Michigan looks to fix dismal ranking in PrEP coverage to curb the effects of HIV ⋆

Only about 20% of individuals in Michigan who are at high risk of being exposed to HIV, which if untreated can lead to AIDS, are prescribed prescription drugs to prevent contracting the virus.

The prescription drugs, pre-exposure prophylaxis, commonly known as PrEP, are up to 99% effective at preventing getting the HIV virus through sexual intercourse. Michigan’s state health department is trying to raise Michigan’s state ranking from ninth-worst for PrEP coverage.

The ranking doesn’t paint Michigan in “a great light, but it’s real,” Amy Peterson, manager of the HIV and STI Prevention Section at the Michigan Department of Health and Human Services, (MDHHS) told the after the department announced a campaign to raise awareness for PrEP usage.

The “MIPrEP. MIChoice” campaign includes personal stories from Michiganders who use PrEP and includes a questionnaire, which can be utilized anonymously to see if users are good candidates for PrEP and see what are the options in terms of health coverage.

One of the biggest barriers to accessing PrEP is not having health insurance, as there are ongoing appointments with care providers and lab testing needed to monitor the effectiveness of the medication, Peterson said.

And those groups who often have less access to health care are most susceptible to contracting HIV, said Drake Collins, prevention specialist at Corktown Health Center in Detroit.

Black or African-American communities are most impacted by HIV in the U.S., the CDC reports. They accounted for about 40% of all new HIV diagnoses in 2021, as opposed to their white counterparts who made up about 25% of new diagnoses.

“I think it really kind of comes down to so many things particularly with people of color. It’s all those social determinants of health. You have medical mistrust for very good and valid reasons. You have just general lack of access; you have lower income, less insurance; less access to transportation. All of those things contribute not just to when we’re talking HIV, but to healthcare overall,” Collins said. “In general, Black folks in particular have worse outcomes than any other demographic.”

Men who have sexual contact with men, or MSM, eclipse other groups in the U.S. for new HIV diagnoses, accounting for 67% of all new diagnoses in 2021. But while 1 in 11 white MSM are estimated to be diagnosed with HIV within their lifetime, the Centers for Disease Control and Prevention (CDC) estimated in 2016 that 1 in 2 Black MSM will be diagnosed in their lifetime.

PrEP has been on the market for about 11 years, but advertisements have focused pretty singularly on LGBTQ+ audiences, Collins said, with it being advertised on LGBTQ+-centric programming. Meanwhile, about 20% of new diagnoses for HIV each year are through heterosexual contact.

Peterson said this public perception that PrEP is only for those in the LGBTQ+ community, specifically gay men, can keep the eligible population of people who identify as heterosexual as feeling like it’s not for them — which really drives down state utilization.

In response, Peterson said the state is moving forward on another public awareness campaign this summer that is specifically for Black women, with the primary target being Wayne County in Southeast Michigan.

Christopher/Caj Monet is featured in MDHHS’ MIPrEP MIChoice campaign | MDHHS photos

Detroit, which has a Black population of 76%, is Michigan’s hotspot for HIV prevalence. Corktown Health Center, an LGBTQ+-centered facility, has focused on HIV care, having originally started as a support services organization for people living with HIV, Collins said.

“If you go to any just random primary care provider across the state, there are a great many of them who don’t know what PrEP is, or don’t just don’t feel comfortable with the information to feel like they’re ready to prescribe it. And of course, there are also a lot of them who are actively opposed to it,” Collins said.

For many people in Michigan, urgent care is the primary point for interactions with the health care system, Peterson noted. People get treated for whatever the pressing medical issue is and larger conversations that include things like sexual health and sexual history aren’t prioritized.

One of the goals with the “MIPrEP. MIChoice” campaign is that patients will know how to ask about PrEP by name, and health care professionals will have the knowledge and comfort level needed to have conversations about sexual health and whether PrEP might be right for someone.

There are physicians who hold personal beliefs that limit their willingness to address HIV or prescribe PrEP. But in terms of what’s keeping the numbers down of people taking the medication, Peterson believes it’s an overall discomfort with talking about sex, both from providers and patients.

“I don’t think it’s about PrEP specifically. … If you have providers who are comfortable testing for HIV and other sexually transmitted infections … those individuals are likely comfortable talking about PrEP,” Peterson said. “I think it’s really about talking about sex. …There’s still a lot of stigma around sex and sexuality and acknowledging pieces of [our lives] that others may have judgment about.”

authored by Anna Liz Nichols
First published at https%3A%2F%2Fmichiganadvance.com%2F2024%2F01%2F24%2Fmichigan-looks-to-fix-dismal-ranking-in-prep-coverage-to-curb-the-effects-of-hiv%2F

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