The shot prevents HIV, but those most in need struggle to get treatment

When Parish Brown reassures nervous patients about reducing the risk of sexually transmitted HIV, she’s not just doing her job as a community health worker, she’s speaking from experience.

She sometimes forgets to take PrEP (pre-exposure prophylaxis) as a daily pill, but can get an injection every month, an option that experts say could improve her condition. HIV prevention in the region.

Dude, I’m about that too, she tells her patients at Whitman-Walker Health, many of whom worry about needle size or side effects. He and his colleagues have been administering injectable PrEP, or Apretude, for months at the 14th Street Northwest clinic.

It The pictures are available starting this week at Whitman-Walkers’ newly opened Southeast Max Robinson Center, which serves a larger percentage of black residents who until now had to cross the Anacostia River for care.

Brown says he wants to expand the reach of Apretude, which the Food and Drug Administration established about two years ago, naming it more effective than a daily pill for people suffering from substance abuse, depression, and those facing poverty or who need to take PrEP cautiously. But, as with PrEP access in general, the people most likely to benefit from the medical innovation often face barriers such as lack of access, transportation, childcare, and insurance.

“We’re seeing where PrEP exists in communities that aren’t necessarily compliant where the need may be most dramatic,” said Lindsey Dawson, associate director of HIV policy and director of LGBTQ health policy at KFF, a health policy research firm. and news company. The disparities we see in PrEP uptake reflect, at least in part, the fact that people of color face intersectional stigma and discrimination across a range of lifelines, including health care.

Of people eligible for PrEP who received prescriptions last year, 94 percent were white, compared with 13 percent black and 24 percent Latino, data from the Centers for Disease Control and Prevention show.

Although new HIV diagnoses in the District are at a fraction of their peak in 2007, a February report by the DC Department of Health shows that new cases are increasing among black residents, who make up about 44 percent of the city’s population but account for nearly three-quarters of HIV cases. Still the black residents and Black women in particular are underrepresented among PrEP users, city officials say.

184 patients receive vaccinations at Whitman-Walker Health’s PrEP clinic; and only 13 people opted out, all of whom cited personal reasons such as not being sexually active or traveling too much to return to filming. About 100 people have been denied coverage by their insurer, said clinic coordinator Michael Golden.

But patients can be easily discouraged from long-term injecting drug use, especially those with long-standing mistrust of the medical establishment or those who face the stigma still associated with HIV in some communities, all barriers that community health workers struggle to overcome. struggle: creatively.

“I call this the White Lotus Room,” Golden gushed in an interview with The Washington Post, stepping aside to reveal an exam room with a tropical island backdrop, a plastic palm tree and a plush parakeet, a stark but relaxing oasis. Spa music played as the water flowed over the Buddha screensaver.

The most common fears encountered by Brown (27) and Golden (26) are needle phobias and concerns about injection site pain, which they compared to the pain experienced after receiving the coronavirus or flu vaccine, which generally improves with gentle movement. Apretude is injected into the gluteal muscle using a 1.5-inch needle one month apart for two consecutive months and monthly thereafter.

That schedule and frequency of injection can be a little scary for some people, Golden said: We’ve learned to kind of fight it though.

Brown and Golden were trained as part of a program that emphasizes trust building and patient comfort, developed by Rupa Patel, a clinical scientist and medical liaison specialist at Whitman-Walkers PrEP Clinic.

Since the 1990s, he said, researchers have found that bringing in a trusted community member who knows patients dealing with a disease that is stigmatized and criminalized in some states, such as HIV, is an effective treatment approach. The health center hired people who were already skilled in nonjudgmental, stigmatizing conversations and trained them to provide clinical care, phlebotomy, advanced testing and injections.

We want to see people who look like us get treated, Brown said, adding that he wins over patients by being himself, treating them with kindness and explaining that the drug is for everyone, men who have sex with men. with, cis women, trans women and all people at risk.

Maranda Ward, an associate professor of clinical research and leadership at George Washington University School of Medicine and Health Sciences, said doctors often rely on marital status or age to determine whether someone should be tested for HIV or PrEP services. , a bias that may leave out those who need treatment.

It’s not that being black is a risk factor, Ward said. Racism, not ethnicity, actually makes patients unaware of PrEP and HIV testing options. Without it, it’s up to the patient to say, I saw an ad for PrEP

Matt Cipala, 46, said he wanted to start injectable PrEP to eliminate the hassle of taking a daily pill. He developed a habit of inverting the bottle after each dose, a trick that failed him when he left for a two-week trip to Colombia without packing the bottle.

So this has been a lot easier and I think it’s working, Cipala said before her third injection. It was great. I hope more people will have access to it.

Whitman-Walker Health offers comprehensive HIV care, said KFF’s Dawson, noting that most clinics are unable to devote the resources and staff to developing an injectable PrEP program.

Some of these problems will not be erased [injectable prep] but it has the potential to lower certain barriers, he said. It has long been a tenant of the HIV fight that a no-doors approach provides the best access to public health.

Even at Whitman-Walker, about half of injectable PrEP patients are white, about 30 percent are black, and 20 percent are Hispanic, clinic data shows.

One of our goals is to increase PrEP uptake among everyone, but especially among our people of color and women, said Clover Barnes, senior associate director of DC Health’s HIV/AIDS, hepatitis, STD and TB administration.

Mayor Muriel E. Bowser cut the ribbon Monday at the grand opening of the Max Robinson Center, anchored by Cedar Hill Regional Medical Center on the medical campus, as part of a plan to transform health care in a long-underserved part of the city.

About half of the city’s residents are enrolled in Medicaid or the DC Healthcare Alliance, a locally funded program for those ineligible for Medicaid, both of which cover Apretude, Barnes said. Some private insurance companies, however, have closed coverage, forcing providers to navigate a maze of pre-authorization, letters and phone calls that require countless staff hours, said Erin Loubier, who is responsible for insurance eligibility and enrollment and health care. compensation at Whitman-Walker.

The stakes for those delays, which can stretch from days to weeks, are high, he said.

From a public health perspective, there’s really a significant incentive to get people on this medication so they don’t become HIV positive from a prevention perspective, and from a treatment perspective so they’re virally suppressed and can’t infect someone else, Loubier said.

Patel, the scientist, said he saw the same phenomenon more than a decade ago when the FDA approved Truvada, the first HIV prevention drug, and later Descovy.

It doesn’t have to be this way, he said.

Fenit Nirappil contributed to this report.

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