Community health clinics and outreach centers for HIV testing and education have been trying to reduce the stigma surrounding infection for years. Through a partnership between the Georgia Department of Public Health and two nonprofit agencies, Athens is attempting to achieve this vision.
In Athens, the city’s first, free Pre-Exposure Prophylaxis center opened on Wednesday, Dec. 5, to provide prevention treatment and guidance for people at risk of HIV infection. PrEP includes taking a pill, Truvada, which can be used in combination with other medicine and care to keep permanent HIV infection at bay.
“We didn't have anything close to this before,” said Patrick Reilly, DPH HIV Testing, Prevention and Linkage program coordinator.
Reilly said each patient only needs to spend about 45 minutes to discuss the process and get a prescription for PrEP, contrasting longer wait times typically found through private medical providers.
Reilly has been trying to improve medical and community resources for those affected by HIV for several years. He received notice from a colleague at the Empowerment Resource Center in Atlanta — a nonprofit health center focussed on prevention and treatment for HIV and other sexually transmitted infections –– that they wanted a satellite space for a PrEP clinic in October.
Live Forward — formally AIDS Athens — is a local nonprofit focussed on helping those living with HIV or AIDS improve their way of life and secure future care. It was decided that Live Forward would host the new clinic within its building on North Avenue.
The PrEP clinic will be open the first Wednesday of every month from 11 a.m.-6 p.m. as a trial period, and hours may extend to every Wednesday if Live Forward staff finds it is popular among the community, said Executive Director Cassandra Bray.
Bray said without Empowerment’s partnership, a clinic would probably still need a lot of time in the making.
“Doing the medical piece was not something that we had done before,” Bray said about Live Forward.
Many community health centers lack enough staff and resources to provide free clinics on their own, making strong cooperation between them an important asset, Reilly said. The importance of PrEP specifically in an area like Athens is incomparable, Reilly said.
He said he has met a multitude of “kids,” the youngest being around 18 years old, who need this type of treatment.
“They knew that they were at risk,” Reilly said. “Either it was too expensive, the labs were too expensive or they didn’t have a place to be able to go. And while they were trying to navigate that system, they seroconverted and were infected.”
Seroconversion is a medical term for the development of infectious antibodies in a previously uninfected individual. With HIV, those with infected partners are at risk of infection, especially without any kind of precautions. PrEP overall not only includes Truvada but also the use of condoms to protect from STIs. If HIV positive partners are taking medication, this adds an extra layer of protection.
According to the Center for Disease Control data, in 2017 Georgia had a 24.9 percent rate of HIV diagnoses per 100,000 people. Southern U.S states made up 52 percent of new HIV cases in 2017, and numbers have remained stable from 2012-2016.
When Bray began working with AIDS and HIV afflicted individuals in 1988, she was offering blood tests for anyone on the street. For those who returned positive, the future was bleak. She said most of her patients would die within six to 12 months.
“It was a very different disease at that point in time. We didn’t have any medications to adequately treat the disease,” Bray said. “We were learning as we went. That’s just the reality of that situation.”
In 1996, a new medicinal regimen was introduced that provided the possibility of living a relatively healthy life under the circumstances. But the stigma surrounding HIV and AIDS remains. Bray said once infected or at-risk individuals can overcome fear or embarrassment surrounding the disease, treatment programs like PrEP will be more effective.
“We know the epidemic has slowed down somewhat, but it's still an epidemic,” said Karla Porch, director of business development for Empowerment. “And the more that we can do to reduce the spread of HIV the best impact we can have.”
PrEP is offered by primary healthcare providers — such as Piedmont Athens Regional Community Care Clinic — but usually requires proof of insurance or high costs for noninsured individuals. The cost of just the Truvada pill without insurance has been estimated around $1,800.
In 1992, section 340B was added to the Public Health Service Act so that drug manufacturers participating in Medicaid must provide certain prescription drugs to health centers and hospitals eligible for the program at a low cost.
Clinics participating in the 340B pharmacy program — Live Forward’s clinic is doing so — are able to purchase Truvada at a reduced cost and provide it to anyone. Insured individuals pay the cost listed in their insurance contract, which is typically higher than the 340B cost. The clinic is then able to provide Truvada at no cost for uninsured individuals because they save money on providing the medication.
The patient in question must be eligible to receive PrEP services, as determined by medical professional at the clinic.
“If this helps to build capacity within our medical community and also build awareness that this program is available, that PrEP is something that anyone can get access to, we’ll encourage primary care clinics to actually start considering it as an option for people,” said Chris Richards, medical case manager for Live Forward.