RN, BSN
In 1981 the first official report of what will be knows as acquired immunodeficiency disease (AIDS) was reported in the United States. This became the start of the AIDS epidemic. Since then, it has been established that HIV is transmitted by sexual contact, contaminated needles and before guidelines were put into place blood transfusions.
HIV is a virus that attacks cells that help the body fight infection, making a person more vulnerable to other infections and diseases. If left untreated, HIV can lead to the disease called AIDS, which is the last stage of infection that occurs when the body’s immune system is badly damaged because of the virus.
By the early 1990s, HIV was the number 1 cause of death among Americans ages 25 to 44. Since 1981, when the AIDS pandemic started scientists and researchers were trying to find a cure for this disease that was taking over healthy young people. In 1987, the antiviral drug Retrovir was introduced to treat HIV. Retrovir had drawbacks, it did not work well on its own and it cause liver problems and deadly low blood cell counts. At the time it was the most expensive prescription drug in history, with a one-year price tag of $16,500 in today’s dollars.
In 1995, The Food and Drug Administration (FDA) approved Saquinavir, the first in a different anti-HIV (antiretroviral) drug class called protease inhibitors. A year later, another class of antiretrovirals, called non-nucleoside reverse transcriptase inhibitor (NNRTI), including nevirapine (Viramune). These drugs paved the way to a new era of combination therapy for HIV/AIDS.
Finally, there was a combination of prescription drugs called highly active antiretroviral therapy (HAART) that greatly lengthened the life span of people with AIDS. HAART required taking multiple pills a day each one having their own side effects. This drove many people to quit their HIV therapy. Prescription drugs are not successful if patients cannot take them due to cost, or unwanted side effects. Unfortunately, none of these therapies cured HIV or prevented HIV from being passed on to sexual partners.
That changed in 2012 when the FDA approved Truvada for a PrEP indication, for people who do not have HIV, to prevent them from getting it when they have sex or inject a substance. Of course, being aware of your own status as well as any partners is key in keeping healthy and obtaining early treatment.
PrEP works by preventing HIV from replicating in the body. It acts as a catalyst that helps the body produce antibodies, which help diseases causing germs and viruses. Used correctly, PrEP eliminates the risk of contracting the virus after exposure. PrEP, taken the right way, is quite effective against HIV contact. It prevents HIV infections 99% of the time.
Before starting the PrEP medication, you need to have an HIV test. If the patient has HIV, taking the tablet increases the likelihood of developing drug resistance. Before taking PrEP medication, patients are required to get input from a healthcare professional.
In the United States, 15% of HIV-positive individuals who are unaware of their status contribute to approximately 40% of new HIV transmissions. Early diagnosis and prompt treatment can help reduce HIV transmission and lower the viral load, preventing the spread to potential partners. One effective method for decreasing new HIV infections is the use of PrEP medications.
As of January 2019, the FDA has approved three PrEP medications:
Due to its effectiveness as a preventive measure, the Affordable Care Act (ACA) mandates most health plans to cover PrEP at no cost to patients. Additionally, copay assistance programs like the Truvada and Descovy copay cards, and generic options through GoodRX, such as emtricitabine/tenofovir, can help reduce costs to less than $30 for a 30-day supply.
According to the CDC, PrEP is safe, but some people experience side effects like diarrhea, nausea, headache, fatigue, and stomach pain. These side effects usually go away over time. Unlike the Retrovir which was highly expensive, PrEP is more attainable.
Most health insurance plans, including Medicaid, cover the cost of PrEP without co-pays. This includes the medication, medical appointments and lab tests associated with PrEP. There are also options for people who do not have health insurance or prescription drug coverage. For people without access to health insurance or prescription drug coverage, a number of options for financial assistance are available, including:
It has been established that PrEP reduces the risk of getting HIV from sex by about 99% when taken as prescribed. Finding an affordable, safe, easy to administer HIV drug is not the problem anymore, the issue is spreading awareness and access to PrEP.
A 2020 study led by researchers at the Johns Hopkins Bloomberg School of Public Health found that just under 20 percent of HIV-uninfected patients visiting Baltimore sexual health clinics were aware of PrEP. There are companies out there who are helping to help greatly reduce if not eliminate HIV in the United States.
Ready, Set, PrEP makes free daily oral PrEP medications available nationwide, and is a key component of efforts to end HIV in the United States. The organization says, “Together we can reduce the number of new HIV transmissions in the United States by 75% by 2025 and by at least 90% by 2030.”
Nurses play a crucial role in the treatment and management of AIDS. They can help in various ways, including the following:
By performing these roles, nurses can significantly contribute to the treatment and management of AIDS, improving the quality of life for individuals living with HIV and working towards reducing the spread of the virus.
Over the past four decades, significant progress has been made in the fight against HIV/AIDS, with the development of safer, more affordable, and effective prescription drugs. From the emergence of the AIDS epidemic in 1981 to the breakthrough of pre exposure prophylaxis (PrEP) medications, individuals can now take greater control of their health and reduce the risk of HIV transmission. PrEP, covered by most insurance plans and accompanied by financial assistance programs, has made HIV prevention more accessible than ever.
Despite these advancements, the primary challenge now lies in raising awareness about PrEP and ensuring that eligible individuals have access to this crucial preventive measure. By working to increase PrEP knowledge and encouraging HIV testing for at-risk patients, healthcare professionals, particularly nurses, can play a vital role in reducing the number of new HIV infections. Through collaborative efforts between medical professionals, patients, and organizations, it is possible to achieve the ambitious goal of reducing new HIV transmissions in the United States by 75% by 2025 and by at least 90% by 2030. With a united front, we can continue to make strides in combating HIV/AIDS and improving the lives of those affected by this disease.
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