The New York City AIDS Memorial in Manhattan this week....

The New York City AIDS Memorial in Manhattan this week. With attention focused on World AIDS Day on Friday, health experts are urging people to get inoculated against the HIV virus.  Credit: Corey Sipkin

When Dr. Sharon Nachman treats teenagers or young adults, she often asks about their sexual health and whether they would consider a medication that can vastly improve the chances of avoiding an HIV infection.

It’s a personal question, but in the confines of her office at Stony Brook Children’s Hospital, one Nachman said must often be asked. A prescription for a medication, a pre-exposure prophylaxis or PrEP, can give users a roughly 99% protection against HIV, the virus that causes AIDS, according to the Centers for Disease Control and Prevention. In people who inject drugs, the medication can reduce the risk of getting HIV by at least 74%, the CDC said.

“This is important for your health,” said Nachman, the chief of the Division of Pediatric Infectious Diseases at Stony Brook Children’s Hospital. “It’s important for you to keep protected and this is one of the best ways we know to protect you.”

Marking World AIDS Day

The doctor’s advice mirrored that of other experts, and the hope is Friday’s 35th World AIDS Day will bring widespread attention to the need to increase the usage of PrEP as a critical tool to help eliminate the HIV epidemic.

WHAT TO KNOW

  • PrEP can reduce the risk of contracting HIV from sex by roughly 99%, according to the CDC. Physicians say more people should consider taking the medication.
  • Nationally, roughly 30% of the "estimated 1.2 million" people who could use PrEP were prescribed the medication in 2021, according to the CDC.
  • New York aims to increase the number of people getting prescriptions for PrEP to 65,000, according to a report looking at HIV prevention and care from 2022-2026.

However, its use is not widespread, often because of factors that include physician access or medication awareness, experts said. People considered good candidates for PrEP include those who consistently have sex without a condom, have a partner with HIV or use needles to inject drugs, according to experts.

Nationwide, women and those within the Black and Hispanic communities are among the groups the CDC said could be helped by increase use the drugs.

“It does prevent new infections,” said Nachman, later noting that “we need to make sure that they’re in the hands of the people who need them.”

Nationally, roughly 30% of the estimated 1.2 million people who could use PrEP were prescribed a medication in 2021, according to the CDC. About 13% were prescribed a drug in 2017, CDC data showed.

Statewide, men made up more than 90% of prescriptions in 2022, according New York’s Ending the Epidemic report.

Increasing prescriptions

New York aims to increase the number of people getting prescriptions for PrEP to 65,000, according to the state report, which studied HIV prevention and care from 2022-2026. As of 2022, the number was 50,558, the report said.

In 2022, Gov. Kathy Hochul signed legislation to provide insurance cost coverage for PrEP medications and for post-exposure prophylaxis or PEP — a drug taken after a possible exposure to HIV to prevent contracting the virus.

On Long Island in 2021, roughly 3,150 people received PrEP, with most recipients being men, according to state data. White patients were the largest group of recipients, the data showed, coming in at roughly 1,900.

The next category, “Long Island Missing/unknown,” showed that about 600 people received the drugs in 2021. Hispanics had around 325 people prescribed the medications, while the number of Black people taking them was less than 250.

Dr. Joseph McGowan, a medical director of HIV services with Northwell Health, said one key reason behind lower usage rates is the lack of a clear public health message about the benefits.

Physicians hesitant

Physicians in some cases are hesitant to bring up the topic of sexual health with patients out of concerns those they are treating will feel stigmatized, McGowan said. Other times, he added, physicians don’t have the time.

Moreover, people don’t often recognize the risk of getting HIV within their sexual network and do not take precautions.

Kerry Thomas, program manager at Thursday’s Child — an HIV support services agency based in Patchogue — said cost may be another barrier, even when people have heard about PrEP.

In those situations, he advises that there can be help to access the medications. The state’s Uninsured Care Programs can provide free access to the underinsured or uninsured.

Still, Thomas said, keeping the issue of HIV on the minds of people on Long Island and elsewhere is challenging, partially because there might be a level of fatigue with public health.

The spread of HIV may also not come to people’s attention because HIV/AIDS is not the death sentence it was in the 1980s or ‘90s.

“So the good news is people are living with HIV,” Thomas said. “They’re living full, healthy lives.”

But to reduce the spread of HIV, he said, people must get tested, take PrEP if they have risk factors and get appropriate treatment if they have HIV.

“Those things will actually [help] get us to see the end of HIV within our lifetime,” Thomas said.

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