We’re fast approaching December, and specifically, World AIDS Day on Dec. 1. While we should absolutely celebrate the progress medicine and society have made in the last year toward controlling the spread of and eventually curing HIV, we still have a ways to go — even and especially on campus.
The state of HIV-preventative care and treatment at the 7Cs remains much the same as healthcare in general here: understaffed, underfunded, and under-resourced. Student Health Services have long wait times for appointments because they have few providers and no money to hire more.
For college students, HIV is often depicted as something ubiquitous, nefarious, and yet not that much of a problem. This is possibly because, nearly 40 years after AIDS-related illnesses were reported in the CDC’s Morbidity and Mortality Weekly Report by providers at University of California, Los Angeles, HIV isn’t depicted as that big of a deal anymore. It’s no longer a death sentence.
This simply isn’t reality, though. Diagnoses remain steady among young people with 8,451 youth aged 13-24 diagnosed in 2016. Those numbers only reflect the number of diagnoses; the CDC estimates that one in seven people living with HIV don’t know they are.
Given that HIV and AIDS are still prevalent, and AIDS can still kill, it would make sense to use all prevention methods available. But this isn’t the case in Claremont.
Since the beginning of the AIDS crisis, education and safer sex materials have been two of the best options to prevent the spread of the virus. People who don’t know what HIV is aren’t very likely to get tested or know their status. Among people who are aware of HIV, providing barrier methods for sex cuts the rate of transmission by 90-95 percent.
Barrier methods, though they’ve been touted as the best method of prevention since the ’80s, are no longer the only (or maybe even best) option. HIV pre-exposure prophylaxis (PrEP) is an antiviral pill that HIV-negative people can take to reduce their risk of contracting the virus. Taken correctly, it can reduce one’s risk of infection by 92 percent.
There are downsides to PrEP. Since the only FDA-approved medication for PrEP, Truvada (the brand name for the much-less catchy tenofovir and emtricitabine), is still on-patent, its maker, Gilead Sciences, can charge $1,600 a month for it.
Most health insurance plans, including SHIP, will cover PrEP. But, there’s still a bigger hurdle: finding a doctor who will prescribe it.
Student Health Services doesn’t prescribe PrEP, instead advising students to use barriers, get tested with every new sexual partner, or remain abstinent. None of these are terrible suggestions, and I can see why SHS makes them.
They’re still not enough.
This problem goes beyond SHS. It’s also a problem for the Claremont Colleges, who could give SHS the funding they would need to train all their providers on how to prescribe PrEP. If all providers undergo training on how to screen for high-risk sexual behaviors and perform HIV testing, this seems like a logical next step.
Yet, the funding just isn’t there.
While students could go off campus to a provider like Planned Parenthood, SHIP won’t cover non-emergency care within 25 miles of campus unless the student gets a referral from SHS first. Compared to the time, energy, and monetary costs of other steps to accessing PrEP, this is relatively benign. But, it still takes up time from the student and provider that could be spent doing something more productive.
I doubt I could get Aetna to change its policies on care referrals (though they’ve contacted me before when I’ve complained about their policies, so let’s see what happens).
I am more confident in my abilities to exact smaller change: getting the colleges to fund PrEP training so that if a student and SHS provider are going to spend 30 minutes discussing PrEP, the student can walk out of it with a set of lab orders and a prescription.
The costs could be minimal, too, if SHS opted for online provider trainings, such as the one on HIV and PrEP run by the Infectious Diseases Education and Assessment program through the University of Washington. Such trainings offer continuing education credits for healthcare providers.
While there are other factors in prescribing PrEP, such as offering the necessary STI and liver function tests to measure eligibility, these are tests SHS already offers.
The Los Angeles County Department of Public Health offers HIV prevention services, including PrEP prescriptions and help paying PrEP copays. But, the closest provider listed on their directory is Planned Parenthood in Pomona. For students who don’t have a car and may be hesitant to ask a friend or get a rideshare to Planned Parenthood or another sexual health clinic, this care is practically inaccessible.
It is vital going forward that the Claremont Colleges devote resources to developing better HIV prevention care on campus. Like many other types of specialized care, it is lacking on campus but, unlike other care, the resources for training providers are abundant.
Moreover, once providers are trained, PrEP is fairly easy to screen for and provide. It requires little more than a medical history interview and some simple blood and urine tests.
None of these are insurmountable challenges, although the fact that PrEP has not been implemented at the 7Cs is indicative of a larger healthcare issue. I worry that, even though the steps to implement PrEP care are simple, SHS is already so overworked and underfunded that it won’t be able to take on the extra burden.
Regardless of the exact financial and time burden PrEP care could place on SHS, World AIDS Day provides the 7Cs with another opportunity to pledge more money and space to SHS, along with similar resources like Health Education Outreach, Monsour Counseling, and campus-specific Peer Health Educator groups.
It’s not enough for the Claremont Colleges to say they support student health and wellness. They need to do more.
We’re closing in on 40 years of AIDS in LA County. We’ve come so far in terms of educating about, preventing, and treating HIV, but we still have so far to go.
Donnie TC Denome PZ ’20, CGU ’21 is a 4+1 Bachelors/Masters public health major from Sunnyvale, CA. This World AIDS Day, they’d like to remind everyone that Gaétan Dugas was not Patient Zero in the HIV crisis.