Howard Brown Health Improves Access to PrEP

PrEP Care
Howard Brown Health Improves Access to HIV Prevention
by Chael Needle

The United States Preventive Services Task Force (USPSTF) recently issued its final “A” grade for PrEP, which will require most private insurance to cover the prevention tool and do so without patient cost-sharing. While dismantling this barrier is important, others remain.

For example, according to a July 12, 2019 Morbidity and Mortalily Weekly report titled “Changes in HIV Preexposure Prophylaxis Awareness and Use Among Men Who Have Sex with Men — 20 Urban Areas, 2014 and 2017,” written by Teresa Finlayson, PhD, et al, “Data from CDC’s National HIV Behavioral Surveillance (NHBS) were collected in 20 U.S. urban areas in 2014 and 2017, covering 26 of the geographic areas included in Phase I of the Ending the HIV Epidemic initiative, and were compared to assess changes in PrEP awareness and use among MSM. From 2014 to 2017, PrEP awareness increased by 50% overall, with >80% of MSM in 17 of the 20 urban areas reporting PrEP awareness in 2017. Among MSM with likely indications for PrEP (e.g., sexual risk behaviors or recent bacterial sexually transmitted infection [STI]), use of PrEP increased by approximately 500% from 6% to 35%, with significant increases observed in all urban areas and in almost all demographic subgroups. Despite this progress, PrEP use among MSM, especially among black and Hispanic MSM, remains low. “

Among its many gold-standard practices as a healthcare site, Howard Brown Health is a leader in identifying PrEP barriers and finding innovative ways to address them. Its holistic focus on research, education and care translates to better health outcomes for its clients and the communities which it serves.

Kristin Keglovitz Baker, Chief Operating Officer of Howard Brown Health, recently corresponded with A&U via email about PrEP.

Chael Needle: What barriers to PrEP access are the most urgent, across the board?
Kristin Keglovitz Baker: Across the country and in Chicago, some communities are using PrEP at lower rates compared with white cisgender men who have sex with men (MSM). These include young black MSM, Latinx MSM, transgender women, and cisgender black women. Access and stigma are two main factors that contribute to this. We are working to increase education and accessibility on Chicago’s south side to reach these communities, and are actively working to reduce shame and stigma around sex and HIV in all communities. There is also a need for different delivery systems for PrEP—one pill a day can be a burdensome schedule for some, and may contribute to problems with adherence. There are some options on the horizon, namely long-acting PrEP like injectables or implants, which would be a great innovation for HIV prevention.

Howard Brown Health provides patient assistance programs for PrEP seekers without insurance, sexual health walk-in clinics, and a PrEP Case Management Program to help those taking PrEP. Why does Howard Brown Health understand these practices to be essential in dismantling barriers?
Howard Brown operates four walk-in clinics in our clinics in Rogers Park, Uptown, 63rd Street, and the Broadway Youth Center, and we also have two outreach screening sites in Oak Park and Hyde Park. It is essential to meet communities where they are at. You should not have to travel long distances for healthcare visits. Once someone does decide to seek healthcare, the environment should be welcoming and affirming from the moment they arrive. If we can bring healthcare to the communities we are trying to serve through our outreach efforts or have walk-in appointments available for people with busy schedules, we’ll reach more people. We are committed to low-barrier, same-day PrEP access agency-wide, which helps normalize HIV prevention and provides it to patients on their terms for their health. Convenient access to affirming, quality healthcare is paramount to eradicating HIV.

I am currently on PrEP and, despite the fact that my physician is an infectious disease specialist, she seems disinterested in talking to me, as a gay male, about sexual practices, my emotional state around prevention and intimate relationships, and so on. How does Howard Brown understand the role of the clinician and other healthcare staff in helping patients to stay on PrEP and stay on top of their sexual health?
A trusting and caring relationship between the provider and the patient is essential to creating and reaching healthcare goals. Sexual health can be embarrassing or feel shameful for some. Others may not have all the information they need to stay healthy. Additionally, someone may come in for a PrEP follow-up visit, but they may be experiencing mental wellness issues, or have questions about a relationship that makes them feel unsafe, or many other issues that can only be identified if a patient is comfortable with and trusts their provider. Howard Brown approaches sexual health in a sex-positive way, acknowledging a patient knows themselves best. The patient is at the center of their health goals and we don’t see sexual health discussions as needing a special time or place but as a part of overall health and well being.

Structural issues like low income and unemployment increase HIV risk for Black MSM. Can structural barriers, which seemingly need long-term solutions, be addressed in everyday practice in healthcare settings like Howard Brown?
Our model of care includes innovative outreach efforts including geographic expansion to reach people outside of everyday practice settings. For example, our Broadway Youth Center’s VOICES program reaches people for HIV screening on Chicago’s south side by hosting evening events that offer free vogue workshops and practice spaces, counseling, education, life skills training. We also have screening locations at our Brown Elephant resale shops. We hope to continue expanding what an HIV screening location looks like to meet the needs of the communities we serve. We are intentionally expanding PrEP access outside of traditional models that only offer PrEP through primary care settings through our walk-in clinic, programs offering same-day prep access, and providing a safe space where providers can talk to patients openly about sexual health, free from judgment. Howard Brown also provides an array of support services including case management, employment assistance, legal assistance, linkage to housing, and job readiness support.

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Chael Needle is Managing Editor of A&U. Follow him on Twitter @ChaelNeedle.