In a 10 to 1 vote, the San Francisco Board of Supervisors passed legislation to allocate $301,600 from the city’s general fund toward educating San Francisco residents about the HIV-prevention pill Truvada.
Now “health navigators,” who will be commissioned by the San Francisco Department of Public Health, will help patients access the drug — whether they have private insurance, Medi-Cal or patient assistance programs through the drug’s manufacturer.
Supervisor David Campos, co-author of the legislation, asked for his colleagues’ support, adding, “San Francisco is already a sanctuary city, so let’s please make it a sanctuary city from HIV.” HIV is the virus that causes AIDS.
With the passage of the legislation, the San Francisco Supervisors have initiated their plan to help eliminate new cases of HIV in the city by making the health navigators more culturally competent as well.
Truvada is an antiviral medication that is taken once-daily in order to prevent new HIV infections in those at highest risk of contracting the disease. The preventive treatment plan is known as Pre-Exposure Prophylaxis, or PrEP.
What’s missing from this version of the measure is co-pay assistance for patients who cannot afford the drug. When Campos introduced the legislation in September, the appropriation was for $801,600. After going through the Budget and Finance Committee, it was reduced to $301,600.
The most important piece of the budget has always been the health navigators, Campos said. In the future, he said, the board of supervisors can still devise a co-pay assistance plan for the drug.
“This is the first step,” said Laura Lane, legislative assistant to Campos. Once the 2015-2016 fiscal year arrives, the other portion of the legislation may be reintroduced. “We don’t want to start something that we may not be able to continue in the future.”
The only dissenting vote came from Supervisor Katy Tang. While she applauded the $500,000, reduction she still voted no. However, she did express support for preventive HIV measures– but did not support the current legislation saying, “I really do feel that this is something we can absolutely address during the regular budget process.”
“PrEP is really one part of the ‘getting to zero’ initiative…and I think that it’s really important for us to look at the broader picture as to how it is that we address these issues in our outreach efforts,” Tang said.
Only one large-scale (n>1000) has been done to date. The results were quite un-ambiguous. Of the 2,500 engaged in the study (half on placebo and half on Truvada), 100 become HIV infected. 36 of those were taking PrEP and 64 were on placebo only. That’s a 44% reduction. That’ great. But its not 100%. Its not like there were zero sero-conversions.
And this is with the most counseled, supported, tested, and monitored group of gay men on earth. We’re taking safe-sex counseling and HIV tests every 4 weeks with condoms distributions, constant monitoring, etc. Even with all that nearly 3% of Truvada takers became HIV positive in 1 year. In 5 years, thats 15% chance of HIV infection.
Granted that’s better than that 25% chance for those not taking the pill but let’s not pretend this some kind of miracle wonder-drug cure. Its not. Its helpful and yes if everybody were on it all the time with 100% strict adherence, HIV infection rates would be lower. But they would not be zero.
Clearly, taking PrEP without condoms is clearly risky.
Katy Tang should just recuse herself if she can’t be bothered to learn about something before voting. The “getting to zero” effort has stalled at around 400 new HIV cases for the past several years; PrEP is the only new tool we have that can change the status quo. The status quo approach has not and will not be sufficient to get to zero new cases, but the UCSF doctor who ran the PrEP study estimates it could cut nearly 90% of new cases if just 6000 people got on PrEP. I’m other words, the studies have been done, the science is in, and she’s lying or ignorant if she says we need more time to study this issue.