This pill prevents HIV, saves lives. Here’s why Mecklenburg doesn’t offer it.

Counties across America are offering the poor and uninsured a drug that can stop the spread of HIV.

But in Mecklenburg County, which has one of the highest HIV infection rates in the nation, the people most at risk still can’t get the drug more than five months after county commissioners agreed to pay to expand its use.

In June, county commissioners set aside $248,000 to plan for HIV education and distribution of PrEP, a drug that provides near-total protection against HIV from sex.

But any strategy won’t be in place until next year at the earliest. County Manager Dena Diorio said officials are still considering ideas for how to spend the money.

AIDS activists and some county commissioners say that means hundreds of people – the vast majority African-Americans and gay men with low incomes – remain at high risk for the virus because they cannot afford the drug and follow-up testing or don’t know it exists.

“My people are still dying,” said Commissioner Vilma Leake, who represents a west Charlotte district hard hit by the virus and whose son died from AIDS. “The Health Department had a responsibility and has done nothing with it. We have done absolutely nothing to correct the problem of AIDS. Where is the action?”

Eighty-seven deaths in Mecklenburg were attributed to HIV in 2015, according to a Emory University report. At least 6,630 people in Mecklenburg County are living with HIV, a more than 30 percent spike since 2012, a recently released county report says.

County officials will present plans for how to spend the money before the end of the year, Diorio said in written responses to Observer questions.

Diorio said one possible option is adding staff needed to distribute PrEP. She said the county spends more than $3 million a year on HIV testing, counseling and other services, a 22 percent increase from three years ago. The Health Department’s annual budget is roughly $72 million.

But at a county commissioners meeting late last month, other officials said the county had not done enough to stop the spread of HIV and more money is needed.

In an interview, Commissioner Trevor Fuller said it appears county leaders have failed to make HIV prevention a priority.

“I don’t understand it,” said Fuller, who has lobbied for more than a year to make PrEP widely available. “We have had this problem for years. I don’t know why we haven’t addressed this with urgency.”

Jaysen Foreman-McMaster, who works as a benefits manager at RAIN, a nonprofit that supports people living with HIV and AIDS, sees clients trying to decide whether they can pay for medical care or other basic needs.

Foreman-McMaster, 38, also has personal experience with PrEP. He contracted HIV in 2005 and now his husband takes the drug.

Given the high incidence of HIV, Foreman-McMaster said he can’t understand why Mecklenburg County has done so little to advance the use of PrEP.

Like other large counties, Mecklenburg should advertise on billboards, buses and other places to raise awareness about the drug, he said.

“In Mecklenburg County, we talk and we talk,” Foreman-McMaster said. “But unless it’s a new sports stadium, we don’t take action.”

‘Tragic missed opportunity’

Mecklenburg officials have pledged in recent years to eliminate all new HIV infections by 2020.

Mecklenburg’s rate of 30.4 new infections per 100,000 is lower than three years ago, but still more than twice the national average and nearly twice the state average.

Activists and researchers say leaders in Atlanta, Nashville, Houston and other southern cities have either completed or are starting plans that emphasize the distribution of antiretroviral drugs such as PrEP. The drugs generally work by lowering the amount of virus in the bloodstream to levels that make transmission highly unlikely.

PrEP (pre-exposure prophylaxis) is sold under the brand name Truvada, which has been approved for use since 2012. The federal Centers for Disease Control and Prevention and the World Health Organization urge doctors to consider it for people at high risk for HIV. That includes gay men who have sex without condoms, people with infected partners and addicts who share needles while injecting drugs.

Taken daily, PrEP reduces the risk of getting the virus through sex by more than 90 percent, the CDC says. It also lowers the risk of HIV from sharing needles by more than 70 percent, the agency says.

But Mecklenburg’s health department does not directly distribute PrEP or conduct extensive public awareness campaigns to promote its use like agencies in some other places.

On Thursday, activists met with Health Director Gibbie Harris and Assistant County Manager Anthony Trotman to discuss the issue.

MeckPAC, a local gay rights advocacy group, is lobbying the county to establish a PrEP clinic that would prescribe the drug and offer follow-up checkups and lab testing at steeply discounted prices.

Another alternative, activists said, is for the county to offer subsidies for people to get treatment at private medical offices.

“This is something we need to pursue,” said Ryan Morrice, a board member for MeckPAC. “It is long overdue.”

Morrice said he believes the county administration has delayed action because officials worry that some commissioners would object to PrEP. He said he has heard some commissioners believe that distributing PrEP means subsidizing immoral behavior.

The CDC recommends the drug along with the use of condoms. Supporters and critics alike acknowledge that some patients will stop using condoms and may even engage in other unsafe practices.

That means a greater risk of sexually-transmitted diseases such as syphilis, already a major problem in the Charlotte area.

But the potential benefits outweigh the pitfalls, activists said, since many STDs can be treated with antibiotics while HIV is generally more dangerous.

“It is a tragic missed opportunity not to harness the power of PrEP,” said Mitchell Warren, executive director of the New York-based AIDS Vaccine Advocacy Coalition. “We won’t end this epidemic without PrEP.”

High costs

Mecklenburg officials do not track how many people take PrEP.

The county said patients considered at high risk for the virus can get counseling and referrals to medical offices that prescribe the drug. The Health Department says its outreach results in testing and treatment for tens of thousands each year.

“The county works collaboratively with community medical providers to address these barriers to receiving care and making PrEP more widely available,” the county said in a written statement.

But local activists said that PrEP still hasn’t reached most of those at the greatest risk.

Studies show the vast majority of people taking PrEP are white. In Mecklenburg, African-Americans account for 70 percent of new HIV diagnoses.

A recently released county report shows the cases are concentrated in low-income neighborhoods in Charlotte.

PrEP, which costs about $1,300 a month, is covered by most insurance plans, and the manufacturer offers payment assistance to the poor and uninsured.

Mandatory checkups and lab testing, however, cost as much as $1,600 every three months at private medical offices, out of reach for the poor and uninsured, activists said.

But in neighboring Cabarrus County, people who take PrEP can get follow-up treatment and testing at much lower costs.

Twice a week, the county’s health department offers required checkups for sexually-transmitted diseases and possible side effects of PrEP. The follow-up visits and lab work cost patients as little as $65.

The program has 16 patients so far, which has allowed officials to run the clinic with existing staff and no significant additional costs, said Erin Shoe, the agency’s chief operating officer.

But Shoe said costs will rise once more patients start coming for services, which are open to both Cabarrus residents and people living elsewhere.

Health officials started the program last year in response to a jump in the number of people living with HIV.

Cabarrus has a population of roughly 196,000 and about 265 residents diagnosed with the virus.

“There are private clinics out there and if you have insurance that’s wonderful,” said Tamara Staehler, Cabarrus’ communicable disease manager. “What we wanted to do is provide something for the uninsured.”

Were pleas ignored?

Activists and some commissioners said that Mecklenburg leaders haven’t responded to past efforts to expand use of PrEP.

In December 2016, a committee of local AIDS activists and other stakeholders the county had convened to recommend ways to reduce HIV infections was supposed to make a presentation to commissioners. The committee had concluded the Health Department should directly distribute PrEP.

Two committee members said county leaders scratched the presentation from the board’s agenda without explanation and have never rescheduled it.

The same night, commissioners voted to oust Fuller as board chairman. AIDS activists said they believe that is one reason the presentation on PrEP was not revisited.

Fuller confirmed the account, but said he does not know why the committee has not been allowed to present its recommendations.

Current Commissioners Chairwoman Ella Scarborough, who replaced Fuller, said she didn’t recall the committee or its recommendations.

Diorio did not directly answer the question in her written responses, but said the county has regularly included presentations on HIV in public meetings.

Commissioner Pat Cotham, who chairs the board’s Health and Human Services committee, said she wants PrEP discussed at the board’s annual retreat in January.

“We are behind the times,” Cotham said. “We need to be putting information about HIV everywhere, but we don’t. We have got to go to the mat for people.”

This story was originally published November 17, 2017 at 4:12 PM with the headline "This pill prevents HIV, saves lives. Here’s why Mecklenburg doesn’t offer it.."