PrEP Must Now Be Completely Covered By Health Insurance Companies

Although we might have been focused on other illnesses for the past few years, HIV, the virus that can cause AIDS, has by no means been eradicated in the United States. 1.2 million people in the U.S. are living with HIV; around 14% of them are unaware they are infected, and only a little over half of those who are aware of their condition are virally suppressed. Fortunately, there are now effective treatments for the virus (but still no cure), as well as a drug that can help prevent getting infected, known as PrEP. And now, in an attempt to prevent the spread of HIV, the federal government has announced that all health insurance companies in the U.S. must completely cover the cost of this drug. But will it be offered to everyone, and when can people expect to get the PrEP pill at no cost?

All About HIV

illustration of the human body and HIV symptoms that affects each part of it
Be aware of the signs and symptoms of HIV, because if it is not treated, it can progress to AIDS.

HIV, or human immunodeficiency virus, was once considered a death sentence, and a diagnosis of it can still sound extremely scary today. And while it is a serious virus that attacks the body’s immune system, and which, if not treated, can lead to the more deadly AIDS (acquired immunodeficiency syndrome), there are now treatments that can slow or prevent the progression of the virus. The problem is that there is currently no cure for HIV (or AIDS), which is why it is important for those who are at a higher risk of contracting HIV to protect themselves with PrEP. 

Fortunately, a lot of myths have been debunked about HIV, but there are some things about the virus that might still be surprising to many people, including the following statistics: 

  • In 2018, there were almost 40,000 new HIV diagnoses.
  • Gay and bisexual African American men account for the largest number of HIV diagnoses.
  • Approximately 23% of people living with HIV in the U.S. are women, and about one in nine of them are unaware that they have the virus.
  • Among all women diagnosed with HIV in 2018, 57% were African American, 21% were white, and 18% were Hispanic/Latina.
  • Young adults aged 13 to 24 accounted for more than 1 in 5 new HIV diagnoses in 2018.

When To Consider PrEP

PrEP, which stands for pre-exposure prophylaxis, is a daily medication that can reduce a person’s chances of getting HIV if taken daily; doing so will reduce the risk of getting HIV from sex by more than 90%, and more than 70% for people who inject drugs. A person can benefit from the drug if they:

  • have a sexual partner with HIV
  • have not been consistently using a condom
  • have been diagnosed with an STD in the past 6 monthsa medical needle with the top off
  • inject drugs and share needles with an injection partner who is infected with HIV

Who Can Get PrEP For Free & When?

According to the Centers for Medicare and Medicaid Services (CMS), the drug will be free for people who are insured. They will not have a:

  • Drug copay
  • Lab test copay
  • Coinsurance fee
  • Doctor visit copay
  • Deductible payment

Health insurance companies will have 60 days from July 19th to comply with the new mandate. 

While the new rule currently only applies to those with health insurance, there is some debate on giving access to the medication to everyone, not just the insured. Kenyon Farrow, managing director of advocacy and organizing at the activist group PrEP4All, called upon the federal government “to look for ways to cover people who are uninsured, particularly in non-Medicaid-expansion states, to be able to access PrEP services.” 

“If we’re serious about ending the HIV epidemic,” Farrow said, “we have to ensure equal access to PrEP in all communities and not only for the insured.”

Don’t Mistake HIV for AIDS

Many people think that HIV and AIDS are the same things, using the two words interchangeably. While they are connected, they are two distinct illnesses. 

HIV AIDS written in black surrounded by red dripping colors as a wallpaper.
Many people confuse HIV and AIDS, thinking they are the same. HIV leads to AIDS, but AIDS cannot happen without getting HIV first.

HIV is a virus that can be transferred from person to person, and it damages the immune system. AIDS is the result of HIV damaging the immune system. The health risks of developing AIDS from HIV are so severe that they can cause pneumonia, tuberculosis, and even cancer. 

Our bodies can usually fight off viruses, but this is not the case with HIV.  Because of this, in the past, if you contracted HIV, it was considered a death sentence. However, thanks to constant research and the development of medications, a person with HIV can live a long and healthy life. The medications controlling HIV prevent it from multiplying and reaching higher stages–one of those being AIDS.

What Causes HIV & AIDS?

HIV attacks a type of white blood cell called a “CD4” in the body’s immune system. Attacking these cells inhibits the body’s ability to fight infections. Once contracted, a person will live with HIV for life. There are different ways HIV can be contracted. It is spread by:

Needle point with blood on the tip laying on top of a white counter.
One way that HIV is contracted is by sharing contaminated needles.
  • Bodily fluids exchanged during unprotected sex. 
  • Sharing needles with someone that has the virus. 
  • Receiving a blood transfusion or transplant from blood with HIV(very uncommon these days due to blood screenings before use).
  • Breast milk to an infant from an HIV-positive mother, or to the fetus in the womb.

After contracting  HIV, the virus can progress into what is known as Acquired ImmunoDeficiency Syndrome (AIDS). It develops when infection reaches HIV stage 3. This happens when a person does not get treatment, or is unaware that they have been infected, and the virus multiplies, damaging the immune system to the point that AIDS develops.

The Lack Of Symptoms

When a person is infected with HIV, symptoms are not always present. Usually, after about 2-4 weeks of infection (called acute infection, stage 1) a person might display flu-like symptoms. The symptoms include fever, weakness, a rash, and enlarged lymph nodes. 

However, not everyone will experience these exact symptoms–if any at all. It is the main reason why STD screenings are so important for sexually active individuals. HIV is largely spread during, because during the acute stage the person has no symptoms, and their viral load is large.

Stages 2 & 3

Stage 2 HIV can last up to 10 years or more. You enter Stage 3 HIV when your immune system is so damaged that it can no longer fight off serious illnesses or infections. This is when the virus is now considered AIDS. The earlier a person is diagnosed with HIV, the better their chances of long-term health. 

Cemetery with white tombstones
HIV and AIDS used to mean a death sentence. HIV can now be controlled before it reaches AIDS and the deadly stages.

If left untreated, AIDS can develop anywhere from 2-15 years after contracting the virus. However, this is only a guideline. Each person’s body is different, so the time span for your specific development can be incredibly different in comparison to the person next to you. Here are some determining factors of what slows down the development of AIDS:

  • Overall health
  • Genetics
  • Other infections
  • Strength of the immune system

 

Diagnosis

Diagnosis of HIV can be done with a simple blood test or saliva swab test. It is important to know that it can take several weeks after contracting HIV to get a positive test result. This is because they look for antibodies instead of the actual virus because it’s easier to find our body’s natural response to the virus.

In order to diagnose AIDS, or stage 3 HIV, a doctor has to count the CD4 cells left in a person’s body. A person without HIV will have anywhere from 500-1,200 of the cells. When it drops to 200 cells or less, then a person receives an AIDS diagnosis. 

Treatment

An orange pill bottle laying on a white table, open with white pill falling out of it.
Treatment for HIV is possible, it will not get rid of the infestion. However, it will stop the virus from spreading into later stages.

As stated, if a person catches HIV in its early stages, and receives the proper medication in time, their life expectancy will remain normal. But once a person develops AIDS, their life expectancy drops significantly. There is no reversing the damage done to the immune system. 

PrEP can offer protection to people who are at risk of contracting HIV. Under the brand name Truvuda, the pill contains two medications, tenofovir and emtricitabine, that can stop the virus, even if exposure occurs. The pill can reduce the chance of infection by 92%. 

A person can have HIV without AIDS, but they cannot have AIDS without having HIV first. That is the difference between the two infections. AIDS can be totally prevented if someone listens to their body and gets checked out if they suspect HIV. This is doubly important if that someone also shares needles or has unprotected sex. It is critical to get checked because it can save you from developing a life-threatening illness. Know your status!