By Dr. Carlton Thomas
As a 50 year old gay physician, I have lived through some incredibly scary times in our community. I remember my teen years when there was no adequate treatment for HIV and AIDS, and thousands of members of our precious community were dying right before our eyes. With that initial horror, people were scared to have sex at all. Scientists produced a “cocktail” of HIV medications in the mid 1990’s that dramatically changed the course of HIV and AIDS in our community. People began to rebound, and deaths from HIV in our community began to dramatically fall. HIV positive individuals began to reach undetectable viral levels and could no longer transmit the virus through sex when that status was maintained.
Still the most recent CDC data from 2019 shows that there were 36,801 newly diagnosed people with HIV (a drop of 9% from 2015). Approximately 1.2 million people in the US are living with HIV but only about 87% are even aware of that diagnosis. Men who have sex with men account for 65% of new cases in the US, while heterosexual encounters account for 23%. Injection drug use and accounts for most of the remaining cases. In another example of health care inequity, African Americans account for 42% of new cases and Latinos 29%, with whites at 25% and Asians at 2%.
We are all ultimately responsible for how we decide to protect ourselves against HIV infection. While condom use is incredibly effective prevention, we are all human and have had those times in the heat of passion where we just don’t use them for whatever reason. I can’t tell you how many times over the years how many friends, patients, and colleagues have called me in an absolute panic because they slipped up. It happens. I am so grateful that in 2012 the FDA approved PrEP (Pre-Exposure Prophylaxis) to prevent HIV infection. When taken properly PrEP is 99% effective in preventing HIV infections. After all of the fear created by the HIV epidemic, finally we have not only amazingly effective treatment, but now we can prevent HIV with a daily pill.
As sex positive physician, I am a strong advocate for the use of PrEP to prevent HIV infection. Initially PrEP users were mostly in big cities where knowledgeable LGBTQ+ friendly doctors were available to prescribe it. In many areas of the US, homophobia still prevents LGBTQ+ patients from receiving the health care we need. Even today it may be hard to find a physician that understands how to properly prescribe and monitor PrEP. Imagine the difference from being the Castro in San Francisco versus being in rural Alabama. While initially many insurances did not cover PrEP and it was incredibly expensive, times have changed and the ability to obtain this amazing source of prevention has dramatically improved. Many people are still left with difficulty navigating how to get on PrEP.
I am so incredibly proud of MISTR and their outreach to people all across America that previously didn’t think they had access to PrEP. Not only do they make sure you get it, but they also make sure there is no cost with free online PrEP and STI testing, no doctor’s office and free delivery. After doing some social media outreach about MISTR one of my followers said “Today I have officially started PrEP! Without Hey MISTR I would have continued to believe that it was unavailable to me. Thank you!.”
With the help of PrEP to prevent HIV in those with risk factors, knowing your status, and getting HIV treated to undetectable levels, we can end HIV.
