Years of debate over the health care act have left too many people with the impression that its can usually be solved by changing federal government policy. The mystifying story of an effective but too-little-used drug to prevent HIV infection is a reminder that’s not always the case.
It’s been more than three years since the Food and Drug Administration approved Truvada as an HIV preventive. In September, the World Health Organization recommended it for anyone at risk of contracting the disease. Yet data from Gilead, the drug’s manufacturer, suggest that only a fraction of the people at risk of contracting HIV are taking it. That’s a missed opportunity, because the HIV epidemic in the U.S. is nowhere close to an end.
There’s strong evidence that the drug, if used more widely, could significantly lower the number of new diagnoses — still almost 50,000 a year. In a recent study of gay men in Kaiser Permanente’s San Francisco health care system, none of those who took Truvada over a period of 32 months contracted HIV.
What’s keeping it from being used more widely? The American medical community broadly has been slow on the uptake. AIDS specialists and clinics are excellent at treating people with HIV; today, a 20-year-old with the infection can expect to live to 71(up from 56 in 2000-2002) — almost on par with the population as a whole.
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But to introduce effective prevention, general-practice doctors, physician assistants and nurses will need to identify patients at risk of contracting HIV, and encourage them to protect themselves by taking drugs. This requires asking patients about their sexual history, including the number of their partners and the type of sex they have. It means having a conversation, something not every doctor has time for.
Getting the country’s roughly 210,000 primary-care doctors to move HIV prevention higher up on their mental checklist will take coordinated effort.