Norway has become the first country in the world to announce that they will be offering the HIV prevention medication PrEP (pre-exposure prophylaxis) completely free to citizens of the country. The drug, called Truvada, can reduce the risk of acquiring HIV by up to 86% with regular daily usage.

Leif-Ove Hansen, the President of HIV Norway stated frankly that “condom use is on the decline and we are happy that PrEP now is an integrated part of the public health service.” It’s a refreshing and important approach.  By making the medication available free of charge, the country is sending an important message that there is no shame and no embarrassment in proactive HIV prevention. Rather than moralizing or judging publicly the decisions that gay men make, a decision was made on practical terms that if men aren’t using protection in their sexual encounters, it’s imperative to reduce the risk in any way possible.

The World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) have both endorsed the drug – especially for homosexual men.

PrEP is currently available in other countries including Canada, United States, France, and South Africa but the high price of the drug makes it difficult to access. Norway is the second European country to obtain it but the first to offer it for free. In the U.S, PrEP is included in many insurance plans, while France reimburses the cost of the drug to patients submitting receipts. The MASS Medical Case Management program offers services for eligible clients to assist with obtaining PrEP in the Newport News, VA area.

Teymur Noori, from the European Centre for Disease Prevention and Control (ECDC) said that Norway may inspire other countries for similar implementation, however that is a process that can take years. But already, more than a dozen countries are actively pursuing demonstration projects.

The ECDC is prioritizing the men who have sex with men (MSM) population in Europe in supporting access to PrEP because MSM transmission is the only mode of transmission that has shown an increase in HIV infection.

Noori notes that data reveal an increase of 42% over the last 10 years, and MSM made up 40% of all HIV cases in
2014.

Keith Rawlings, MD, director of HIV medical affairs for Gilead Sciences in Foster City, California, said countries should look beyond targeting only MSM.

In the United States, for instance, where PrEP has been licensed since 2012, risk varies greatly by geography, sex, and race.

The CDC estimates that about 1.2 million people may benefit from PrEP in the United States, although not all would necessarily use it due to the stigma attached to it.

“While about 40% of those people are MSM, about the same proportion are actually women,” Rawlings said.

Dr. Rawlings also described a significant racial and sex differentiation even within the MSM population. One in 2 Black MSM in the United States have a lifetime risk of getting HIV, while 1 in 4 Hispanics and 1 in 11 white MSM have the same lifetime risk. However, most of those receiving PrEP in the US are white. He said white males are more than six times as likely to receive PrEP as their Black or Hispanic counterparts, while white women are about four times as likely to start on PrEP as their Black or Hispanic counterparts.

Addressing these gaps and finding subgroups of people who carry the most severe burden of HIV infection will be important for all countries, Dr Rawlings said.

The Intake Specialists and Case Managers at MASS conduct individual needs assessment and development of comprehensive service plans, as well as complex HIV/AIDS and STD treatments to clients and inmates.

MASS has implemented HIV testing and a group level intervention in the numerous Hampton and Newport News jails, as well as, established a presence at many community fairs for National HIV/AIDS Days during the year.  MASS has provided HIV testing and prevention services to over 1000 inmates and clients in the communities which are high-risk for HIV/AIDS.

MASS will be on location November 30th at Norfolk State for a World AIDS Day testing event from 10am-4pm. Case Managers will be on site offering free testing and they will also have more information on PrEP for all that are interested.