University of Utah Health has opened Salt Lake City’s first free PrEP clinic, one of only two in the nation.
HIV Pre-Exposure Prophylaxis, known as PrEP or its brand name Truvada, is taken once a day with minimal side effects and has proven to be more than 90 percent effective at preventing HIV when taken as directed. At a cost of more than $15,000 a year, however, Truvada is expensive. Most health insurance plans cover the PrEP drug, but the people most at risk for acquiring HIV—young men ages 18 to 25 are the least likely to have health insurance.
UofU Health opened the volunteer-run clinic to address the resulting gap, and its model is one that could be echoed nationwide. Along with PrEP, the clinic will offer HIV testing, prevention, treatment, and counseling for sexually transmitted diseases. Patients can meet with a case manager, a pharmacist, and a medical provider during their visits. Clinic physicians will work on a volunteer basis to provide care at no cost to the patient—no bill for the visit, labs, prescriptions, or treatments.
Though Utah has a lower HIV incidence rate than most of the country, it also has the lowest rate of HIV testing in the United States, says Adam M. Spivak, MD, and Susan W. Keeshin, MD of the University of Utah Health Center’s Clinic 1A.
“With the free PrEP Community Clinic, we expect to uncover new cases of HIV among people who have never been tested before,” they said in a statement. “The clinic provides a necessary service, linking patients to HIV care and appropriate medical therapy. It will not only improve the health of these at-risk patients but also decrease the likelihood that they will spread the disease to others.”
The clinic is the culmination of an idea — more a demand — from medical student Jorgen Madsen, who came out his first year at the University of Utah School of Medicine and wanted to find ways to improve the relationship between the LGBT community and health care providers. He scheduled a brainstorming session with Spivak, an infectious diseases physician and researcher at the UofU School of Medicine who was known to be an LGBT ally, to find what could be done to show support to Madsen’s still-closeted classmates. How could they reduce stigmas and false ideas? How could established and up-and-coming doctors become better educated about the concerns of a young gay man worried about the threat of HIV?
With Keeshin, an assistant professor of pediatrics and HIV specialist, and Ben Holdaway, a community activist formerly with the Utah AIDS Foundation, Spivak and Madsen conceptualized a free PrEP clinic that would allow Utahns at risk of HIV to bypass the traditional health care system of insurance approvals, doctor referrals and billing. At-risk individuals include all those who have unprotected sex and people who inject drugs and share needles.
“Utah can get a bad rap, but in some ways, it’s almost not fair,” Madsen said. “There’s a lot of support here, a lot of loving and caring people who want to serve but don’t know how.”
The free PrEP Clinic launch coincided with Quiet Heroes, a documentary film that debuted at the 2018 Sundance Film Festival that showed the early impact of the HIV/AIDS epidemic in Utah and the nation. Infectious diseases and HIV specialist Kristin Ries, MD, and her medical assistant Maggie Snyder, PA-C, were on the frontlines of HIV treatment during the height of Utah’s AIDS epidemic in the 1980s and 1990s. When fear and discrimination were running rampant, they were the first medical providers in the Mountain West region to open their doors and care for AIDS and HIV patients. They treated more than 90 percent of people with HIV in Utah.
After establishing a comprehensive HIV program with Holy Cross Hospital, Ries and Snyder opened the AIDS/HIV clinic at the University of Utah in 1994. They brought 500 patients from Holy Cross with them, quadrupling the patient volume at the U’s Infectious Disease Clinic, Clinic 1A. Clinic 1A was recognized as one of the nation’s top university HIV programs, as well as one with the lowest hospitalization rate.
“A positive HIV diagnosis remains devastating in spite of modern treatment methods because of the stigma associated with the disease,” Spivak and Keeshin wrote. “Our hope is that opening this free PrEP clinic will help both assuage the stigma and prevent new incidence of the disease. If that proves successful — over a period of 18-24 months — we hope to see it applied as a model for community-based HIV prevention elsewhere in the country.”
The clinic is at the University of Utah Health Redwood Health Center, 1525 W. 2100 South, on Saturday mornings. Their number is 801-585-2512 to schedule an appointment. The clinic is on Instagram at slcprep, and Facebook at prepslc