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tv   Inside Story  Al Jazeera  January 30, 2015 5:00pm-5:31pm EST

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>> preventive drug unraveled the message delivered day after day. play safe. three years ago nicholas had the scare of his life. >> i had put myself at risk by having unsafe sex. i learned that they didn't
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disclose their hiv status. >> gourdine ended up testing negative for hiv, but the experience left him shaken, and the new awareness of what engaging in risky behavior could mean. >> i was concerned, devastating. that is the one word that describes it. >> now he takes a daily pill which he says protects him from ever feeling that fear again. it's part of an overall program called prep or pre-exposure to propalx. it it protects against infection by 92%. >> hiv does not get into the cells. it's met on the surface of the cells by the drug. >> the program includes taking truvada every day and checking in with a doctor every three months.
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a year of truvada costs $13,000, but most health insurers cover the drug. only an estimated 4,000 people who are hiv negative are taking it. a clinical research director at whitman walker one of washington, d.c.'s oldest clinics serving the gay community. he said that the prep's adoption especially in a high-risk population, could be the answer. >> washington, d.c. has the highest prevalent of any urban city hiv in the united states. we're shy of 3% overall of the population, which is higher than some rates in countries in africa. if you're african-american, and you have sex with men, and you're between the ages of 20 and ho, your chance of having hiv would be one in five. >> for decades gay health advocates have centered on condom use and awareness on status.
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in the 1980's when contracting a.i.d.s. was essentially a death sentence, that message work. now officials are skeptical of promoting prep. >> i'm afraid we're losing those skills if we say we don't have to have those conversations any more. why bother if people are hiv positive and taking medications as they should or negative and taking their prep. in a way it could be viewed as an excuse for not taking responsibility for our actions. >> for many , they worry about an experience gap where today's young people have no idea what it was liking to through the early days of the hiv crisis. >> we have a major crisis going on in the united states, specifically in youth. and in youth we have about 18%
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of people who are hiv positive and they don't know their status. >> earlier this month the washington, d.c. lgbt community center tried to bridge this gap by offering a free photo shoot for anyone who was tested in hiv because many young people in washington, d.c. don't know their ohio status. every year there is an estimated 50,000 new cases in the united states. >> youth think a whole lot differently than in my generation. if you were 10 years old in 19 6, you've never seen that death and dying. we changed our about behaviors because of being afraid of dying devon has chosen to take truvada. >> there is angst just because of seeing so many of your
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friends die off, and not wanting to see that happen, but we have to recognize that we are in a different space in the epidemic. >> he knows he lives and dates in a community with some of the highest hiv infection rates in the country. >> i know the statistics not just from a place where i read them on paper, but those are my friends. those are people in my social network and people in my community. at this point in my life i do know more men who are hiv positive than negative. >> every week barrington war ward talks with other african gay men about tough topics surrounding sexuality. >> when we're talking about the conversation of being for or against prep, i think that's the wrong frame. we really should be talking
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about giving people choices and access to additional per convention. preconvention. this is an opportunity to take some responsibility for my own sexual health, and those who are taking responsibility for their own sexual health as well, and not place that burden or their sexual health in someone else's hands. >> as the current rate of hiv infection there could be a half million new cases over the next ten years. the question is with will a wider use of truvada will help slow the virus' spread. >> pre-exposure and preventing the spread of hiv this time on the program. does the use of drugs like truvada nuclear risky behavior by removing the looming danger
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of contracting the virus that causes a.i.d.s. or is it an insurance policy where moralizing won't stop real people from making sometimes less than ideal choices. joining us for that conversation whitney, senior director of the public health division at the a.i.d.s. healthcare foundation in los angeles. justin, at the whitman walker health clinic income washington, d.c. and from new orleans, deon haywood, executive director of women with a vision. given the direction of research. where the dollars were going wasn't a preventive medicine. always one of the next steps some place that we would have to anticipate going. >> we certainly want to find a
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vaccine and certainly we want to find a cure. unfortunately, vaccine has not gone anywhere, and we have not found a cure for hiv. >> is truvada just a great new weapon in your armament, or does it need to be carefully negotiated with an at-risk population? >> it's not really new, but people living with hiv have been taking truvada for some time and it's a very effective tool for those living with hiv. the question and the new part is whether people who are not infected with hiv should take the drug. i think that's still something that we need to talk about, and i think that's something that we need to talk about how we talk to populations about it, how we talk to the gay community and all communities about it. if you take the pill, it does not mean that you don't take other things to protect yourself.
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that's the problem with the current discussion happening. >> justin, as whitney suggested, you can still do other things, but do other things sort of fall by the way side because of human nature? >> the? would tell us that's probably not the case. and the idea of syringe exchange, there was the fear that people would use more drugs. that played out to be the option, and it has been shown that adoption of prevention strategyies have not changed much. that is if condoms work for you, they'll continue to work for you. and strategies have to be part of someone who is in care and
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prescribed truvada or any other trug that comes along. >> deon, is it a different case for women? are they particularly vulnerable vulnerable, and does this put at least strength on their side of the table when negotiating their sexual lives? >> you know, when you think about women and prevention, and what i've heard from clits from clients, it will probably be up to the individual what that would mean from prep. how accessible is it for them. are there living conditions where they're in a place where it should be taken. >> so when you're doing
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counseling and introducing prep into the conversation, do your clients say yes, that sounds like something i would like to try? >> some of them have said yeah i would like to try. but some of them have said, i'm not stable. if you're homeless, if you're in a domestic violence situation, it may be difficult for people to adhere, and some have concerns about what it's going to do to me. what are the side-effects to living every day life. those are some of the things that we see women ask. >> that's where we'll continue. we'll be back with more inside story with a short break. we'll continue our look with drug-based strategies to stop the spread of hiv. is the this is medicine one that
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>> we're back with inside story on al jazeera america. i'm ray suarez. the world can look back on 35 years of terrible human tragedy, and now more than ever triumph. medicines have reduced mother-to-infant transmission, and added years of healthy life to people infected around the world. millions around the world are still infected by hiv. today we're looking at drugs when used by high-risk people can stop the spread of hiv. justin goforth, what has been the change when you look back at the change of the introduction of anti-retro virals. that could be a test case of how people take on new information and use it to inform the choices they make in their lives. >> that's a good point. we have effective anti-retro virals as far as stopping the
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spread of hiv in the mid '90s but it's now changed to once a day regiments instead of five times a day. we look at the option of staying on treatment as an effective way of keeping someone healthy that is liveing with hiv. pre-exposure prophylaxis is in its infancy. the one-pill truvada today is not the pre-exposure prophylaxis of 2016 and 2017. it will continue to evolve, and we'll find easier ways to dose this. less than once a day would be great. an injectable is an injection every three months. we're really in the beginning of trying to figure this out as a
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public health intervention. >> until that world gets here. >> sure. >> what can the way people integrate treatment in their lives tell us about how people will use prep? for instance, did people think oh well, if i get hiv i can live with it. it's a manageable disease, so it's not as dangerous as i might have thought that it was before? >> that's hopefully where people are thinking. i think much of the community does not understand what you just said yet. what you said is the truth of where we are with hiv treatment, that it is a chronic manageable illness if you stay engaged in care and stay on treatment. at first you have to have an awareness, and then education, and then adoption and engagement and care. all of that has to happen with pre-exposure of prophylaxis. we're just at the beginning of that. the most affected communities
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that could use this inter presentation has almost no awareness that this exists. >> unfortunately, the way a lot of americans think about hiv and a.i.d.s. is stuck in past decades. they don't think of it as a small town, southern or rural disease. what should people know in 2014 about not los angeles, new york, san francisco and miami, but vicksberg and huntsville and places like that. what do you do to keep from becoming positive in those places? >> here in the south many of us, as you may have heard from the social determinants from health. if you're in a rural area people have access--lack of access to healthcare. it's hard based on transportation to get where you
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need to go. many of us, like here in louisiana, we live in states where governor has not accepted medicaid expansion, and so all of the things, poverty education, unemployment, all of those things are still issues here throughout the south. and also contributes to people being at risk for hiv also making it hard for people who are hiv positive, and living with hiv needs, hard for them to access services as well. the criminal justice system place a large part. the fact that we have not adopted legal syringe access here in the south has made it difficult. >> that social profile that you laid out, when we talk about truvada, it's a very expensive medication, but we're also talking about a population that has trouble accessing medical
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care and is at risk for infection. where does prep fit into that profile? >> i'm really not sure.y not sure. hiv continues to be one of those things that where those at the bottom still have a hard time accessing medication, getting to their doctor's appointment and fitting in with their every day life. there will be people who will be able to access it easily, and there will be people who cannot, and it will be some of the same things that i feel like we're seeing now around who has access to the best medication. who has access to the best care . i've had clients in the last couple of months they can't afford medication or some medications are not available. they're waiting for medication so they can take it as part of their anti-retro viral
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cocktails. i think if we don't look at systemic issues, the hiv in the south, i don't know if much will change. >> if this is not a silver bullet, is there an ideal answer given the nature of the risk where it may be introduced first as a way of piloting this and learning some lessons before moving forward? if you're right now not hiv positive but you're sexually active, who should be on truvada. >> well, i think we need to retune the conversation. i think its possible that pre-exposure prophylaxis is something as talked about earlier might work in the future. but having to take 365 pills
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does not seem like a really good idea. just as an example i think it was mentioned earlier that the anti-retro viral therapy has been around for a while, but less than 30% of people in this country are virally repressed. we have to work on the idea that people are going to take this medication every day. think about your lives and whether or not when you get that bottle of antibiotics, whether you take the whole dosage. we can't just throw out--we can't throw out condones. we can't throw out the things that we know work and has kept people safe for many years just because we have truvada as prep. it's terribly expensive, and we need to have a conversation as a community about how we're being
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taken advantage off by the of by the drug companies. >> when prophylaxis is used in a wealthy country to stop the spread of hiv, it can make financial sense because a.i.d.s. is expensive to treat. dollars and cents, justice and fairness, does geography and bad luck mean that the world's poor >> i'm ali velshi, the news has become this thing where you talk to experts about people and al jazeera has really tried to talk to people, about their stories. we are not meant to be your first choice for entertainment. we are ment to be your first choice for the news.
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>> you're watching "inside story" on al jazeera america. i'm ray suarez. we've been talking about drug developments in hiv treatment. health workers have tried to get people to change how they cover
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a.i.d.s. but for the poor, does it change that much at all. deon, you mentioned that you're working with populations who may not have reliable access to healthcare, so they may resemble much of the rest of the world in asia and africa. do you anticipate the cost of the drug will come down as it did for arvs, and until it does, is there going to be a social justice dimension through the introduction of truvada? >> i'm hoping it does. because as it stands right now many of the people that we see and work with, many people throughout the south, it doesn't
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help them if this doesn't. the right for prevention programs that fit communities instead of a one-stop shop, and making sure we hold elected officials and health departments responsible for the type of services that our communities is giving and what they should give. >> whitney, just before the break you called out gilead, the company responsible for developing this drug. what's worked in the past? a.i.d.s. drugs have come down in price tremendously over the years. can't we expect that truvada will do the same? >> well, that would be great. it's come down a lot in the developing world in african countries. for instance, the same drug you're talking about would cost less than $500 in an african nation for a year.
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it really is outrageous that we're paying this soul. gilead has made it's money. they could really charge $1 a bill, and it would be okay. it's the state of our affairs that we're not pressing on them to lower that price. and rather they like to see how much they can exact from communities. >> anyone watching this program could conclude that we're not home and dry yet. that truvada is not the final answer to anything, but does it bring in an exciting possibility for its use in uninfected people at least as a bridge to somewhere else? >> i think it's very exciting. those who work in public health, it's incumbent to decide who this is a good prevention for and get it to them.
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the data of effectiveness if taken as prescribed is extraordinary. we don't get that kind of data around prevention. condoms, years and years of condom research shows that there is 60% to 80% effective if used consistently. if you use truvada consistently we're talking 90 per season tile in prevention against hiv. this is exciting. i would like to say around the financial issue, gilead has a very generous patient assistance program. if you're low income, gilead will help you get access to this drug. >> to our guests, thank you all for being here with me today. that brings us to the end of this edition of inside story. thanks for being with us. in washington, i'm ray suarez.
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somebody once said to me "what's the difference between gay marriage and straight marriage?" i said, well, there really isn't a difference. >> in 2008, voters in california approved proposition 8, which bans same-sex marriage in the state. two couples challenge the law in a case that went to the u.s. supreme court. half of the plaintiff team is chris perry and sandy steer. >> you grow up believing you are a second-class citizen from the moment you recognize you are gay or lesbian. and until recently, you didn't think you ever would be equal. >> the other couple involved in


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