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The Daily Tar Heel

Orange County offers new HIV medication

The Orange County Health Department is offering prescriptions for pre-exposure prophylaxis, known as PrEP — a preventative medication for individuals who are at high risk for exposure to HIV.

Dr. Christopher Hurt, a clinical assistant professor at the UNC School of Medicine, said PrEP works by preventing a permanent HIV infection before a person comes in contact with the virus.

“It’s kind of like having a shield inside your cells that helps protect them from HIV infection,” Hurt said. “Rather than having a physical barrier like a condom, it’s like having a chemical barrier.”

Stacy Shelp, spokeswoman for the health department, said the growing rate of HIV infection in Orange County was a significant reason for introducing PrEP.

“Obviously, we don’t have as high an incidence as some other larger counties, but we have seen kind of a consistently growing rate of infection,” Shelp said. “In 2011, we had 13 cases. In 2012, it was 15 cases. In 2013, it was 17 cases. Every case is one case too many.”

According to a press release from the Orange County Health Department, the Centers for Disease Control and Prevention has determined that when taken consistently, PrEP reduced the risk of HIV infection in high-risk individuals by up to 92 percent.

The health department defines high-risk individuals as couples in which one partner is infected with HIV and the other is not, men who have sex with men and engage in high-risk sexual behaviors or have been diagnosed with a sexually transmitted infection within the last six months, heterosexually active men and women who do not use condoms regularly and people who use IV drugs and share needles.

Shelp said any person who comes to the sexually transmitted disease clinic and is willing to have the appropriate counseling, blood tests and follow-up work is eligible for the program.

Andrea Mulholland, a family nurse practitioner with the health department, proposed at a meeting of the Orange County Board of Health in August that Orange County should begin to prescribe PrEP.

“Based on my practice here, a lot of people do not use condoms, despite the role condoms play in risk reduction and that they are freely available,” Mulholland said at the meeting. “Therefore, we need to be thinking ‘outside the box’ and discussing innovative ways to prevent new HIV infections. PrEP provides us a way to do so.”

PrEP prescriptions are filled by the UNC Health Care Patient Financial Assistance Office, which allows the health department to dispense one-month prescriptions for $4.

Individuals who receive the treatment are required to attend follow-up appointments every three months so that the health department can recheck HIV status, test for pregnancy and assess kidney function.

According to a report from the North Carolina Department of Health and Human Services, from January to June of 2014, there were 12 cases of HIV reported in Orange County. There were seven cases of AIDS.

Hurt said it takes approximately eight to 10 years before the HIV infection will advance to AIDS, which causes severe immune deficiency.

“We see AIDS in people who avoided getting tested for whatever reason,” Hurt said.

“A lot of those patients are people who didn’t think they had any risk, and unfortunately, we’re seeing a lot of Latino people who are undocumented and who are afraid to get tested because they do not want to be reported to immigration and be deported.”

Hurt said he realizes talking to health care providers can be embarrassing, especially for young people. He said he has been working to create a safe environment for people to discuss their sexual health.

“We are working with the North Carolina AIDS Training and Education Center to put together a list of providers in the Triangle area and across the state that are willing and knowledgeable in providing PrEP,” said Hurt.

He said the information will be put on the center’s website within the next couple of weeks.

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