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NYS PrEP Plan
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"Mr. Cuomo's plan makes New York the first U.S. state to include Truvada in a major public-health initiative. Analysts say the program, which also calls for more aggressive testing and treatment, will be closely watched across the country.....
....."For high-risk HIV-negative individuals, pre-exposure prophylaxis...is key to reducing the risk of transmission," said Howard Zucker, the state's acting health commissioner, referring to the medication"
"As part of the initiative, state health officials will be working to educate health-care professionals and prescribers about Truvada-especially in areas of the state where officials say there is less knowledge about the medication....
....Health-department staffers also will host focus groups with gay men, who are at a higher risk of contracting HIV than the general population, to come up with "effective messaging around PrEP," a state health official said."
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Truvada, the Drug in Cuomo's AIDS-Eradication Plan, Spurs Debate
Some Prominent AIDS Activists Question Cultural, Health Impacts
http://online.wsj.com/articles/truvada-the-drug-in-cuomos-aids-eradication-plan-spurs-debate-1405290287?tesla=y&mod=djemHL_t&mg=reno64-wsj
Wall St Jnl
By Mike Vilensky
Updated July 13, 2014 9:57 p.m. ET
A cutting-edge medication that can help prevent HIV in healthy individuals is gaining favor with government officials, including New York Gov. Andrew Cuomo.
But in advocating for the drug, sold under the brand name Truvada, officials seeking to curtail HIV/AIDS infections are going up against some surprising opponents: high-profile AIDS activists who say they have serious questions about the drug's cultural and health impacts.
Debate over Truvada is escalating as New York state health officials strategize ways to increase use of the medication. Mr. Cuomo has made the drug a central piece of the plan he announced late last month to curtail new HIV/AIDS cases in New York by 2020.
Mr. Cuomo's plan makes New York the first U.S. state to include Truvada in a major public-health initiative. Analysts say the program, which also calls for more aggressive testing and treatment, will be closely watched across the country.
"For high-risk HIV-negative individuals, pre-exposure prophylaxis...is key to reducing the risk of transmission," said Howard Zucker, the state's acting health commissioner, referring to the medication.
Truvada, a pre-exposure prophylaxis, or "PrEP," was initially approved by the U.S. Food and Drug Administration a decade ago for treatment of HIV, and has since served as a component in AIDS-treatment drug cocktails. In 2012, it also was approved for HIV prevention in HIV-negative people.
The drug, which prescribers say should be taken daily to be effective, thwarts HIV by blocking the activity of an enzyme needed for the virus to replicate.
On Friday, the World Health Organization, in a news release, advocated for PrEP use in healthy at-risk people. In May, federal health guidelines recommended that individuals at high risk of HIV infection consider Truvada.
New York Governor Andrew Cuomo speaks during a ceremonial bill signing in New York on July 7. Associated Press
New York state health officials said their goal is to cut new HIV/AIDS cases to 750 in 2020, a reduction of more than 2,000 from the norm in recent years.
As part of the initiative, state health officials will be working to educate health-care professionals and prescribers about Truvada-especially in areas of the state where officials say there is less knowledge about the medication.
Health-department staffers also will host focus groups with gay men, who are at a higher risk of contracting HIV than the general population, to come up with "effective messaging around PrEP," a state health official said.
So far, Mr. Cuomo's plan has garnered support among New York legislators and AIDS nonprofits, but it has mobilized a faction of AIDS activists against Truvada who are concerned it could give people a false sense of security and encourage laxity in condom use-effectively spreading sexually transmitted infections.
Michael Weinstein, president of the AIDS Healthcare Foundation, a global AIDS nonprofit, expressed concern that users won't comply with the pill's daily regimen while also not using condoms.
"We're asking people who are negative, young and who may be dabbling in recreational drugs to take this every day? It's Russian roulette," he said.
Supporters of Mr. Cuomo's plan point out that condom use has been advocated for decades without total compliance. Adding the option of a pill, they said, will help.
"Contrary to claims from some...that PrEP could encourage riskier behaviors, recent studies have shown this not to be the case," said Dr. Zucker.
Larry Kramer, the author of "The Normal Heart" and co-founder of the Gay Men's Health Crisis, said in an email that he had concerns about anyone taking a daily medication.
"It has not been out there long enough to witness the arrival of any side effects," he said.
Supporters of the plan said health-care officials support and monitor use of the medication.
Mr. Kramer also expressed concerns about the program's finances: "Five million dollars doesn't buy all that much in this fight."
State health officials said the $5 million allocated in next year's state budget is in addition to the Medicaid money and funds already allocated toward HIV programs.
Health officials said Truvada, made by California-based Gilead Sciences Inc., is covered under the state's Medicaid plan. Most private insurers also cover the drug, but some require preauthorization and copays.
Some AIDS activists see a broader cultural problem.
Perry Halkitis, a public-health professor at New York University, and Jeffrey King, director of In the Meantime, an advocacy group for black, gay men, both said they wanted to hear less from Mr. Cuomo about medication and more about community outreach.
"The future of AIDS should not be predicated on a health-care provider," Mr. Halkitis said.
They said while Truvada may be helpful, they would like to see more policy work on destigmatizing homosexuality in black communities. Among gay and bisexual men, African-Americans are disproportionately at risk for HIV, according to the Centers for Disease Control.
State health officials said they would give out free at-home HIV/AIDS tests at LGBT centers and hire local disease-intervention specialists, among other community-outreach strategies.
Officials from AIDS organizations including Housing Works, the Gay Men's Health Crisis and Harlem United, among others, have praised the governor's plan as having the potential to end the AIDS epidemic in New York state.
Corey Johnson, the Chelsea councilman, said despite "anxiety surrounding [PrEP]...it's worked." And Sen. Brad Hoylman, a Manhattan Democrat, compared the governor's plan to his advocacy for same-sex marriage years ahead of some in his party.
Mr. Cuomo, he said, "is ahead of the curve."
The governor has at least one unlikely ally in this battle. Rob Astorino, the Republican Westchester County executive and gubernatorial candidate seeking to unseat Mr. Cuomo, "doesn't have any issues" with the governor's HIV initiative, his spokeswoman said. Mr. Astorino's position, the spokeswoman said, "is that we should be doing everything possible to prevent the disease."
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