UCSF 360: In The Circle
UCSF 360: In the Circle with Dr. Robert Grant
PrEP is a new HIV prevention approach in which HIV-negative people take a daily pill to stay negative. PrEP cut HIV infection risk by as much as 99% among gay and bisexual men in clinical trials—but it only works if people can get it.
That’s why UCSF 360 director Dr. Malcolm John and UCSF Professor of Medicine Dr. Robert Grant launched the Sexual Health Improvement Program in 2014: to boost PrEP access in San Francisco.
Dr. Grant, who directs SHIP and whose own research contributed to the 2011 FDA approval of PrEP, shares how the program is working to end HIV transmission and promote a new vision of sexual health.
What do we know about the need for PrEP access and education in San Francisco?
Dr. Robert Grant: We think about 10% to 15% of gay and bisexual men in San Francisco are already taking PrEP, and as many as 30% could benefit from PrEP if it were available to them. We feel confident that we could expand our PrEP services to include hundreds of people. Also, as we learn more about the practical aspects of providing PrEP, I’m sharing those best practices broadly throughout the San Francisco community of health care providers.
If PrEP use expands the way we think it can and should, new HIV infections in San Francisco could plummet to very low levels. That would truly be something to celebrate.
What makes SHIP unique?
Dr. Grant: Our sexuality is such an important part of our lives. At SHIP, we see PrEP as an incredible opportunity for not only reducing HIV transmission but also fostering a more positive view of sexual wellness. PrEP is a responsible choice and an amazing opportunity to have safer sex, to feel safer during sex, and to heal from prior trauma around fear of HIV.
SHIP also serves as an entry point for primary care and other health services at UCSF Medical Center. One patient in his 40s had been getting his sexual health services at a community-based organization and came to SHIP because he thought he might need more than sexual health care—and sure enough, we found multiple ways he could benefit from primary care, including treatment for high blood pressure, high cholesterol, and gastrointestinal issues.
If a patient says, “I only want care for sexual health,” we respect that. But if we see other ways they could benefit from interacting with our clinic or with UCSF Medical Center, we bring that to their attention, and they can choose what services they want to use.
What do you find most rewarding about your work at UCSF 360?
Dr. Robert Grant: What’s most rewarding for me is hearing the personal stories of people who come to the clinic, and being able to offer them something that will help them feel safer.
I’ve heard from many SHIP patients that PrEP is an amazingly powerful experience. They’ve learned to feel safer during sex and to be more open to relationships. For some people, PrEP is a powerfully healing experience—and it keeps them free of HIV. Those are the stories that motivate me and make me so excited to be working with SHIP at UCSF 360.