(The Root) — On Monday the U.S. Food and Drug Administration approved the first pill to prevent HIV infection in adults who do not have the virus — but are at risk of becoming infected. Studies have shown that Truvada, a little blue tablet taken once a day, can dramatically reduce transmission of the virus.
This development, known as pre-exposure prophylaxis, or PrEP, adds to a growing list of recent breakthrough medical strategies that reduce the spread of the disease. It also comes as a good-news curtain raiser to the International AIDS Conference, which kicks off in Washington, D.C., this weekend — the first time on U.S. soil in more than 20 years.
African Americans have been slammed by HIV since the beginning of the epidemic 30 years ago, and desperately need new ways to stop the virus. More of us are living with HIV/AIDS, newly infected or dying of the disease than any other ethnic group in this country. Of the 1.1 million Americans infected with HIV, 510,000 are black.
Still, as HIV advocates across the country called the FDA approval of Truvada for prevention "historic," "groundbreaking" and "lifesaving," African-American activists reacted with much more guarded optimism and a healthy dose of caution.
"Yes, this is an important advancement for African Americans and gives us another prevention option," says Ronald Johnson, vice president of policy and advocacy at AIDS United in Washington, D.C. "But it's not a magic bullet. This isn't something that you can take every once in a while when you're going out. It does not replace safer sex and must be used in conjunction with consistent practices, including condom usage. "
Phill Wilson, president and CEO of the Black AIDS Institute, is more blunt. "The FDA got this one right, but here's what I'm worried about," he said in a statement. "We do not know if our community will embrace this new tool. Will we get the information that will allow us to learn what PrEP is and what PrEP is not, who should be taking it and who should not, where to find it and how to use it?"
Even with these caveats, Wilson and other activists hope the medication can provide added protection for the two groups most at risk of contracting the virus in the U.S.: heterosexual black women and black gay and bisexual men.
Of all the women living with HIV in this country, approximately 66 percent are African American. In fact, one out of every 32 black women will be diagnosed with HIV infection during her lifetime — a rate higher than in many African countries. The vast majority of these women become infected with HIV by having unprotected sex with a man, often in what they consider to be a "committed relationship."
Truvada may also slow the spread of HIV among black gay and bisexual men. According to a new report released this week by the Black AIDS Institute, black gay and bisexual men make up nearly one in four new HIV infections, though they account for only one in 500 people living in the U.S. By the time a black gay man reaches age 25, he stands a roughly 1-in-4 chance of being infected with HIV. "For the most at-risk population on the planet — black gay and bisexual men — this approval is not a moment too soon," says Wilson.
The challenge will be reaching them. Many have been driven away from health care and other services by negative experiences and are isolated from family and other support because of homophobia. "We now need to find a way to deliver this drug to where they are," Wilson adds.
And, for this medication, price is an object and a point of contention. Truvada has been on the market to treat HIV since 2004, and it's generally covered by health insurance. At this point, it's unclear whether insurance companies will pay for Truvada for prevention. A year's supply costs $13,900, according to Gilead Sciences, the drug's manufacturer.
Currently, more than 2,000 HIV-positive Americans are stuck on waiting lists, unable to afford lifesaving medications. The bulk of those without access to treatment live in the South, and most are people of color. So in a time of strained financial resources, who should get the drugs — the sick, or the healthy who want to stay that way?
The issue of access and affordability is most pressing in East and southern Africa, the areas of the world most heavily affected by the HIV epidemic. Ironically, Truvada's most promising results — 75 percent reduction in HIV transmission among couples in Kenya — occurred in Africa, which needs a preventive treatment desperately but may never be able to afford it. Of an estimated 10 million HIV-positive Africans, only half receive medication, which leaves nothing to spare for prevention.
Still, Dr. Clement Chela, the director general of Zambia's National AIDS Council, says that he will do whatever it takes to get preventive medication to his country. Zambia is one of the hardest-hit regions in the world, with 14.3 percent of the population infected with HIV. About a third of those who need HIV-fighting medication do not receive it.
"We will work hard to make sure to make this drug available to Zambians, despite the cost," Chela said by email shortly after the FDA announced approval. But he was quick to add, "We would not like to use such an expensive drug for this purpose until we are able to put more people on ARVs [antiretrovirals]."
Activists urge that even as the science races ahead, people of color must be in the forefront of HIV/AIDS decision making. "This medication has been approved, but it's just the beginning," says Fields. "We have to be at the forefront as PrEP rolls out into the black community. It's critical that we make our voices heard."
Linda Villarosa runs the journalism program at the City College of New York and writes frequently about HIV/AIDS and other health issues.
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