California Governor Gavin Newsom has signed a law that will allow the sale of HIV prevention drugs without a prescription. S.B. 159 will allow the drug treatments PrEP and PEP to be sold in over-the-counter pharmacies.
The bill saw near-unanimous support in the California legislature. It received only one “no” vote as it passed through the Senate and the Assembly. The bill is now set to become law on January 1, 2020.
Breakthroughs in HIV Treatment
PrEP and PEP are drug treatments that shield against the HIV virus either before or after exposure. PrEP (pre-exposure prophylactic), is a combination of the HIV medications Tenofovir and Emtricitabine. It is meant to be taken daily by people who have a high likelihood of exposure to HIV.
That category is surprisingly broad as defined by the Centers for Disease Control and Prevention. First, it includes “people who are HIV-negative and in an ongoing sexual relationship with an HIV-positive partner.” Listed next are gay or bisexual men who have had unprotected anal sex or been diagnosed with an STD within the past 6 months.
Heterosexual men and women are also at risk. The CDC specifically mentions heterosexuals who don’t regularly use condoms during sex with partners of unclear HIV status. The CDC also recommends PrEP for “people who have injected drugs in the past 6 months and have shared needles or [drug equipment] or been in drug treatment in the past 6 months.”
When taken daily, PrEP reduces the risk of contracting HIV through sex by about 99%. In addition, daily use reduces the risk of drug-related transmission by 74%. However, the CDC notes that “PrEP is much less effective when it is not taken consistently.” It is also recommended that PrEP users continue to use other forms of protection, as PrEP does not protect against sexually transmitted infections (STI) other than HIV.
While PrEP is meant to be taken ahead of exposure, PEP (post-exposure prophylactic) is intended for emergencies of unexpected HIV contact. PEP consists of antiretroviral medications taken after exposure to HIV to prevent infection. A patient has 72 hours after contact to begin taking PEP. Once treatment begins they must take one or two doses a day for 28 days.
Providing Access to Care
The new law will end prior authorization requirements that prevent the treatments from being sold without a prescription. In a statement praising the decision, LGBTQ civil rights group and bill co-sponsor, Equality California, pointed out that the time-sensitive nature of PEP treatment made the requirement problematic.
“Removing the pre-authorization requirement is especially important to guarantee that people can get medicine within the first 72 hours post exposure,” the statement read.
The governor’s decision comes at a time when nationwide rates of gonorrhea, chlamydia, and syphilis are at record highs. Meanwhile, new HIV infections for kids 0-19 in California have held in the 160s and 170s each year from 2013 to 2017. In light of these figures, increasing access to PrEP and PEP could be an important step towards eliminating such illnesses.
“All Californians deserve access to PrEP and PEP, two treatments that have transformed our fight against HIV and AIDS,” Newsom said in a statement. “I applaud the Legislature for taking action to expand access to these treatments and getting us closer to ending HIV and AIDS for good.”