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HEALTH CARE

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improve it after our counseling. We don’t withhold statins for fear
of negligent behavior. Because we reassess PrEP patients every three
months, the risk of developing drug-resistant HIV is low — it is es-
timated that 25 HIV cases are prevented for every drug-resistant in-
fection caused [5].

The fact is that our highest risk patients already are having unsafe
sex — otherwise the statistics wouldn’t be as grim as they are. We
must perpetually counsel that condoms still matter, because PrEP’s
90 percent protection is not perfect. But let’s also provide PrEP to
reduce harm. Together, we can change the course of HIV.

References:
Centers for Disease Control and Prevention. (2016.) Four sce-

narios of the potential impact of expanded HIV testing, treatment
and PrEP in the United States, 2015-2020. Retrieved from
h t t p : / / w w w. c d c . g o v / n c h h s t p / n e w s r o o m / i m a g e s / 2 0 1 6 /
croi_four_scenarios_graph.jpg

Reece, M., Herbenick, D., Schick, V., Sanders, S.A., Dodge, B.,
and Fortenberry, J.D. (2010). Condom use rates in a national prob-
ability sample of males and females ages 14 to 94 in the United
States. Journal of Sexual Medicine 7(suppl 5):266–276.

Texas Department of State Health Services. (2015). New HIV
Diagnoses in Texas by Age Group, 2005-2014. Retrieved from: http://www.dshs.state.tx.us/hivstd/reports/epiprofile/sec02.shtm

Moline, J., Capitant, C., Spire, B. … Delfraissy, J.. (2015). On-demand preexposure prophylaxis in men at high risk for HIV-1 infection.
New England Journal of Medicine 373(23):2237-2246.

Grant, R.M., Liegler, T. (2015). Weighing the risk of drug resistance with the benefits of HIV preexposure prophylaxis. Journal of Infectious
Diseases 2015;211(8):1202-4.

Resources:
Treatment guidelines: http://www.cdc.gov/hiv/pdf/prepguidelines2014.pdf
Counseling: http://www.cdc.gov/hiv/pdf/PrEPProviderSupplement2014.pdf
Billing and coding: https://www.nastad.org/resource/billing-coding-guide-hiv-prevention
Medication Assistance Program: 1-855-330-5479, http://www.gilead.com/responsibility/us-patient-access
Gilead’s optional written agreement for patients and physicians: http://www.truvadapreprems.com/#

PrEP sites for general public in San Antonio:
CentroMed (Santa Rosa Pavilion only), 315 N. San Saba, Ste. 103, 210-922-7000
Alamo Area Resource Center, 527 N. Leona St., 210-358-9995

Coming online by the end of the year:
San Antonio AIDS Foundation, 313 S. Hackberry, 210-225-4715

Author information:
C. Junda Woo, MD, MPH, is Medical Director of the San Antonio Metropolitan Health District (Metro Health). She provides

training to community physicians on public health issues, LGBT-friendly healthcare, intimate partner violence and human trafficking.

38 San Antonio Medicine • November 2016