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Dreams Do Come True by Nicholas Van Sickels, MD

February 27, 2018 By Nicholas Van Sickels

An impossible dream for people gripped by fear of an uncontrollable epidemic

Dreams do come true. Thirty years ago, a simple way to prevent HIV was an impossible dream for people gripped by fear of an uncontrollable epidemic. Now it seems the nightmare may be ending. Pre-exposure prophylaxis, or PrEP, has revolutionized the HIV prevention arena. One pill a day, prescribed by a medical provider and taken by an HIV-negative individual, can prevent infection. This isn’t a test – the science is in.

PrEP has gained so much momentum in the last few years since the Centers for Disease Control (CDC) approved it as a prevention strategy. At CrescentCare, we were quick to start work getting people into care. Having begun as the NO/AIDS Task Force, how could we not? Our dedication to ending the HIV epidemic in New Orleans continues to be at the forefront of our efforts. Since 2015, CrescentCare’s PrEP caseload leapt from 90 to more than 600 in 2017. That’s not just 600 people at greatly reduced risk for HIV-think about all their sexual part-
ners, too. Even if exposed to HIV, a person on PrEP is a dead end to the spread of the virus in that scenario. Many HIV infections occur as the result of newly infected individuals who don’t even know they have the virus, with unchecked levels of infection, coming into sexual contact with others. PrEP has become an invaluable tool in the arsenal we’re using to overcome HIV.

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There has been some skepticism. It’s true that the only 100% effective method of prevention is abstinence, but total abstinence is an unrealistic solution. Condoms do work, and we advocate for condom use while on PrEP, increasing the amount of protection in place. Even still, condoms sometimes break, and some folks have a hard time negotiating condom use – these are people who can stand to benefit tremendously from PrEP. Once it’s part of your daily routine, you just take it each day; there’s no in-the-moment decision making that can be clouded by any number of factors. Simply put, PrEP changes the game.

Another factor that’s changing the game is the Undetectable = Untransmittable campaign (U=U). Basically, if you take your HIV medications every day, and we don’t see the virus in your blood, you cannot transmit it period. Furthermore, early testing and immediate treatment help people to reach that undetectable level faster on average within 4-weeks. That’s something else we’re working on, with our CrescentCare Start Initiative, linking people to care within 72-hours of a positive test result. Between interventions like this and PrEP, we stand a good chance of ending the HIV epidemic in our city and our community.

There’s still work to do, and New Orleans continues to be counted among the top five cities for new HIV infections in the United States. This must change. It will change. Between testing, education, PrEP, and effective HIV treatment, I have no doubt we’re going to conquer HIV in our lifetimes. That’s the real dream coming true.

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For more information regarding PrEP at CrescentCare, contact PrEPClinic@CrescentCare.org or call 504-293-6842.

Filed Under: Health Tagged With: Volume 35 Issue 19

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