Chapter 1
The Importance of PrEP

A Complete Program of Wellness

Pre-exposure prophylaxis (PrEP) provides nearly 100% protection from HIV infection through the use of a daily pill with few side effects or toxicities. Demetre Daskalakis, M.D., M.P.H, is an early proponent of PrEP whose clinical work and advocacy have greatly expanded access to the intervention in the U.S. First as an infectious disease clinician at the Mount Sinai Health System and now as New York City's Deputy Commissioner for the Division of Disease Control, Daskalakis maintains a close relationship with many of his former patients -- including those living with HIV and those on PrEP -- and trains providers across the country on expanding PrEP access. He's seen PrEP succeed not only as a powerful force for HIV prevention, but as a central component to deepen primary care engagement, as the story of his relationship with PrEP patient Rubén Cabrera attests.
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Seeking Prevention, Finding Care

Rubén Cabrera first heard about PrEP as one half of a "magnetic" couple. He describes a feeling of relief upon starting PrEP.


More Than a Prescription

While the PrEP prescription and dosage process is fairly simple, the PrEP protocol includes engagement in a system of care that can provide multiple opportunities for deepening a provider/patient relationship. As the relationship progresses, providers can live up to the full promise of PrEP as a bridge to primary care, which can include frank and respectful conversations about sexuality, drug use and other stigmatized topics.
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Frank Conversations

Cabrera's journey to access PrEP brought him into consistent care for the first time since coming to the United States. But he was very shy when talking about sexual behavior.


Taking Action to Tackle HIV

As a prescient college student and gay New Yorker in 1994, Daskalakis vowed, "I'm going to take care of HIV. I don't want anyone to get this, and I don't want anyone to die anymore." Daskalakis's quest to end the epidemic spurred him to innovate. He brought HIV testing to sex clubs and bathhouses, and he sent teams of educators armed with detailing kits on PrEP to provider offices across the city. He is leading efforts to share the news that people with HIV who have a suppressed viral load are at no risk of sexual transmission of HIV to others, and is part of an eye-catching LGBTQ health campaign encouraging people to "bare it all" through honest conversations about sexuality with healthcare providers.
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Focusing on Data, not Dogma

"The only bad HIV test result is the one that someone has never had," Daskalakis says. Whether a person is living with HIV or is HIV negative but at risk of exposure, it's an opportunity to stay healthy.

Bridging The Gap