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July 9, 2018

MNHC PrEP Clinic offers Options to Help Prevent HIV among Latino Gay Men

HIV continues to be a serious threat to the health of the Latino community. According to the Centers for Disease Control (CDC) in 2015, Latinos accounted for about one quarter of all new diagnoses of HIV in the United States, despite representing about 18% of the total US population. The HIV diagnosis rate among Latino men is more than three times that among white men. Seventy-five percent of new diagnoses among Latino men occur among men who have sex with men (MSM). Additionally, while new HIV diagnoses among MSM overall stabilized between 2010 and 2014, diagnoses among Latino MSM increased 13 percent during this period.

To better understand the reluctance of Latino men in San Francisco to seek healthcare services and to evaluate their health literacy, MNHC’s Clínica Esperanza conducted a focus group with the Hermanos de Luna y Sol (HLS) participants. HLS is the HIV prevention support group from MNHC located at the Latino Wellness Center. Findings revealed a low awareness of HIV prevention among the participants due to fear of being a guinea pig, fear of side effects, a notion that taking drugs to prevent the spread of HIV was a conspiracy, homophobia, fear of being “outed”, shame about sexuality, lack of access to healthcare for young men, especially those who are undocumented, and just general mistrust and fear of the healthcare system.

To address these issues, in late 2015 Clinica Esperanza staff launched a targeted health education outreach strategy for community members to gain awareness about the use of PrEP to prevent HIV. This effort grew into the opening of a formal PreP (Pre-Exposure Prophylaxis Treatment) clinic.

PrEP consists of providing individuals who do not have HIV and are at substantial risk of getting the infection a daily antiretroviral pill, Truvada® along with ongoing monitoring. In 2011, the CDC recommended the use of Truvada® prophylactically to prevent acquiring HIV. When taken consistently, PrEP has been shown to reduce the risk of HIV infection in people who are at high risk by up to 92%.

After an initial intake process and appointment with a nurse practitioner, MNHC PrEP patients are prescribed one pill of Truvada/day. They must return every three months for HIV testing, labs, testing for other sexually transmitted diseases and treatment, if necessary. Patients also receive assistance on how to navigate their insurance, and payment assistance through the drug manufacturer, Gilead Sciences.

The clinic is held on Thursday nights from 6:00pm – 9:00pm at the Shotwell location.

“Studies have found that Latino men are typically late healthcare adopters,” said Shaddai Martinez-Cuestas, director of HIV Services at MNHC. “The clinic was designed to address this issue and we are pleased that retention is high and patients are engaged in maintaining their health status.”

While the targeted outreach has focused on Latino MSM, the PrEP treatment is open to all populations, including trans women as well as other ethnic groups. It could also include women who are HIV-Negative with an HIV-Positive male partner, or a woman w/ multiple male partners.

In addition to the efforts at MNHC, Clinica Esperanza and Instituto Familiar de la Raza, received a grant from the Department of Public Health, Community Health Equity and Promotion Branch for establishing navigation services for the PrEP clinic at MNHC, as part of a larger citywide PrEP awareness and linkage program. In July 2017, a PrEP navigator and a coordinator from IFR joined the clinic team. The City Clinic navigator was essential in training and supporting the transition.

The PrEP clinic currently treats nearly 40 active patients and has treated a total of about 100 patients since its inception. Attrition rates are expected based on a patient’s own risk assessment and behavior.

“We hope to continue to provide ongoing access to this critical prevention tool to those in need minimizing any barriers to access,” added Shaddai. “We know it makes a difference.”

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