Health Service offers HIV-prevention medicine for students

Tufts Health Service, beginning last year, has been able to offer prescriptions for two medical interventions designed to combat the prevalence of Human Immunodeficiency Virus Infection (HIV). According to Margaret Higham, the medical director of Tufts Student Health Service, the two interventions consist of Pre-exposure Prophylaxis (PrEP) and Post-exposure Prophylaxis (PEP).

PEP and PrEP are styles of medical interventions used to prevent a wide variety of medical issues, Higham said. PEP is used after possible exposure, while PrEP is taken on a regular basis by people who are at risk.

Both of these interventions are important in the prevention of HIV infections, Higham said. However, these types of interventions are not limited to HIV, she explained.

“PEP [is] taking medication shortly after exposure to prevent something from happening,” Higham said. “A good example of it would be emergency contraception, medication you take shortly after unprotected sex to prevent pregnancy. PrEP is medication you take ahead of time to keep yourself from getting something, [such as] birth control pills; you take them regularly to prevent yourself from getting pregnant.”

In terms of preventing HIV, Higham explained that Tufts Health Service can prescribe both styles of interventions. If students believe they have been exposed to HIV and therefore may be in need of PEP, they should first come to Health Service and seek a consultation.

Higham explained that Health Service would first try to glean a more specific understanding of the type of exposure encountered.

“There are certain types of exposures that are riskier than others. We’d want to explain to them about the medications that are used, we’d want to talk to them about the cost, we’d want to do … some preliminary testing.”

Higham noted that if students believe themselves to be in need of PEP, time is extremely critical, since the medications must be taken soon after exposure in order to be effective. If Health Service is closed, the student should notify the doctor on call, according to Higham.

Once an HIV screening test has been completed and the student is confirmed to be HIV negative, Health Service will be able to write a prescription for the student for either PEP or PrEP, Higham said.

“We would tell [the student] about the side effects, we’d tell them about the medication [and] how to take it and then we would write a prescription which would go to the pharmacy of their choice,” she said.

The ability of Tufts Health Service to write prescriptions for these two interventions differentiates Tufts from other schools, many of which do not offer prescriptions for anti-HIV PEP and PrEP, Higham said. She noted that Tufts began offering these prescriptions due to the high priority of HIV prevention among college students.

“HIV rates in college-age men are rising,” she said. “In all other age groups they are stable or declining … so this is an urgent health care issue for our students. We see students with HIV, we see students get HIV and we now have ways of preventing it with medication, and we need to let our students know that.”

In terms of cost, Higham said that the medication used in the PrEP HIV intervention is Truvada, which can cost over $1,000 per month. However, because the medication has been covered by most health insurance plans since it was approved by the Food and Drug Administration (FDA) in 2012, the cost is usually around $35 per month.

Meanwhile, PEP consists of Truvada combined with another medication, meaning that students will have to pay for two pills, Higham explained. However, since the regimen for PEP consists of taking the medications for only 28 days, the overall cost will be lower than for PrEP, which is taken on a regular basis.

Sophomore Jonathan Moore, who has been on a PrEP regimen for the last three months, expressed his general satisfaction with the process of prescription and usage of the intervention.

“The practitioners are extremely competent about what FDA regulations are, very strict about insuring that folks stick to the regimen and that folks stick to the pattern of coming back and getting tested every three and six months," he said. "I hope that my experience is emulated by other students, especially for folks that are queer and trans."

Moore added that he hopes that further use of PrEP will be encouraged among people who have the resources to take it and who have a risk of contracting HIV.

“As a black gay man, as soon as I realized I could get [PrEP], there was no reason for me not to,” he said.

Accordingly, he encouraged students who may be worried about the potential cost to reach out to the Lesbian Gay Bisexual and Transgender (LGBT) Center and Health Service for further information.

Nino Testa, the director of the LGBT Center, added that he was pleased with Health Service’s ability to prescribe both PrEP and PEP. However, he noted that beyond the Tufts campus, access to the two interventions may be more limited, and that this is an issue which should be addressed.

“More broadly, [there is] the question of who has access to these medications that are potentially life-saving for people,” Testa said, “if their insurance doesn’t cover it, how they can get access to it [and] how we can more broadly [educate] about what PrEP and PEP are in communities where … these conversations are stigmatized.”

Testa also expressed his opinion that the importance of PEP and PrEP on the Tufts campus extends beyond the LGBT community.

“I think it’s absolutely relevant and important that everyone know about PrEP and PEP and make an active decision about whether or not it makes sense for them in their sexual lives, and that’s not just a queer thing, I think it’s for everyone,” he said.