One of the most exciting and rewarding parts of my service has been acting as the Care Coordinator in the Jacksonville Area Sexual Minority Youth Network’s (JASMYN) pre-exposure prophylaxis (PrEP) pilot program.
In the last ten years, there have been two major milestones in HIV prevention. The first is known as Treatment as Prevention (TasP). When people living with HIV take antiretroviral medications, the number of copies of HIV in their bodies can get so low that the infection is “undetectable” and the chance of transmission to sexual partners is practically zero. The second milestone is pre-exposure prophylaxis (PrEP). When high-risk HIV-negative people take antiretroviral medications, their chances becoming infected with HIV are reduced by more than 90%. There is currently one medication, Truvada, that has been FDA approved for use as PrEP. Between PrEP and TasP, we have the pharmacological tools to end the HIV epidemic in the United States. Unfortunately, people living with HIV and those at highest risk for HIV face numerous barriers in accessing and adhering to these treatments.
Before 2016, there were no established programs in which people without health insurance could access free PrEP in Jacksonville. This is in spite of the fact that according to the CDC, Jacksonville has the ninth highest HIV diagnosis rate in the country. In Jacksonville, the highest HIV infection rates are in young, Black men who have sex with men (MSM) and trans women. The fact that these rates continue to grow reflect the widespread racism, homophobia, and transphobia in our community.
Fortunately, after many years of advocacy, JASMYN was able to secure funding to implement a PrEP pilot program for young people in Jacksonville. Along with HIV/ STI testing and risk reduction counselling, PrEP is now available at our free Sexual Health Clinic. MSM and trans women disclosing significant HIV risk factors during HIV/STI testing and counselling sessions are referred into our PrEP program. These risk factors can include a high number of sexual partners, inconsistent condom use, a recent sexually transmitted infection, and engaging in survival sex (exchanging sex to meet basic needs, like food and shelter).
Once a client is interested in PrEP, I provide health education and coordinate the medical visits required before a PrEP prescription can be written. I then facilitate client enrollment into a patient assistance program to cover the cost of the medication and arrange the delivery of their medication. After a client has started PrEP, I ensure that they have a medical appointment at least every three months and receive their medication refills on time. I also meet with them regularly to assess medication adherence and address barriers to staying healthy.
Acting as the Care Coordinator for our PrEP program has been one of the most rewarding parts of my service term so far. I feel very privileged to have built close relationships with clients and to bear witness to the obstacles and oppression they face every day. I am also so grateful for the opportunity to engage in direct service to address a critical health disparity with a novel biomedical prevention strategy.
For more information about JASMYN, please click here.
This blog post was written by NHC Florida member, Rachel Marren.
Rachel serves at JASMYN as a Care Coordinator.