LA Supervisors approve ambitious plan for HIV-prevention drug (updated)

The Los Angeles County Board of Supervisors approved Tuesday the development of an ambitious program to distribute an HIV prevention drug countywide.

Supervisor Sheila Kuehl authored the motion that gives the Departments of Public Health and Health Services 30 days to create a plan to get the antiretroviral drug Truvada to those at high risk of contracting HIV. 

Supervisors Mark Ridley-Thomas and Hilda Solis amended the motion to also require a plan from the Sheriff's Department on how it would distribute the drug in county-run jails and youth detention camps.

The health departments and the Sheriff have 30 days to present their plans to the Board.

Truvada is a once-a-day pill that has been found to be quite effective at preventing HIV infection if used properly. The strategy is called pre-exposure prophylaxis, or PrEP. The Truvada builds up in the body, and in the case of exposure to HIV, wards off infection. 

The drug is part of a larger strategy that includes screening, testing and treatment to prevent the spread of HIV and help those who contract the infection manage it, according to Kuehl.

The supervisor said there are about 60,000 people living with HIV in L.A. County, and 1,900 new cases annually.

Keuhl said she is proud that the board passed the motion.

"It’s not a panacea, but having it available for use along with all our other prevention strategies will definitely save lives," she wrote on her Facebook page moments after the vote.

Kuehl's motion follows up on a 2014 recommendation by the LA County Commission on HIV that the supervisors authorize and expedite a PrEP plan. 

Critical to the strategy, according to Kuehl, is access for uninsured and underinsured high-risk individuals, including African-American and Latino gay males and women and transgender persons.

Truvada has been available through local demonstration projects that work with those at high risk. But some who work with that community have reservations. 

They worry that a lack of education about the drug and inconsistent use could hurt more than it helps.

Some advocates say it can be hard to get their clients to take a pill every day, and that users might think it’s okay to engage in unprotected sex. Experts say ideally, Truvada should be used in conjunction with condoms.

Another potential problem: if someone does not take the drug consistently and contracts HIV, the infection could be harder to treat.

The motion was approved after most of the individuals who spoke during the public comment period voiced support for the plan, saying Truvada saves lives and provides peace of mind. Critics of the plan cited increased taxpayer costs for a drug that they argued isn't needed because the individuals who would take it are not sick.

The county health departments and Sheriff's office have to come back to the supervisors in 30 days with a PrEP timeline, a plan for monitoring and evaluation and a financing strategy.

This story has been updated.