Teen PrEP program ramps up in San Francisco
Three youth clinics of San Francisco Department of Public Health (SFDPH)—Cole Street Youth Clinic, Dimensions Queer Youth Clinic, and the Michael Baxter Larkin Street Youth Clinic—are providing comprehensive PrEP services for young people ages 12 to 24. So far, about 90 young people have been able to access PrEP services and interest has continued to increase over the past year.
HIV and adolescent health care providers from SFDPH initiated the PrEP program after identifying a gap in PrEP uptake among adolescents and young adults.
“Working in an HIV specialty clinic for youth, I kept having this repeated experience of talking to young people newly diagnosed with HIV—some under the age of 18, and still in high school in San Francisco—who didn’t know about PrEP or didn’t have access to it,” said Adam Leonard, NP, from Cole Street Youth Clinic and Larkin Street Youth Services.
“PrEP knowledge, awareness and uptake is low among adolescents and young adults compared to other age groups,” said Hyman Scott, MD, medical director of Bridge HIV at San Francisco Department of Public Health. “We wanted to address that disparity with a concerted, coordinated effort across the youth-serving clinics in the SFDPH and also provide support to other youth providers outside the health department.”
Scott, Leonard and PrEP coordinator Miranda Nordell worked together to bring PrEP services to youth-focused clinics affiliated with the San Francisco Department of Public Health.
Nordell rotates her time between the youth clinics, seeing young people interested in PrEP and helping them to decide if it’s the right strategy for them. For clients who decide to start PrEP, she provides tailored adherence planning, help navigating issues related to confidentiality and assistance with insurance. She even provides a mobile phone number to clients so they can text or call her when they have questions.
“Most of my PrEP clients check in with me by phone, at least once a week. Some check in with me every day, and that’s what has helped them most with daily adherence. For a lot of them, this is the first time they’re taking a daily medicine—it’s the first time they’re taking any medicine. It may even be the first time they are going to a pharmacy. There’s a lot more walking through potential barriers, and touching base in and outside the clinic that needs to happen in order for them to be successful,” said Nordell.
To help younger clients afford Truvada, the medication used for PrEP, the program offers financial assistance through an Emergency Youth Truvada Fund established by the Getting to Zero Consortium.
Medication affordability, said Scott, is one of the biggest challenges for youth who may not have insurance, or have concerns about confidentially if they are on their parents’ insurance. Truvada can cost upwards of $2,000 per month without insurance, and people under age 18 are not eligible for the Gilead co-pay assistance program.
Another ongoing challenge are the confidentiality and safety concerns of young people who wish to take PrEP without informing their parents or guardians.
“Particularly for LGBT youth—who may not be out to their parents—there could be safety concerns,” said Scott. “It can go beyond not wanting their parents to know they’re on PrEP, particularly if they’re still living at home. They may be outed from their parents opening a letter listing Truvada or PrEP. For some youth the risk of becoming homeless as a result is real.”
Fortunately, young people in California are protected by a law that stipulates people 12 years of age and older can consent to sexually transmitted infection prevention, treatment and care (including PrEP) without a parent needing to be notified.
“It’s not foolproof, and certainly we’re working with some challenging structural issues,” said Nordell. “But we are able to help young people use an online tool which guides them through how to request their insurance company limit the information shared with the primary account holder. Insurance companies are required by law to take this into account.”
Ultimately, the team hopes that PrEP services (and HIV care for people who are HIV-positive) are accessible no matter how young people get connected to health care or social services.
“Every door should be the right door,” said Scott. “A young adult or adolescent who is interested in sexual health services, no matter where they’re able to access those services, should be able to access them stigma-free with the support they need to initiate and adhere to PrEP and/or treatment if they’re HIV-positive.”
HIV and young people
The incidence rate of HIV among young adults and adolescents in San Francisco has been on the rise in recent years. The estimated HIV incidence among people age 13 to 29 has increased from about 100 (per 100,000) in 2009 to 150 (per 100,000) in 2013. Across the entire U.S., young people are also disproportionately affected by HIV, accounting for 22% of all new HIV diagnoses yet comprising only 16% of the population.
Where to get PrEP
Miranda Nordell (PrEP coordinator): 415-985-7737
Cole Street Youth Clinic
555 Cole Street (at Haight); 415-751-8181
Hours at Huckleberry Youth Health Center (at Cole Street Youth Clinic): Monday, Wednesday, and Friday: 9:30 am – 5 pm (by appointment)
Drop-In Clinic for youth up to age 25 (drop-in, no appointment necessary): Tuesday, 1:30 – 5 pm Thursday, 1:30 – 6 pm
Health services for queer, trans and questioning youth; 3850 17th St. San Francisco (between Noe & Sanchez); 415-934-7700
Hours: Thursday: 5 pm – 8 pm; Saturday: 12 pm – 3 pm
Michael Baxter Larkin Street Youth Clinic
For people age 24 and under; 134 Golden Gate Avenue (between Jones & Leavenworth) 415-673-0911 ext. 259
Comprehensive primary care and sensitive services Monday, 8:30 am – 3 pm; Tuesday, Wednesday, Thursday, and Friday: 8:30 am – 4:30 pm Closed every day from 1:00 pm – 1:30 pm