Unexpected Barriers Encountered When Accessing PEP/PrEP
8/15/2012 2:00:00 PM
By Alex Garner
Now that Truvada has been approved as Pre-Exposure Prophylaxis for HIV prevention, one would think that obtaining access to it would be as simple as going to your doctor and requesting a prescription. Unfortunately, for many men across the country it isn’t that easy.
Below is a letter to the editor I received that details the experience of a gay male PhD candidate at the University Of Michigan. He had previously tried to access Post Exposure Prophylaxis through Student Health and had a bad experience. When he tried to access PrEP he encountered a doctor that wasn’t too familiar with the new guidelines. He was referred to an immunology specialist who will hopefully provide the needed prescription.
I spoke with Robert A. Winfield, MD, Chief Health Officer and Director of University Health Service and he was very distressed by the report of a bad experience with student health. Dr. Winfield stressed their “sensitive and thoughtful approach” when dealing with patients. He was eager to resolve this situation and said that when their staff meetings resume in the fall they will, “review the guidelines to make sure the medical staff are familiar with them.” He added that requests for PrEP will be dealt with the “pressing urgency required.”
The doctor also pointed out that requests for PrEP are considered a “low frequency event.” I think that is the most important take away from all of this. While HIV prevention, PEP, and PrEP might be regular parts of our lives, they are not necessarily on the radar for the average general practitioner.
We have to be our own best patient advocate. Our community became quite adept at this during the height of the AIDS crisis. Those lessons need to be applied today.
We’ve got to do the research and talk to our friends and colleagues because in the real world most people aren’t well versed on issues of gay men’s health. And others simply don’t care about our issues. We’ve got to work in collaboration with health care providers so that they better understand our needs and concerns. It’s our lives and our bodies so it falls to us to take the initiative and makes sure we are getting the healthcare every human being is entitled to.
To the Editor:
SUBJECT: University Health Services Effectively Denies Preventative Treatment for HIV, Needs Policy
I am writing to express frustration with recent experiences myself and others have had while seeking services at the University Health Service clinic on campus. The University of Michigan is a world-renowned leader in providing excellent care, which is why it is perplexing that they are out of step with Michigan Department of Community Health guidelines regarding post-exposure prophylaxis for HIV or “PEP.”
PEP offers those who have been exposed to HIV a 48-72 hour window to seek treatment that has been proven effective at preventing HIV infection. It is not new: the CDC has had guidelines in place regarding their prescription for at least a decade.
Three years ago, I was out of town visiting friends in Philadelphia when I needed access to PEP. I called their 24-hour hotline to seek a prescription immediately, which was important because I only had 48-72 hours to begin treatment or they would not be effective. I was told flatly by the nurse staffing the hotline that “You just have to live with the consequences of your actions.”
I was furious and disgusted – her denial of service was tantamount to malpractice. I called the local media, and after numerous stories from American Independent writer Todd Heywood, pressure began to mount that the state health department should issue guidelines regarding pre-exposure prophylaxis, which they did last year. You can find them online here.
I had hoped that others would not be subjected to the kind of immoral treatment that I was given three years ago. But I believe that to not be the case. This week I again visited UHS to seek a different kind of new treatment just approved by the Food and Drug Administration last month. Instead of taking a regimen of pills after being exposed, new treatments now exist for those at risk of infection to take daily before potential exposures to prevent their infection. For those who take these pills daily, they can be upwards of 90% effective in preventing infection. I visited UHS seeking a prescription.
I knew that I was in for an uphill battle, but I was surprised by the curt refusal of the doctor who saw me to even look at the CDC guidelines I had brought with me. She admitted that she was ignorant about these new treatments, but was clearly not interested in educating herself for a patient who was in need.
But even more upsetting was the fact that the doctor revealed to me that UHS clinicians recently met to discuss post-exposure prophylaxis (the drugs they denied me three years ago), and that they had agreed to only refer patients out for these treatments – despite the fact that MDCH guidelines on PEP specifically state that patients seeking PEP should seek care from their primary care physicians.
In other words, the doctor effectively admitted to me that UHS denies access to PEP. As anyone with any experience with healthcare bureaucracy knows, referrals can take months. PEP has a 48-72 hour window. Those needing access have no time to waste waiting for an infectious disease appointment that could take weeks or even months.
I do not yet know whether the hospital clinic I have been referred to will give me access to PREP. But I do know one thing: UHS needs to wake up and realize that there are needs not being met by its clinicians, and it desperately needs a policy in place to address these needs. I am not alone: I have dozens of friends who all have similar horror stories regarding UHS and its treatment of sexually active gay men.
I sincerely hope the doctor was wrong, and that UHS was planning to implement a sensible policy regarding PEP and PREP. I sincerely hope their staff will do the right thing and do so immediately, so that other students like me do not have to be subject to their shameful ignorance.
Sociology & Women’s Studies
University of Michigan
Editor’s note –The name of the attending physician was removed from the above letter.
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