Robin O’Donoghue grew up in Fairbanks and was first exposed to pre-exposure prophylaxis or PrEP which is a method of preventing HIV transmission while in college. PrEP is a pill that’s taken daily or injection that drastically decreases the chance in HIV transmission. After a few years of discovering the facts about PrEP, O’Donoghue was given an appointment.
“[Aftergetting more educated, and getting older, I wanted to improve my health,” O’Donoghue said. “And the statistics show that If you’re a sexually active gay person, you ought to be on PrEP in the event that you can.”
In the beginning, O’Donoghue did not possess insurance. He turned to an online service that was free known as Mistr to obtain prescriptions. The prescriptions were sent via post, as well. he’d provide the required samples for laboratory tests by mail. As he gained insurance for health, he began using PrEP through an office in Juneau. In the Affordable Care Act, also referred to as Obamacare PrEP is said to be provided for free under nearly all insurance. However, O’Donoghue soon began hitting problems in his prescription.
“Normally it’s covered completely and there are no dollars taken out of pocket. However, I’d get charged almost 500 dollars,” O’Donoghue said. “The pharmacy would tell me that it’s insurance. Insurance would claim it’s the pharmacy’s fault. The issue wouldn’t be resolved.”
He claimed that at times he was forced to decide between having to pay out of pocket or resolving to take the pills he missed. In the span of two years, he claimed that he spent around $1500 on wrong costs. In the event that he could not pay, he he often didn’t take his medication. There were times when the patient was not protected from HIV.
Just like with birth control pills, PrEP takes up to a few weeks to become effective. It’s important to take it regularly and, if you miss pills, you need to begin the waiting time. Once it’s working, PrEP is 99% effective for preventing HIV transmission through sex and about 70% effective for preventing HIV when sharing needles.
In the end, O’Donoghue explained that he reverted to ordering prescriptions online with Mistr because it was cost-free.
However, not everyone is able to make use of the online services for prescriptions. If you don’t have a residence or a consistent address for mailing, or isn’t talking to those they live with having PrEP, they might not be able to trust getting prescriptions via mail.
Robin Lutz, executive director at the Alaskan AIDS Assistance Association also known as 4As Lutz said that the association is in talks to people who are newly identified with HIV. O’Donoghue experienced difficulty getting access to PrEP has been a member of the board at 4As and his story is one that Lutz knows about. She added that Alaskans have many obstacles in accessing PrEP.
“We were told about patients who received misinformation regarding PrEP and patients who made an appointment with their physician during a time where it was appropriate to suggest or discuss PrEP and the opportunity was not taken advantage of,” Lutz said. “We saw people who received an appointment to PrEP but couldn’t fill it due to concerns about insurance coverage, incorrect information and costs.”
Lutz stated that no of these obstacles come as a surprise and most of them are connected with the discomfort people experience discussing sexuality and HIV. However, Lutz said, when people are able to access PrEP, PrEP is a game-changer to stop HIV transmission.
Prior to PrEP, condoms and other kinds of barrier were the primary method for preventing.
“Condoms do not work for all,” Lutz said. “It requires some kind of communication, and based on the kind of sexual relationship you’re having it could be that you’re not the person who wears the condom. This means that it involves some sort of negotiation. The best part about PrEP is the fact that it’s something you control as an individual, to safeguard yourself.”
The Alaska Division of Public Health recently investigated an HIV cluster that originates from the Interior region, which has seen 24 cases connected to it in the last two years. Joe McLaughlin, epidemiologist for the division, said that assessments made about the HIV cluster has helped the division understand the obstacles in HIV detection and prevention.
“We’re going to look at ways to increase access to testing, enhanced strategic messaging to help promote awareness and adoption of PrEP, HIV, STI screening and other strategies for prevention to increase bisexuality among men and other groups that could gain from the information. create and disseminate information healthcare professionals can utilize to assess the needs of preparation for their patients,” McLaughlin said.
To overcome some of the issues with access, Lutz said 4As is offering the same-day PrEP program beginning December. 4. The clinic will be located in Anchorage to ensure that patients don’t be waiting around to receive their prescription. They say that same-day programs have proved to be very successful throughout the 48 lower states and if it works well in Anchorage they could provide it at one of the clinics they have in Juneau and in the Mat-Su Borough. 4As has also announced an all-state support program that will assist those who are stuck as O’Donoghue experienced in trying to get access to PrEP.
“Someone could phone and say, “Hey I’m trying complete my PrEP prescription and my pharmacy has told me I’m required to pay an amount of $500 to pay for it”” Lutz said. “And we’re able to recognize ‘Oh, this is not true… let’s fix this issue immediately to ensure that you don’t experience an interruption to the prescribed medication.'”
From Dec. 4 Alaskans can contact any office of 4As in Anchorage, Juneau, or Mat-Su Borough for assistance accessing PrEP.
It is also possible to learn about HIV testing and prevention with an ophthalmologist or health.alaska.gov.
The following is the 2nd installment of a series that explores the ways in which Alaska responds to a rash of new HIV diagnoses that originate from the interior. You can read the first story here.
