Preventing H.I.V., battling stigma 

Governor Andrew Cuomo's ambitious goal of ending AIDS by 2020 will take more than a single approach to achieve, says Dr. William Valenti, senior vice president and co-founder of Trillium Health in Rochester.

One of the most promising tools in the arsenal is the FDA-approved drug Truvada. The drug, commonly referred to as PrEP (Pre-exposure Prophylaxis), has been shown to reduce the risk of H.I.V. infection in healthy, at-risk people by 92 to 95 percent.

Trillium is one of six sites in New York participating in a study that will hopefully lead to expanded use of the drug, Valenti says. But there are stumbling blocks; critics say that the drug could encourage promiscuity, although Valenti says there's no evidence to support that.

"I was naïve and I thought that PrEP, which is scientifically proven to work, would have people breaking down the door to try this," Valenti says. "But it's been the old adage of throwing a party and nobody came."

Trillium has 50 patients in the study, Valenti says, though the goal is to have 100.

The drug has been in use for some time, usually as one of three drugs taken together by AIDS patients in the "drug cocktail." The pill, which must be taken daily, contains two anti-viral drugs that work to stop the virus from multiplying and then kill it before it can attack the immune system.

PrEP, when used with condoms, could significantly help bring down the rate of new H.I.V infections in the US; the rate continues to hover around 50,000 annually.

In the old days of H.I.V. prevention, Valenti says, people were given a condom and expected to behave.

What's different in the PrEP program is the unique connection that the study participants establish with a health care provider, he says.

PrEP prescriptions have to be refilled regularly, which requires participants to come into the clinic. That gives Trillium's medical staff an opportunity to talk to participants about their sexual behavior and to do risk assessment, Valenti says.

Continuous counseling involves increasing participants' awareness about what constitutes risky behavior, he says, and helping them determine how they can reduce their risk of H.I.V and sexually transmitted diseases.

"It's a program designed to keep people connected," Valenti says. "One of the realities of human behavior is the way we evaluate risk; everybody evaluates risk differently."

Addressing the problems posed by the stigma of H.I.V and AIDS is more complicated, he says.

"If you have H.I.V., there's the stigma for your bad behavior," Valenti says. "And the stigma with PrEP is that it will cause people to be promiscuous."

But several major studies have looked at that, he says, and there's no evidence that people on PrEP take more risks, sexually.