PrEP: Will We Succeed or Fail?

Last week I was invited to participate in a Congressional briefing on HIV pre-exposure prophylaxis (PrEP) that was sponsored by the HIV Prevention Action Coalition and the Congressional HIV/AIDS Caucus. The briefing brought together speakers with policy, clinical, and community experience in working to improve awareness of, access to, and use of PrEP. I very much appreciated the information, insights and lessons that were shared by everyone on the panel. The other speakers were:

• Megan Coleman, FNP, Director of Community Research, Whitman-Walker Health, Washington, DC
• Edwin Corbin-Gutiérrez, Manager, Health Systems Integration, NASTAD
• Martha Sichone-Cameron, MPH, Director of Prevention, The Women’s Collective

In preparing for the briefing, I thought about how we had previously mobilized to make scientific advances in HIV testing, prevention and treatment available and the impact that these advances have had on the epidemic. Each of these three advances made a substantial difference in the course of the epidemic.

• After HIV testing became available, new infections started to drop for the first time, and in 3 years, they had dropped by about a third.
• When researchers found that giving HIV medication to pregnant women and their newborns reduced mother-to-child transmission, the number of prenatally acquired AIDS cases was cut in half in 3 years.
• When highly active antiretroviral treatment became available, the number of deaths among people with AIDS was cut by more than half in 2 years.

In each of these cases, scientific advances made it possible to alter the course of the epidemic. But science alone wasn’t responsible for the infections that were averted or the lives that were saved. The impact of these advances was only made possible because we as nation—government, advocates, health care providers, the legal system and many others—worked hard to ensure that these scientific breakthroughs were made available to those who needed them.

We now have another opportunity to scale up a life-saving intervention by increasing awareness of PrEP, access to it, and use of it among persons at greatest risk of HIV infection. Important efforts are already underway to improve use of PrEP, but we still have a long way to go before we fully realize the impact that PrEP could have in the United States.

If you’re interested in what else I had to say about PrEP and treatment as prevention, you can full text of my remarks here .