With HIV diagnoses on the rise nationwide and in Rhode Island, a new R.I. Department of Health initiative is looking to expand access to a preventative treatment for the virus that is often spread through unprotected sex and shared hypodermic needles.
Health officials say they are trying to knock down barriers for people in susceptible populations to receive preexposure prophylaxis, commonly known as PrEP, a medication that reduces the risk of getting HIV.
As part of the initiative, RIDOH has launched a webpage highlighting Rhode Island PrEP Champions, a network of health clinics in Rhode Island that offer PrEP, in some cases to patients under 18.
The webpage includes other HIV resources.
“There are a lot of clinics around the state that offer PrEP access, but there hasn’t been a way to sort of coordinate it,” said Dr. Joseph Garland, medical director of the Corliss Street Clinic in Providence, a PrEP champion operated by Brown University Health.
RIDOH “tried to bring us all together to develop a web-based resource for people to access PrEP and look through the resources,” he said.
In October, public health officials announced that Rhode Island was seeing an above-average number of HIV diagnoses but did not release official numbers. This comes after a decade of a downward trend in the number of diagnoses. Each year, around 60 to 90 residents are diagnosed with HIV, according to RIDOH data.
“There’s a suggestion of a trend of some increase compared to some previous years,” though data is not finalized, said Dr. Suzanne Bornschein, medical director and state epidemiologist at RIDOH.
Nationally, officials have seen a similar trend with HIV diagnoses rising in 2021 and 2022 after a steep decline amid the COVID-19 pandemic in 2020. According to the Kaiser Family Foundation, an estimated 1.2 million in the U.S. are living with HIV, with an estimated 13% not knowing they have it.
HIV also has a disproportionate impact on certain populations, particularly people of color, gay and bisexual men, and other men who have sex with men and transgender women.
But receiving PrEP medications consistently, either orally or by injection, can reduce the risk of getting HIV by as much as 99%.
“PrEP is a real game changer for HIV prevention,” Bornschein said.
Still, some people may not feel comfortable discussing their sexual health with their health care providers, while other times providers may not be informed about PrEP, health care providers say. Patients may not know about PrEP as well.
“Knowledge is still a major barrier to people accessing it,” Garland said.
Even when people know about PrEP and want to receive the medication, some physicians may not prescribe it, some doctors say.
“One story I hear very commonly: I was seeing a physician who wasn’t comfortable prescribing PrEP,” said Dr. Philip Chan, chief medical officer of Open Door Health, a clinic focused on sexual and LGBTQ+ health. “This initiative is also for health care professionals and physicians to encourage them to consider being PrEP champions and learning about it and prescribing it.”
Rhode Island has been one of the top states in terms of PrEP-prescribing rates, but disparities remain.
Officials say Black and Hispanic communities often have less access to the medication.
These disparities are a key focus of the PrEP champions initiative: “All the work that we do is sort of guided by health equity and making sure that we are reaching the most vulnerable population,” said Aaron Frechette, the infectious disease communications coordinator at RIDOH.
Another barrier to access is the cost of medication, the target of a state law set to go into effect on Jan. 1 that will require health insurers to provide access to a PrEP drug without out-of-pocket costs for PrEP or prior authorization requirements.
“Under the Affordable Care Act, commercial insurers are required to cover at least one form of oral PrEP and the related health services” but many coverage plans did not include PrEP in their services, Frechette said.
Most clinics on the PrEP champions webpage offer sliding fee structures, lowering the cost for those with high financial need.
Though reducing insurance barriers is key, those at risk of HIV still need to be able to connect to someone who can prescribe PrEP, Garland says. The RIDOH initiative gets “people to a prescriber, and therefore then the prescriber can access the benefit of the law and [get] people the medication,” he said.
The Rhode Island PrEP Champions program – which was launched at the beginning of December, HIV/AIDS Awareness Month – is still accepting new community partners and clinics to become PrEP champions.
“We are seeing some enthusiasm, both from members of the public who could benefit from it and our community partners who do a lot of work out in the community with these populations that have faced barriers to getting PrEP,” Frechette said. “We’re just really hoping to continue to grow this and continue to be able to connect people without services [to the services] that they need.”
