One winter night in 2000, Danny, who was 21 at the time, went home with a guy he met at a crowded bar in San Francisco. Random hookups weren't out of the ordinary for Danny, but this one ended badly: As he was buttoning up to go home, his new friend mentioned he was HIV positive. Usually conscientious about safe sex, Danny hadn't been, and he panicked. " I was in shock" he says. "I just couldn't believe it." He vaguely remembered reading about an emergency treatment that could prevent infection, so when he got home he called the California AIDS hotline. Memory served. A monthlong regimen known as post-exposure prophylaxis treatment (PEP)- usually given to health care workers who have been stuck with needles-was available at local clinics and emergency rooms to people who had recently been exposed to HIV. The side effects of debilitating nausea and fatigue were a small price to pay for its potential benefits: A study of health care workers published in the New England Journal of Medicine linked the rapid administration of the drug to an 81 percent decrease in the risk of contracting the virus.
Danny went to a city clinic, where after a consultation, he was given a prescription for two antiretroviral drugs-the same kind that HIV-postive patients have taken since the 80's
Remember that. The same kind patients have taken since the 80's
"Why did you say you'd have to remain calm Drugmonkey?" some of you are no doubt saying. "This story is what medicine is all about, the prevention of disease and maintenance of health are the very essence of medicine, at the very core of what health care professionals do. This is a happy story Drugmonkey. You must be a bad man. "
Read on:
Danny was lucky that California is one of the few states (along with New York, Massachusetts, New Mexico, and Rhode Island) where policies ensure that the general public-not just hospital workers who have been exposed on the job-can access the drugs. Elsewhere, the desicion is up to individual hospitals, clinics and doctors.
You read that right. The decision as to whether to take action to prevent a chronic, fatal if left untreated disease is left up to each individual hospital, clinic, and doctor. Unless you're a hospital worker.
"Oh cut the drama Drugmonkey. So some egghead rule writer never got around to updating policies no one looks at. What ethical clinician would not try to prevent disease?"
Surveying all 50 state health departments and more than 50 ER's nationwide, I (MJ writer Justine Sharrock) encountered STD clinicians and workers at AIDS hotlines and Planned Parenthoods who did not know PEP could be prescribed to the public. An Alabama health department official told me "It's not available" A nurse at a North Dakota clinic said he all but encouraged patients to fly to San Francisco.
Let me......go over a few things as those last two comments sink in.
It's not like PEP is some sort of exotic, special treatment where the meds have to be flown in from the factory within 72 hours. Remember the part about the drugs being the same ones that patients have been taking since the 80's? Here's a common PEP regimen, usually to be taken for 1 month after possible exposure:
Kaletra 400/100mg 1 tablespoonful twice a day.
Plus one of the following:
Epivir 300mg/day or 150mg twice a day or Emtriva 200mg/day
Topped off with Retrovir 200mg three times a day or 300mg twice a day.
There are others, but those of you in the profession get the idea. Any doctor, any Physician's Assistant, any Nurse Practitioner can write prescriptions for these meds. I can almost promise you a pharmacy in your town stocks them. If you have prescription insurance, they're probably covered. They are literally just like any other prescription that goes through my hot little hands in the course of a workday.
Yet a nurse in North Dakota tells people to fly to San Francisco, which is more useful advice than you'll get at certain health departments in Alabama.
As we ponder why, let's apply what I call the "rabies test." Let's say there was a drug protocol that was shown in the New England Journal of Medicine to be 81% effective in preventing rabies after a dog took a chomp on your leg. There were no other proven ways to prevent rabies. The regimen was FDA approved and widely available, yet there were hospitals and clinics that said "unless you're a dogcatcher, we don't feel like giving it to you."
That'd be pretty fucked up wouldn't it?
You wouldn't stand for it would you?
So why is this allowed to stand?
You know why.
It's because gays and lesbians are the new niggers of the 21st century, and if you think they are not in a liberation struggle against the very same forces that held down those of the 20th, I just proved you wrong.
And I remained calm for the most part.