The Alabama Department of Public Health is working to determine whether a new measure, described by state officials as potentially “revolutionary,” will become standard state practice in fighting the spread of HIV/AIDS.
State health officer Don Williamson said the measure involves treating sexual partners of HIV/AIDS patients with pre-exposure prophylaxis, or PrEP, within three days of being exposed to HIV/AIDS. It works by building up a viral resilience to the disease, thereby greatly reducing chances of transmission. If delivery to patients proves practical, it could become standard treatment in Alabama.
“The problem is that in science it may work, but in practical application it doesn’t work, or is impossible,” Williamson said. “It’s an entirely different thing to treat people with antiviral drugs.”
The potential new strategy is part of an effort by the state to curb the transmission of HIV/AIDS in Alabama.
According to data from the department, an estimated 12,329 people diagnosed with HIV/AIDS were living with in the state at the end of 2013. As of March 31 this year, that number jumped to an estimated 12,404 people, with 37 new cases. Calhoun County ranks ninth in the state in number of people living with HIV in that time, with an estimated 197 cases.
The issue has not been restricted to Alabama. The Centers for Disease Control and Prevention reported that in 2011, 49 percent of new HIV diagnoses reported were in the South, even though the region only accounts for 37 percent of the nation’s population.
According to data from the CDC, treating people who have been exposed, but not diagnosed, has proven to be an effective measure against the spread of HIV/AIDS.
‘Right thing to do'?
Williamson said he has considered the proposed strategy for a little more than three weeks. He and his HIV/AIDS specialists will conduct studies, see if other states intend to adopt the practice and review data to determine whether the practice could be adopted in Alabama. Williamson said the strategy is a long way from becoming a reality.
Potential issues with the new practice include funding, retraining doctors at clinics and finding feasible ways to provide timely treatment of people exposed to HIV/AIDS.
“This could eventually turn into the absolutely right thing to do,” Williamson said. “Or it could be something that looks great as an idea, but doesn’t work in real life.”
The CDC administered clinical trials of PrEP in which all participants received pills containing PrEP or a placebo, as well as intensive counseling on safe-sex behavior, regular testing for STDs, and a regular supply of condoms. All participants were instructed to take their medicine daily.
In all studies, HIV transmission risk was lowest for participants who took the pill consistently. Among gay and bisexual men, those who were given PrEP were 92 percent less likely to get infected. Among heterosexually active men and women, PrEP reduced the risk of contracting HIV by 62 percent. In couples where one sexual partner was HIV-positive, those who received PrEP were 75 percent less likely to become infected.
Among injection drug users, a once-daily tablet containing tenofovir, one of the prescribed PrEP drugs, reduced the risk of infection by 74 percent.
Who will pay?
The program would cover people with predictable, ongoing exposure to HIV/AIDS in the state, such as injection-drug users or couples in which one sexual partner has already been diagnosed. The program is currently covered by private health insurance, and Williamson said people who are already eligible for Medicaid could take advantage of the program, if put into standard practice. Williamson said the state could possibly adopt the measure as a public health intervention.
Currently, the state uses two strategies to stem the transmission of HIV/AIDS in Alabama. The primary measure is educating the public on how to avoid behavior that increases the likelihood of transmitting the disease, mainly by correcting commonly held stereotypes and making sure people know there is no quick fix to the disease.
The secondary preventative strategy is to treat people diagnosed with HIV/AIDS with antiviral drugs to reduce their viral load to the point that likelihood of transmission is practically nil.
Michael Murphree, CEO of the Medical AIDS Outreach of Alabama, said the southeastern U.S. is currently experiencing an epidemic-level number of cases. Murphree characterized the disease as one of poverty. Murphree said because of the state’s refusal to expand Medicaid or Medicaid eligibility — coupled with the state’s high poverty levels — many people do not have access to proper treatment.
The disease is more prevalent among straight males in Alabama, particularly among blacks. As of March 31 this year, an estimated 8,131 black Alabamians were living with HIV/AIDS, roughly 66 percent of all diagnosed cases in Alabama. There were an estimated 3,588 diagnosed cases of HIV/AIDS among white residents in that same time, roughly 29 percent of all diagnosed cases in the state.
Since 1999, Calhoun County has had at least one HIV-related death in all but two years, with 43 confirmed deaths between 1999 and 2012. Roughly 56 percent of the deaths have been among the black population, with 18 deaths. Thirty-four of the deaths have been among males, accounting for 80 percent of all deaths in Calhoun County in that time.
Murphree, like Williamson, said one of the most effective means of addressing the problem is educating people on how to reduce opportunities for exposure and transmission. One of the biggest issues with education, Murphree said, is that many assume the disease only affects a certain demographic, a stereotype that needs to be corrected immediately.
“Bottom line is, it’s a virus,” Murphree said. “It cares nothing of a person’s background. The biggest piece is to quit saying, ‘Who’s going to get this?’ Everyone wants to say it’s someone else’s disease. Instead of saying, ‘I don’t have to worry about this,’ disregard profiles. Everybody get tested.”
Coming Monday online in The Star: Action against AIDS, Part 2: The stress on financial resources to fight HIV/AIDS.