The eyes of Damon Jacobs were slowly filling up with tears.
It was a warm and busy day in late June, and at a national HIV conference in Philadelphia, Jacobs was talking about the time that he first learned about AIDS. He was 14, and Rock Hudson, a movie star known for his all-American good looks and sense of humor, had contracted the disease.
“There was lots of media coverage contrasting this healthy 1950s heartthrob image with a very ill, very thin and sick man,” says Jacobs. That portrayal made Jacobs and his fellow gay friends afraid that if they came out of the closet, they might someday end up unhealthy and frail like Hudson. From the summer of 1985 until 2011, Jacobs says, he carried that fear on his shoulders.
After 26 years, pre-exposure prophylaxis, or PrEP, lifted that burden—but only briefly. Better known as Truvada, PrEP is a pill that can prevent HIV if taken once a day. When Jacobs first read about it after seeing dozens of friends die from AIDS, he was sure that people would flood the streets with joy. But the opposite happened: “Nobody was talking about it,” he says.
Jacobs is now a family therapist who works in AIDS research in Manhattan. He says he regularly sees young men in his practice who have tested positive for HIV, but who have never heard of PrEP. Jacobs blames this on primary care physicians and government agencies alike. “I encourage us all to think about how to get information to the people who need it the most,” he says.
According to the most recent statistics, there are more than 17,000 people living with HIV in Philadelphia, 12,000 of whom have full-blown AIDS. There is no data tracking exactly how many people use PrEP in the city. But national statistics are troubling: A study by the American Society of Microbiology found that white people, who make up 27 percent of new HIV cases in America, account for 75 percent of PrEP’s user base. Conversely, African-Americans, who make up 44 percent of new HIV cases in the nation, only constitute 10 percent of PrEP’s users; Hispanics, who make up 23 percent of new HIV cases, represent 12 percent of users.
In a majority-minority city with a HIV high rate, that’s a major cause for concern. And at least two measures show that PrEP is being underutilized in Philly: Philadelphia FIGHT, the city’s largest AIDS service organization, counts just 250 active PrEP users on its rolls. Meanwhile, only 170 people are taking advantage of the Philadelphia Department of Public Health’s free PrEP program, though nearly 700 have been referred to it. Read more »