Utah will soon be home to one of the only free HIV prevention clinics in the U.S., and it all started with a plucky medical student named Jorgen Madsen. Starting in January, everyone — whether they have insurance or not — will have access through University of Utah Health to a game-changing medication-based HIV prevention strategy known as pre-exposure prophylaxis (or PrEP), which earned FDA approval in 2012 and has been shown to be more than 90% effective at preventing HIV.
Madsen, who says he came out of the closet during his first year at the University of Utah School of Medicine, wanted to find ways to improve the relationship between the LGBT community and health care providers, so he scheduled a brainstorming session with Adam Spivak, M.D., an infectious diseases physician and researcher at the School of Medicine who was known to be an LGBT ally.
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, say, a young gay man worried about the threat of HIV?
Together with Susana Keeshin, M.D., 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.
If someone could reduce their risk of acquiring HIV from taking the once-a-day pill for whatever reason, the group was determined to make that happen.
"We went together, asking people at the U and in the community with resources, money, clinic space and lab-testing abilities to help us," Spivak said. "To date the response has been overwhelmingly positive, allowing us to make this clinic a reality much sooner than we thought possible."
The clinic is set to open in early 2018 at two locations: first at the Redwood Health Center, and potentially later at Clinic 1A at University Hospital. Logistics are still being worked out, but office hours will likely be held Saturday mornings. Spivak and Keeshin will run the clinic, and medical students and residents are already lining up to volunteer.
"Beyond prescribing and managing the medication itself, our clinic will provide HIV and STD testing and sexual health counseling — all free of charge," Spivak said.
Madsen couldn't be more pleased. The same medical student who entered school afraid to share his true self will see a PrEP clinic he helped develop open before he starts his fourth year. It's only the second clinic of its kind in the U.S. — the other is in Atlanta, GA.
"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."
While the HIV problem in Utah isn't nearly as bad as it is in other regions of the United States, said Spivak, our state still sees 150-200 new cases diagnosed each year — a number that over time has unfortunately remained constant.
While certain LGBT community members are often well informed about PrEP, other groups who are at risk, such as women, people who inject drugs and especially young minority men who have sex with men are often still in the dark or unable to access PrEP services.
"I call one of my patients my PrEP Champion," Keeshin said. "He has a lot of female friends, and he says they have sex with more people than he does. He recognizes his risk, and he tries to help his friends understand theirs. It's something that affects everyone."