Andy Fyne – HIV Prevention Manager

SB 159 was just signed into law by Governor Gavin Newsom. This important law has the potential to help Marin County further reduce its 20 new annual HIV infections by making powerful HIV prevention medications easier to access.

Fred’s date last Saturday was going well – really well!  Until, that is, he noticed that the condom broke.  His date told him that he hadn’t had an HIV test in a few years, and Fred feared that he may have been exposed to HIV.  Fred thought about PEP – a 28 day course of medication that has shown to help in blocking infection.  He knew that he needed to get on the drug within three days – and the sooner the better. No way was Fred going to go to an emergency room, and he wouldn’t be able to see his Doctor within three days.  He told himself he would just “roll the dice,” and Fred rolled over to sleep.

This is a fictitious scenario; but, it underscores the fact that PEP (post-exposure prophylaxis) is difficult to come by – especially given that it needs to be started as soon as possible after exposure to HIV if it is to work.  What if Fred could have gone to an all-night drug store for PEP?  Given his reluctance to go to an emergency room, the only community source available today for PEP in Marin besides a health care professional, could a pharmacy have made a life-changing difference?

The authors of Senate Bill 159, which authorizes pharmacists to furnish both PEP and pre-exposure prophylaxis (PrEP)to patients without a physician prescription, definitely think so. (PrEP is a medication taken by HIV-negative people to prevent becoming infected.)  The law, signed by Governor Newsom, goes into effect on Jan. 1, 2020. It is the first law in the nation to permit pharmacists to furnish both  PEP and PrEP without a prescription. The thought is that having PrEP and PEP available in more locations throughout California will help more people to take these preventive drugs and speed the HIV epidemic to an end.

State Sen. Scott Wiener, D-San Francisco and a co-author of SB 159 correctly asserts that we still have enormous work to do to increase awareness about PEP and PrEP and to make them easier to take. “Right now, it is still too hard.  Not everyone wants to go see a doctor.  They either don’t have a primary care physician, don’t know where to go, or it might take them months to get an appointment. And unfortunately, there are still too many physicians who don’t understand PrEP, make judgments or try to talk people out of it.”

Work also needs to be done to end the racial disparities we see with PrEP uptake.  Young gay men of color go on PrEP at lower rates than their white counterparts, despite being at higher risk of infection..  There is hope that simplified pharmacy access to PEP and PrEP in people’s communities, will increase our ability to protect lives.

The Spahr Center is currently organizing key figures in the county to discuss the opportunity that pharmacy access to PEP and PrEP holds to reduce the 20 new HIV infections that occur in the county each year, and how best to implement this new prevention approach.