The PrEP Paradox

The PrEP Paradox

By Patricia M. Davidson

How in the world did we get where we are today on PrEP?

I mean, the first part is easy: Through tremendous social and medical research, tireless footwork and advocacy, empathy, and interprofessional cooperation, the health care industry developed a product that could eliminate HIV in our lifetime.

From a New York Times op-ed by James Krellenstein and Peter Staley of the Prep4All Collaboration and physician Aaron Lord of the New York University School of Medicine:

Taken daily, Truvada, the brand name for a type of pre-exposure prophylaxis, or PrEP, is up to 99 percent effective at preventing H.I.V. infection. Used as directed, it’s one of the most effective methods of preventing a viral infection ever discovered, as good as the polio vaccine, the miracle of modern medicine. When you combine PrEP’s effectiveness with the discovery that people living with H.I.V. cannot transmit the virus to others once they become undetectable, we could be on the verge of a swift end to the epidemic.

Always, it seems in these crazy times, comes the flip side. Putting profits before people, stigma-induced silence/lack of awareness, misunderstanding of the LGBTQ community even among health professionals, and a lack of open communication are all cited as reasons for the disparity by Jason Farley, PhD, president of Association of Nurses in AIDS Care and faculty at the Johns Hopkins School of Nursing.

Dr. Farley should know. Not only is he a leader on the PrEP front but he works across the globe to prevent the coinfections that HIV invites as it decimates the human immune system. He has seen the unnecessary suffering from the prisons and hospitals of South Africa to the streets of Baltimore, MD. He has seen the tide begin to turn—only to stop—as preventable deaths and HIV’s spread continues.

Here’s the rub: In other countries, a generic version of the drug can be had for $6 a month. In the United States, the price for Truvada is $20,000 a year. If the stigma doesn’t get you, the price tag will. So millions of people remain at risk in one of the world’s wealthiest nations.

What to do? Get the drug from other parts of the world where it’s $6? That would simply be stealing from the poor rather than working with pharmaceutical companies and those unwilling to have uncomfortable but essential conversations about sex—many within our own health care industry.

Nurses got into this business to save lives, not money. But as more nurses take leadership roles at health systems large and small, and as budgets shrink and costs escalate, we are now an even more essential part of maintaining safe, high-quality, economics-minded care. It’s part of the job, and we’re good at it. Still, as long as we have a voice, the bottom line must never be the cutoff point.

We work at the razor’s edge where promising drugs succeed or fail. When they save lives, we make sure people know about it, no matter who makes the money. Nurse researchers like Jason Farley have sweated to get PrEP to our communities through all the stigma, lack of awareness, and over-the-top price tag. He has proselytized for PrEP, because it works. He deserves to be heard when he says PrEP must be made available to all who need it. Right now.

HIV/AIDS is a known killer. Today, we could wipe it off the face of the earth if we simply shared. That’s a priceless opportunity that we can’t afford … to miss.


trish_blog-shotPatricia M. Davidson, PhD, MEd, RN, is dean of the Johns Hopkins School of Nursing and a fellow of the Australian College of Nursing, the American Heart Association, the Preventive Cardiovascular Nurses Association, and the American Academy of Nursing. She is counsel general of the International Council on Women’s Health Issues and actively involved in the international activities of Sigma Theta Tau International. Follow her on Twitter (@nursingdean).

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