that HCV can live on a surface for up to 2 weeks and in a syringe for up to 63 days. While the virus may lose some of it virulence, it is still considered to be infectious.
So, for the reasons stated above, it’s rather clear why there are so many people living with Hepatitis C. If left untreated, Hep C often leads to liver disease including liver cancer and other liver-related problems, which may lead to death. We know that many people living with HIV are co-infected with Hepatitis C, which can complicate both conditions. It is extremely important that persons living with HIV are tested for Hep C.
For years the outcry from folks in the healthcare and prevention world has been that while we can test individuals for Hep C, many had no access to treatment. There have been virtually no programs to help pay for treatment and nowhere to send clients for assistance.
Until recently, the most common treatment for Hep C was interferon. I’ve heard many Hep C clients compare their treatment to chemotherapy. The side effects were nearly intolerable and the outcome was often disappointing. Many people were weakened by the treatment and died.
BUT then, a HUGE change! A couple of years ago we began hearing about the progress in the treatment of Hep C – not just a treatment, but an actual cure! Last spring, I attended a conference where the instructor, a local physician, used the word “cure.” Just a few days ago, one of our staff members asked a healthcare provider, “is this truly a cure?” and the answer was YES. Most studies have shown a high success rate between 85 and 100 percent.
This is outstanding news, and of course we are very excited. The problem is the cost. The new course of treatment is about 12 weeks, but can be as little as eight or as many as 20. The average cost for that treatment is approximately $80,000 to $100,000. There are some medications coming on the market that claim to be about half the cost, but is even $50,000 realistic for most people? Many insurance companies are refusing to cover these drugs because of the cost. Most drug companies have patient assistance programs for folks who cannot afford their medication, but those programs are very limited and don’t come close to covering the number of people who need help. Hopefully, over time the cost will come down considerably, but for now, many people are left out of the opportunity for a cure.
None of this is to suggest that the pharmaceutical companies are the bad guys. I understand that research is extremely costly and it often takes years to bring a drug to market.
I am thrilled with the fact that people with HIV are living longer, healthier lives because of the ongoing progress of HIV medication. And, here we are with an actual cure for Hepatitis C.
But, it is still difficult for me to accept that $1,200 a pill is reasonable. I have no idea how much profit is in that one pill, but if I had to take one pill once a day for 12 weeks, that is $100,800. So, the good news is, there is a cure for Hepatitis C. The bad news is, it’s going to cost you $100,000.
There is a great deal of information coming out about PrEP. This column addresses that information and offers answers to questions one might have about a new way to fight HIV/AIDS infection.
“PrEP” is the drug Truvada, manufactured by Gilead. PrEP is another way to keep a person from being infected with HIV. Up until now, all we have been able to advocate to prevent HIV infection, other than total abstinence, is the practice of safer sex in several ways, one of those safer ways being through the use of condoms. But let’s face it, there are times when a condom is not handy or the moment and the mood are at a pace where a condom just never gets used. There are some who do not like to use condoms and prefer to go without and take their chances. All of this is where PrEP comes in.
PrEP stands for Pre-Exposure Prophylaxis. It is a way for people who do not have HIV but who are at very high risk of getting it to prevent HIV infection by taking a pill every day. The pill contains two medicines that are also used to treat HIV. If a person takes PrEP and is exposed to HIV through sex or injection drug use, these medicines can work to keep the virus from taking hold in the body.
PrEP is a powerful HIV prevention tool and can be combined with condoms and other prevention methods to provide even greater protection than when used alone. But people who use PrEP must commit to taking the drug every day and seeing their health care provider for follow-up every three months (source: AIDS.gov).
“Pre-exposure” means “before an event happens;” “prophylaxis” is defined as “an action to prevent disease especially by specified means against a specified disease.”
PrEP is actually a combination of two drugs called tenofovir and emtricitabine. Truvada stops HIV from reproducing in the body. Truvada is one of the drugs often used to treat HIV-positive persons; it is prescribed in concert with other drugs (sometimes called a “cocktail”) to treat HIV-positive persons because one drug is not enough to prevent the virus from replicating and spreading in the body of someone already infected with HIV. There is also a Post Exposure Prophylaxis, called “PEP.” This, too, is the drug Truvada.
PEP differs from PrEP in that PEP is when an individual starts taking HIV medications after having been exposed to HIV and takes the drug for a month. AIDS.gov informs: “PEP must begin within 72 hours of exposure, before the virus has time to make too many copies of itself in the body.” A person on PEP is advised to discuss with their doctor the possibility of being prescribed PrEP after having been on PEP as a way to maximize protection. PrEP is for persons who are considered at-risk for HIV infection. How do you know if you might be “at risk?”
Here are some, but not all, of the risk factors for HIV which could indicate someone is a good candidate to be on PrEP: being in a magnetic relationship – a relationship where one partner is HIV negative and the other partner is HIV positive, being an individual who engages in condomless receptive anal sex with a partner who is HIV positive or with a partner whose HIV status is unknown, being an injection drug user, or being forced to have sex by a partner when one has not wanted to.
PrEP is generally well-tolerated by most individuals. However, it is important to discuss the topic of the possible side effects of taking Truvada with a health care provider. PrEP may not be for someone who finds it difficult to adhere to a regimen of taking medications on time. Truvada must be taken once a day every day for it to be effective. The CDC website says when PrEP is used consistently, it can reduce a person’s chance of being infected by HIV from sex by more than 90 percent.
Among persons who inject drugs, the CDC says using PrEP consistently could reduce the risk of getting HIV by more than 70 percent.
Does taking PrEP mean people can stop using condoms? No. Gilead recommends condoms should be used in addition to taking PrEP. While using PrEP significantly decreases the chances of contracting HIV from sex, it cannot prevent a person being infected with sexually transmitted diseases; the CDC condom fact sheet states consistent condoms use can help prevent acquiring sexually transmitted infections. The CDC says, while an individual on PrEP can significantly reduce risk of HIV infection if taken daily, a person can combine additional strategies like condom use with PrEP to reduce risk of HIV infection even further. It is highly advisable that individuals consult with health care professionals experienced with infectious diseases like HIV when considering PrEP. There are important protocols a patient must first undergo prior to taking Truvada and then there are recommended quarterly visits to the health care provider to have labs checked. Health care providers who are knowledgeable, trained, and experienced in the field can be your best initial resource; that could lead to a satisfying long-term health care relationship when it comes to being on PrEP.
If you have questions about PrEP or would like to explore getting on PrEP, I encourage you to contact your health care provider.
Prevention efforts to halt the spread of HIV traditionally focused on HIV-negative individuals.
But according to the Centers for Disease Control and Prevention, a strategy centered solely on HIV-negative persons is not enough to stop HIV transmissions. The Atlanta-based CDC says it is crucial to include HIV-positive persons in efforts to reduce the risks of transmitting HIV.
POZ Magazine (Jan. 2015) reported the CDC accented the “centrality” of HIV-positive people to prevention efforts because targeting them is more probable in reducing HIV incidence than working to change the behaviors of millions who are at risk for infection.
The AIDS Education and Training Center (AETC) Program, the training arm of the Ryan White HIV/AIDS Program, informs the rate of new HIV infections in the United States has remained in the stable range of 50,000 per year. Antiretroviral therapy (ART) – sometimes referred to as highly active antiretroviral therapy (HAART) – improves the health of HIV-positive individuals who are in appropriate medical care and lowers the risks of HIV transmission.ART reduces the HIV viral load, which can prevent new infections, an outcome termed “treatment as prevention.”
It is important to understand that maximal suppression of the HIV viral load does not mean one is cured of HIV. The CDC defines viral load suppression as less than 200 copies per milliliter of blood; an HIV-positive person is considered “undetectable” when the HIV viral load is less than about 40 copies per milliliter of blood. Current medical literature indicates there has never been a recorded case involving an undetectable HIV-positive person transmitting HIV.
Unfortunately, not all HIV-positive Americans are taking antiretroviral therapy, which means many people have yet to achieve maximal suppression of their viral load. Clearly, other risk reduction and behavioral modification methods are needed in the fight to prevent new HIV infections.
The clinical interaction with HIV-positive persons about transmission risk behaviors with the goal of reducing HIV transmission is referred to as “prevention with positives” (PWP).
While many people with HIV infection have a real desire to prevent others from being infected with HIV, it can be challenging for some people to disclose their HIV+ status when engaging in high-risk behaviors that could place others at risk for infection. HIV-positive individuals who repeatedly present with sexually transmitted infections may be placing themselves and others at additional health risks, as STIs are often accompanied by increased risk for HIV transmission. In these cases, information alone may not be enough to change risky behaviors in sexual practices or drug use. Personal conversations involving a harm-reduction approach may provide clear concepts of the risks of certain behaviors and strategies on how to reduce those risks or avoid them completely.
Some HIV-positive persons may have trouble sticking with their safer goal behaviors; a referral to a mental health clinician or to prevention case management could be beneficial. A mental health assessment can reveal disorders that can increase the chances of risky sexual and drug use behaviors. Health care providers can counsel an HIV-positive person to understand risk and to work to modify harmful behaviors to self and to others. What is involved in “prevention with positives?”
The CDC now counsels health care providers to encourage their HIV-positive patients to begin ART within three months of diagnosis, regardless of CD4 count. The chance of an HIV-positive individual transmitting the HIV virus is virtually eliminated when ART treatment is successful and an undetectable viral load has been achieved.
There can sometimes be interruptions in a person’s medical care. These gaps may be created by personal patient circumstances such as mental health issues, substance abuse, or lack of financial resources. Maintaining consistent contact with a healthcare provider is key when a person is trying to suppress their viral load. Many HIV services now have a component designed to helping clients with multiple barriers stay active in care. (Having not referenced the cascade until now, it might be better not to bring it up, as it is rather an in-depth topic.)
Partner notification may be one of the most difficult issues for the HIV-positive individual. HIV service professionals (that is a big word for people not in the field) can help patients who are newly diagnosed by offering confidential partner notification – helping disclose to partners who might have been exposed with or without the patient present. Generally, HIV Testing counselors help clients identify which option works best for them. Health professionals are advised by the CDC to assist people with HIV in finding insurance. Providers are also urged to counsel HIV-negative patients about pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis. When someone tests positive at an AIDS Service Organization here, they are immediately linked to case managers that will assist them in securing the necessary resources they will need to initiate and remain engaged in care. If you have questions about PWP, I encourage you to contact your health care provider.
Health department officials suggest that anyone who isn't sure whether or not they'll test positive, should come in. The process is simple and involves a mouth swab or a finger prick and 30 minutes later your results are in.
Fresno Health Officials say that positive HIV tests are up 6% percent.