New California Law Could Increase Access to Post-Exposure Prophylaxis HIV Medication
A new California law (AB 879) requiring the state Department of Health Services to form a task force aimed at creating treatment guidelines for inadvertent sexual or needle exposure to HIV could help increase access to post-exposure prophylaxis, or PEP, medication, the Sacramento Bee reports (Sanders, Sacramento Bee, 11/2). California Gov. Gray Davis (D) last month signed the measure, which was introduced by California Assembly member Paul Koretz (D) (Kaiser Daily HIV/AIDS Report, 10/14). The law requires the department's Office of AIDS to convene a task force to develop guidelines for the use of PEP in the general population. The law also establishes requirements for task force meetings and membership, saying that the task force should be made up of no more than 10 members, including physicians, people living with HIV/AIDS, HIV service providers, drug makers and representatives from the Office of AIDS (Kaiser Daily HIV/AIDS Report, 3/11). The state currently has PEP guidelines only for health care workers and sexual assault survivors who are exposed to the virus. Researchers have found that people who may have been exposed to HIV can avoid infection if they take a regimen of antiretroviral drugs within 72 hours of exposure and continue a course of treatment for several weeks (Kaiser Daily HIV/AIDS Report, 10/14). Although doctors are not barred from prescribing PEP for use in the general public, many physicians "know little or nothing about it," according to the Bee.
Some PEP advocates say that there has not been enough research conducted on the medications to "draw firm conclusions" about using PEP for nonoccupational exposures in the general public, the Bee reports. In order to complete a "definitive" PEP study, researchers would need thousands of PEP patients for a significant statistical sample, which would be difficult, according to the Bee. Some people are concerned that increasing the availability of PEP -- which costs between $640 and $1,700 per person -- could lead to an increase in high-risk behaviors, but advocates of PEP say that the treatment is "time-consuming, often sickening and not likely to be taken lightly," the Bee reports. Koretz said that PEP could ultimately save money for the state because its costs "pale in comparison" to the cost of lifetime treatment for an HIV-positive person, according to the Bee. Currently, Rhode Island and Massachusetts are the only states with PEP guidelines in place for the general public, according to Koretz. The CDC does not support or oppose PEP use for nonoccupational HIV exposures, the Bee reports.
Dr. Michelle Roland, an HIV expert and assistant professor of medicine at the University of California-San Francisco, said, "Essentially, the guidelines will probably say these are the circumstances under which it is reasonable to offer this intervention -- and if and when you offer it, this is how to do it." But Randy Thomasson, executive director of Campaign for California Families, which lobbies on social issues, said the law is part of a "bad trend of liberal politicians" to reward irresponsibility, according to the Bee. He added, "Promiscuous sexual behavior does not deserve a Band-Aid or a morning-after pill. It deserves a tough-love approach to motivate promiscuous people to give up their sex addiction" (Sacramento Bee, 11/2).