By Fred Clasen-Kelly, The Charlotte Observer
Smaller North Carolina health departments in places such as Surry, Orange and Cabarrus counties provide patients with a drug proven to prevent the spread of HIV.
But Health Director Gibbie Harris said Tuesday that Mecklenburg County, which has HIV infection rates among the worst in the nation, likely will not prescribe the drug.
The comments came during a presentation before the Mecklenburg County Board of Commissioners’ Health and Human Services Committee.
Commissioners, AIDS advocacy groups and others had questioned why Mecklenburg leaders had not spent nearly $250,000 set aside in June to expand HIV education and use of PrEP, which provides near-total protection from HIV through sex.
Harris offered a strikingly candid assessment about the agency nine months after officials acknowledged that two clinics failed to notify at least 185 women about their risk for cervical cancer following abnormal Pap smears.
Fallout from the lapses led to the resignation of former Health Director Marcus Plescia in June. Consultants recommended a complete overhaul of the agency and cited poor patient care and mismanagement.
“The department is going through a lot of change,” said Harris, who was hired on a permanent basis in October. “It would be a little challenging to add a service. We want to make sure we do what we do well.”
But activists, researchers and some county commissioners say the result is that hundreds of people – particularly African-Americans and gay men – will remain at high risk for HIV because they cannot afford follow-up treatment required to get a prescription for PrEP.
Mecklenburg’s rate of 30.4 new HIV infections per 100,000 is more than twice the national average. 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.
“It’s a major health crisis,” said Commissioner Vilma Leake, who represents a west Charlotte district where new infections are concentrated. “What are we doing to eradicate AIDS? Why aren’t we providing the medication?”
Activists say leaders in Atlanta, Nashville and other cities are launching plans that focus on the distribution of antiretroviral drugs such as PrEP. The drugs lower the amount of virus in the bloodstream, making transmission far less likely.
PrEP (pre-exposure prophylaxis), sold under the brand name Truvada, has been approved for use since 2012. The federal Centers for Disease Control and Prevention 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.
PrEP reduces the risk of getting the virus through sex by more than 90 percent, research shows. It also lowers the risk of HIV from sharing needles by more than 70 percent, the CDC says.
However, mandatory checkups and lab testing for people taking the drug cost as much as $1,600 at private medical offices, too much for those without insurance, activists said.
In Mecklenburg, new HIV infections are concentrated in low-income neighborhoods in Charlotte. Many of those most at risk struggle with housing and employment, officials said.
MeckPAC, a local gay rights advocacy group, is demanding the county establish a PrEP clinic that would prescribe the drug and offer follow-up checkups and lab testing at discounted prices.
Another option, the group has said, is for the county to offer subsidies for people to get treatment at private medical offices.
On Tuesday, MeckPAC board member Matt Comer said there is momentum among advocates and health care providers for expanding the use of PrEP, but public money is needed.
“HIV is one of the deadliest viruses humans have ever encountered,” Comer said. “We have an opportunity in the United States to eliminate this 30-year epidemic. We need the resources.”
Health departments in at least five North Carolina counties offer PrEP to patients.
Gaston County and Guilford, which contains Greensboro, have developed plans and may start distributing the drug as soon as January.
Mecklenburg’s health department does not prescribe PrEP or conduct extensive public awareness campaigns to promote its use.
Harris said she had met Monday with representatives from major hospitals and others to discuss HIV prevention. Distribution of PrEP dominated the discussion.
Only about a dozen health care providers in Mecklenburg County prescribe PrEP, and most of them are not located in neighborhoods most affected by the virus, Harris said.
Another issue, Harris said, is that many doctors are unaware of PrEP.
She promised to work with hospitals and other stakeholders to find solutions.
She said next month the county would announce a plan for how to spend the $248,000 set aside in June to help promote HIV education and increase use of PrEP.