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Michigan still lacks system to provide HIV exposure drug

Image has not been found. URL: http://images.americanindependent.com/2010/06/MichiganMap_Thumb.jpgLANSING — A policy directing Michigan health care providers to provide a potentially life saving intervention for people exposed to HIV through consensual or non-consensual sexual activity or drug use has still not been issued by the Michigan Department of Community Health.

“We are in the process of finalizing both the n-PEP [non-occupational post exposure prophylaxis] document and our communication to local health departments regarding ‘client acknowledgment’ forms,” said Kelly Niebel, acting spokesperson for the MDCH. She said the new n-PEP policy should be finalized sometime this month.

n-PEP is a prescription of anti-retroviral medications given to a person within 72 hours of an exposure. The prescription is a 28 day course and is considered highly effective in preventing HIV infection. The Centers for Disease Control and Prevention in Atlanta issued national guidelines on the chemical prevention in 2005, while the World Health Organization issued international guidelines in 2006.

In December of 2009, a Michigan Messenger investigation found that access to the life saving medications was dependent on one’s location in the state. The MDCH said it did not have a “written in stone” policy on the issue, which allowed local medical care facilities to define their own policies, independent of federal and international standards.

Shortly after the Michigan Messenger report broke, Amna Osman, director of Division of Health, Wellness and Disease Control, told Messenger that the state would have a new policy by “early” 2010. However, by the end of 2010, the policy remained bogged down in bureaucratic red tape. In February of this year, Michigan Messenger reported that e-mails obtained through the Freedom of Information Act showed that the policy had been delayed in the office of one attorney in the MDCH legal department.

On Friday April 1, the MDCH sent a letter to local health departments advising them to review forms that misstated the state’s HIV disclosure law. The move came six weeks after advocates raised concerns about civil rights issues associated with the use of those documents.

The continued delay of development of an n-PEP policy was widely criticized by advocates.

“When it comes to HIV exposure, delays cost lives. The old saying at the height of the HIV/AIDS crisis was, ‘An ounce of prevention, because there is no cure.’” said David Holtz, executive director of Progress Michigan. “Refusing to take the necessary action to make sure that every person exposed to HIV has access to preventative medicine is unconscionable and inexcusable. It’s a delay that costs Michiganders their health and their lives, and costs Michigan’s taxpayers untold amounts of money to fight a disease that could – and should – have been prevented.”

“What is the reason for this delay?” asks James Krellenstien, who runs the website pepnow.org.”It is truly unbelievable that State of Michigan still does not have any n-PEP policy. One must wonder how many unnecessary HIV seroconversions took place due to this inexcusable delay in policy. But one question that keeps coming back to me, is what does the state department of health have to figure out? The scientific research is unequivocal; n-PEP can reduce the probability of HIV seroconversion significantly after exposure to HIV through sexual, injection drug or other routes. As I have said before, human biology does not change when one crosses state lines, so the fact that the state cannot even issue preliminary guidelines for a lifesaving treatment is truly mind boggling.”

The continued delay has prompted Equality Michigan to reach out to the MDCH, says Emily Dievendorf, policy director of the group.

“There is no question that the delay in the policy has allowed unnecessary harm to continue,” said Dievendorf. “I believe in the creation of quality public policy, and if the Michigan Department of Community Health has real policy development and implementation issues to work out, I am eager to address those concerns at the earliest opportunity. I look forward to nurturing a productive and open partnership with the Department of Community Health to best ensure the health of Michigan citizens.”

“I wish our state health department was more proactive in these issues,” says Mark Peterson, a director for the group Michigan Positive Action Coalition. “Any statement the state makes along the lines of the CDC guidance is good for the community and for physicians. I don’t understand why they have not adopted the CDC guidelines.”

During the entire debate over the issue, MDCH officials have consistently said health professionals should follow the CDC guidance while the state finalizes its policy.

While the state continues to struggle with developing a cohesive policy on n-PEP, Neibel says the department is keeping abreast of a newly approved use of anti-retrovirals in prevention. The new procedure is called Pre-Exposure Prophylaxis, or PrEP. In this procedure, people at risk for HIV infection take an anti-retroviral drug called Truvada daily. If taken daily, the medication was shown in a recent study to have about a 90 percent ability to prevent infections. The study also found that contrary to popular belief that using the medications in this way would lead to an increase in risky behavior, the study found that daily use of Truvada actually resulted in increased condom use by the men in the study.

The CDC released interim guidance on the use of PrEP earlier this year. Those guidelines apply only to men who have sex with men as no similar study has been conducted in relation to heterosexuals or intravenous drug users.

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