Is it the job of a university to protect and provide for its students? The answer is obvious. But when it comes to healthcare, the answer is less so. Particularly in the case of an institution’s ability to maintain students on PrEP (pre-exposure prophylaxis), a daily pill for HIV negative people to prevent infection. Mostly taken daily, PrEP guarantees nearly complete protection against contracting the virus. Even though the FDA approved it in 2012 and the CDC began recommending it two years later, Colleges and universities often don’t prescribe it because they don’t know about it, or they’re misinformed. By providing PrEP in a primary care college health setting, clinical providers can have a significant impact on the health of their student body.
Evidence of its effectiveness is in users like Shamor:
"I started taking PrEP because my best friend from Uni's husband is HIV+ and my bestie told me that he was taking Truvada. This was back in 2011 and I asked if people without HIV+ partners could take it. When I got back to the US from London in 2014, I asked the clinic for PrEP. So I guess I found out about it in 2011, but didn't start it until 2014. I take it as a precaution. I've had partners lie to me before and I wanted to take all measures to have the safest sex possible so that I could make it as enjoyable as possible.
To be honest, when I was a lot younger, in my earlier 20s, I did some pretty risky things and that was before Truvada was available. I think if anything, taking Truvada daily is a reminder that I'm making less riskier sexual decisions these days. It's really had no change on my sex life. I wouldn't say that I've had more sex with HIV+ people, but I've [had unprotected sex]] with someone knowing they're positive and been super calm because I knew he was undetectable and I'm on PrEP. Sometimes I have safe sex with a condom, and sometimes I don't but I like knowing that condom or not, my sex is always safer with PrEP.”
The stats says as much as Shamor.
As a person of color, Shamor is among the community of sexual minority men that are most impacted by HIV, making up 69 percent of all new diagnoses in 2018, while the transgender populace is disproportionally affected as well. And even though Black and Hispanic/Latinx populations are mostly likely to be newly diagnosed with HIV, PrEP users are more likely to be white. Some historically black colleges and universities can even discourage discussion of sexuality and HIV prevention. In some circles, there are also concerns that PrEP usage could encourage risky sexual activity. However, the truth is that – as Shamor points out - it’s happening anyway, especially among college students who are often exploring their sexuality for the first time.
Access and awareness can be positive forces for change. So is diversity, which the vast majority of universities pride themselves on, or are working to achieve. Now is their chance to close important gaps among their students and maybe even save their lives.
Michael, another PrEP user has said:
“On Nov 26, 2005, I was the victim of a sexual assault. My HIV infection resulted from that action. Afterward, I lost trust in others and in my own ability to make good decisions. I am grateful to have had access to health care coverage and medications. Today, I live fearlessly, but with a new understanding of the good and the bad people are capable of. I found the most amazing man and we were married in 2015. I currently take Descovy and Isentress. PrEP has not changed my relationship with sexuality, but I believe I would not be positive today if PrEP were available to me in 2005.”
Michael’s trauma is heartbreaking, and sadly not unique:
As schools are proactive about preventing violence with physical campus checkpoints, so too can they prevent the long-term effects of these occurrences with PrEP at their disposal.
School advocacy of the benefits of PrEP is undoubtedly important, but ultimately it’s just one step on a longer journey toward true accessibility.
Maintaining a prescription for PrEP is most certainly a process. After testing for STIs, and confirming the absence of HIV, a provider can prescribe PrEP for a three-month period. Patients then need to return every three months to confirm they’re still HIV-free because PrEP can make the virus resistant to treatment if it has already been caught. The process is even further complicated in the pandemic era and with students who may be studying abroad for semesters or years at a time (or even those just on Summer break). While some providers can prescribe a four-month supply on occasion, a more sustainable solution already exists, if schools choose to provide it.
Most students say they are likely to use STI self-testing services if they could take it privately and test themselves in the privacy of their home or residence. For HIV prevention, this generally involves a self-administered finger prick, well worth the pricing and potential consequences of going perennially untested.
Ash Wellness works with universities to offer the full spectrum of at-home PrEP testing, so students both remote and on-campus can safely and comfortably test themselves at home without four trips a year to the local clinic. Ultimately, if more universities prescribe PrEP through the use of at-home testing services, they can move toward creating a more inclusive, and undoubtedly safer college community. Contact Ash today to learn more!