more is needed. >> it's a huge problem. >> including a mind set change. >> yes. >> see you back here at 6:00. that's all of our time. "inside story" is next on al jazeera america. ♪ >> for years the struggle to limit the spread of hiv was to change people's behavior. does the use of a preventive drug treatment challenge the decades of hard work? it's "inside story." ♪ ♪ >> hello i'm ray suarez. in a dance club in new york's west village in a clinic in san

francisco, in a marks place in south africa, the word went out. people can stop the spread of hiv in its track by stopping, hiv, limit the number of sex partners because in terms of infectious disease you were having sex with every partner the other person has ever had. the pharmaceutical revolution that's transformed hiv and aids, lengthened lives reduced infection, has now moved to prevention. unraveled the message played day after day play safe. >> three years ago nicholas had the scare of his life. >> i was playing with fire by having unprotected sex.

they didn't disclose their hiv status. >> gordine was left testing negative for hiv but the risky behavior, what it could mean. >> i was quite concerned deaf saited. -- deaf stated. >> devastated. >> prevada prep, preexposure proafprophylaxis. the centers for disease control says this reduces the risk of hiv infection if adhered to properly. >> where prep is so, important hiv doesn't get into the cells it's met on the surface of the cells by the drug. >> meaningmeaning taking truvada every

day, and checking in regularly. a year of truvada costs 13,000. but is mostly mostly covered by health insurance. prep's adoption especially in a high risk population, could be the answer to his city's ep dem epidemic. >> washington, d.c. has the highest prevalence of any urbanity of hiv in the united states. we currently are just shy of 3% overall of the population which is higher than some rates of countries in africa. your chance in having hiv would be one in five. >> gay rights advocates have centered condom use and awareness of status.

and in the 1980s when contracting hiv was essentially a death sentence, that message worked. now 30 years later some medical professionals are skeptical about promoting prep. >> i fear we may be losing those conciliation if we are just saying we don't have to have dps those skills if we are just saying we don't have to have those conversations anymore. discussions around sex because why bother if everyone answer just either hiv positive and taking their medications as they should or negative and taking their prep. in a way it could be viewed as an excuse to just not take responsibility for our actions. >> a lot of that worry stems from what many in the gay community attribute to a generation gap or an experience gap if you will. where today's young people have no idea what it was like to go through early days of the hiv crisis. >> we have a major crisis going on in the united states. specific in youth and in youth

we have you know about 18% of people who are hiv-positive and they don't know their status. >> earlier this month the washington d.c. lctd lgbt center tried to bridge this gap by offering a free photo shoot to anyone who got tested for hiv. because many in washington, d.c. don't know their hiv status. every year there are an estimated 50,000 new hiv cases in the united states. >> youth think a whole lot differently than we did in my generation. if you were ten years old in 1996, now as a 28, 29-year-old you have never seen that death and dying. we have changed power behaviors because of fear of dying. >> i've seen friends get sick but never die from hiv. >> 24 yeerd devon bearington ward has chosing to take

truvada. >> is something about truvada or prep, seeing so many of their friends die off and not wanting to see that happen, we have to recognize that we are in a different space in the etch demic and have to evolve in the times. >> he knows he lives and daylights in a community with some of the highest hiv rates in the country. >> i know the statistics not just from a place where i read them on paper from the epidemiology report, but those are my friends. those are people in my sexual networks. those are people in my community. at this point in my life, i do know more men who are hiv-positive than are negative. >> every week bearington ward attends a meeting at a center about tough topic around sexuality. >> i identify in that space like wow that's exactly how i felt. >> when we were talking about the conversation of being for or against prep, i think that's the

wrong frame. we really should be talking about giving people choices and access to an additional means of prevention. we can't hold gay men to a standard that we don't hold heterosexual people to. which is the fact that people don't use condoms 100% of the time. so this is an opportunity to take some responsibility for my own sexual health and for those who are using prep, but take responsibility for their own sexual health as well, don't take that burden or place their sexual health in someone else's hands. >> at the currently rate of hiv prevention there could be a half a million more case he in the next ten years. the question now is whether wider use of truvada will help stop the virus's spread. preexposure, proaf prophylaxis and preventing the spread of hiv on the program.

removing the looming danger of contracting the virus that causes aids or sit an insurance policy for life in the real world where moralizing won't stop real people from sometimes making less than ideal choices? joining us for that conversation whitney cordova, in los angeles justin goforth community relates in washington d.c and from new orleans deonon haywood, executive director of women going forward. always the next steps some place we would have to anticipate going. >> well sure, i think we certainly want to finder a vaccine, we certainly want to find a cure.

and i think everybody's always wanted that. unfortunately, vaccine research hasn't really gotten anywhere and we have not found a cure for hiv. >> so is truvada a great new weapon in your armament or is it something that really has to be carefully negotiated with an at-risk population. >> well, it's really -- it's not really new. but if people living with hiv have been taking truvada for some time, it is an effective tool. the question in the new part is whether people not infected with hiv should take the drug. i think that's still something that we need to talk about. and i think that's something that we need to talk about how we talk to populations about it, how we talk to the gay community and all communities about it. because it's not, if you take the pill that doesn't mean you don't do other things to protect yourself. and i think really that's one of

the big problems with the current discussion that's happening. >> just tin goforth you as whitney suggested you can still do other things. but do other things sort of fall by the way side because of human nature? >> so the research would tell us that that's probably not the case. and what you're talking about really in public health speaking is risk compensation which is the idea that if, in syringe exchange programs reflection, there's been argument that people might use more heroin or injectable drugs if you give them more access to needles. that plays out actually in the opposite. ing risk taking behavior or adoption of other prevention strategies hasn't really changed much in individuals that enroll in these studies. if condoms work for you they will continue to work for you. the counseling around using other prevention strategies absolutely has to continue to be a part of someone who's in care

and prescribed truvada or any other drug that comes along. >> deon hayward is this different for women and put a little strength on their side of the table when negotiating the sexual lives? >> you know when you think about women and prevention, i think part of my concern and i've heard clients that clients come through our office talk about are things that are already a barrier. many women some are able to negotiate condom use some are not based on what type of situation they're in. so i think it's -- it's -- it would probably be up to the individual. of what that would mean for them to use prep. how accessible sit for them -- is it for them? are there living conditions in a place in a positive place where they are in a place to take it and take it as it should be taken? >> so when you're doing

counseling and introduce prep into the conversation, do your clients say "yeah that sounds like something i'd like to try"? >> some of them have said yeah i'd like to try but some of them have said i'm not stable, if you are homeless, if you are in a domestic violence situation, it may be difficult for people to adhere and some of them have concerns about what it's going to do to me. you know what are the side effects to living everyday life. so those are some of the things that we see women ask. >> that's where we'll continue. we'll be back with more "inside story" after a break. when we return we'll continue our look at drug based strategies to stop the spread of hiv. is preexposuring proaf prophylaxis medicine a great answer or one to be used with care? stay with us. december 21st, 1988

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>> we're back with "inside story" from al jazeera america. i'm ray suarez. december 1st is world aids day. the world can look back at 35 years of terrible human tragedy and now more than ever triumph. medicines have reduceed mother to infant transmission and added years of life to infected persons around the world. today we are looking at

preexposure proaf prophylaxis, drugs that when used by high exposure people can voy hiv. justin goforth the introduction of antiretrovirals that may be a test case for how people take on new information, and use it to inform the choices they make in their lives. >> i think that's a good point. we had effective antiretrovirals as far as stepping the replication of the virus in people that have hiv insistence mid '90s. but it wasn't until the mid 2000s, we had regimens of drugs that were easy to take, wunsonce a day regimens instead of five times a day. we had to have the uptake adoption staying on treatment as an effective way to keep somebody healthy that's living with hiv.

preexposure prophylaxis is in its infancy. the one pill truvada per day is not going to be the prophylaxis of twe 16 or 2017. it will continue to evolve and we have to find easier way to dose this. less than once a day would be great. an injectable is in research that would be much an injection every six months. we are at the beginning of trying to figure this out as a public health prevention. >> until that day gets here, what can people who integrate it into our lives tell us about how people will use prep? for instance, did people think oh well, if i get hiv i can live with it? it's a manageable disease so it's not as dangerous as i might have thought that it was before? >> so that's hopefully where

people are thinking. i think that much of the community doesn't even understand what you just said yet. and what you just said actually is the truth of where we are with hiv treatment that it is a chronic manageable illness if you stay engaged in care and stay on treatment. so first you have to have awareness and then you have to have education and then you have to have adoption and engagement and care and all of that has to have engagement and care. we are at the beginning of the most affected communities that could really use this intervention i would have to say have almost no are understanding that this exist. >> deon haywood they don't think of it as a small town or southern or rural disease. what should people know in 2014 about not l.a. and chicago and new york and san francisco and

miami. but macon and vixburg and huntsville and things like that. what's different about being hiv positive or trying to keep yourself from being positive in those places? >> here in the south many of us, i'm sure many of you have heard about the social determine determinative and health, if you are in a rural area, people have access -- lack of access to health care. it is kind of hard based on transportation to get where you need to go. we still many of us like here in louisiana live in states where you know, our governor hasn't accepted medicaid expansion. and so all of the things, poverty, education unemployment, all of those things are still issues here throughout the south. are and also contributes to people being at risk for hiv.

also make it hard for people who are hiv positive and living with hiv and aids, hard for them to access services as well. the criminal justice system plays a large part, the fact that we have not adopted legal syringe access programs here throughout the south also makes it difficult. >> so that social profile that you just laid out i mean after all when we are talking about truvada it is a very expensive medication but we're also talking about a population that has trouble accessing medical scare and is still at greatly risk for infection. where -- >> yes. >> doshes prepdoes prep fall into that profile? >> i'm really not sure. hiv continues to be one of those things that those who are at the bottom still have a hard time accessing medication, getting to their doctors appointment and fitting it in with their everyday life. so i think there will be people who will be able to access it

easily and there will be people who cannot and it will be some of the same things i feel like we're seeing now around who has access to the best medication, who has access to the best care. you know i've had clients in the last couple of months who they can't afford medications, some medications are not available they're on a waiting list to get medication just so they can take it. a part of their regular antiretroviral cocktails that they may take. and so i think -- i think if we don't do more about changing some of the systemic issues that put people or assist hiv the hiv numbers here in the south, i don't know if much is going to change. >> so whitney enguran cordova if this is not a silver bullet and we agree it is not is there

an ideal answer, given the nature of their risk where it may be introduced first as a way of piloting and learning lessons before moving forward. if you right now not hiv positive but you are sexually active, who should be on truvada? >> well i think we need to re-tune the conversation. i think it's possible that preexposure prophylaxis might be something that as i think was talked about earlier might work in the future. but having to take 365 pills doesn't seem to be a really good idea. and just as an example i think it was mentioned earlier that antiretroviral therapy has been around for a while. but less than 30% of people that are in this country on treatment are viral reply suppressed. which means there's no detectable virus in their blood. we have to work on this idea that people are going to take this medication every day. think about your own lives and whether or not when you get the

bottle of 18th ain't ant antibiotics have kept a good number of people safe for many many years just because we have this truvada as prep. and it's terribly expensive as you mentioned and i think we really need to have a conversation as ocommunity about how we're being -- as a community about how we're being taken advantage of by the drug companies in particular giliad. >> we'll be back. when 18th retrovirals are used in a country to help the spread of hiv aids is expensive to treat, dollars and cents justice and fairness. does geography and bad luck mean the world's poor won't get

truvada? stay with us. world, affect the nation and touch your life. >> i'm back. i'm not going anywhere this time. >> only on al jazeera america.

>> you're watching "inside story" on al jazeera america. i'm ray suarez. we've been talking about developments in drug treatment around hiv prevention ownership the last three decades health workers have tried to get people to reduce the exposure that causes aids but the preexposure drug is expensive. does that mean that for the world's poor the public education around hiv doesn't really change that much at all? still with us, whitney enguran cordva, justin goforth whitman walker health in washington d.c. and deon haywood, executive director of women with a vision. deon, you're working with population he that may not have

reliable access to health care so they may resemble people in the rest of the world latin america and africa. do you anticipate that the cost of the drug will come down, and until it does whether there's going to be a social justice dimension to the introduction of truvada? >> i'm hoping it does because as it stands right now the majorities of people we see and work with and many people in the south this drug would not be available to them if it doesn't. in terms of the social justice piece you know, i think in the last couple of years we're all realizing that we have to think of hiv as a social justice issue, the right to health care, the right to expressive sex education, the right to prevention programs that fit individual communities instead of a one stop shop and making sure that we hold elected officials and health departments responsible for the type of

sthafts our communityservice that our communities are getting. >> what's worked in the past? the aids drugs have come down in price tremendously over the years. can't we expect that truvada will do the same? >> well, that would be great. i mean it's come down a lot in the developing world. and in african countries. for instance, the same drug that you're talking about would cost less than $500 in an african nation for a year. so it really is outrageous that we're paying this kind of sum. and giliad's already made its money. they have their research, they haven't changed the formulation. they could charge $1 a pill. the state of affairs that we are not pressing on them to lower that price and rather they would like to see how much they can exact from communities.

>> justin, anybody who has watched this program can include weinclude -- can conclude that we're not home and dry yet that truvada is not the answer to anything. but does it bring a possibility for the use as uninfected people that is a bridge on the way to somewhere else? >> i think it's very exciting. those who work in community health and public health it's so cument onincumbent on us to figure out who this is a good prevention for. the data on if you take it as prescribed is extraordinary. we don't get that kind of data in public health interventions around prevention. condoms, years and years of condom research shows they are anywhere from 60 to 80% effective if used consistently and if you use truvada consistently we're talking 90s%90spercentile.

>> very quickly. >> giliad has a very generous patient assistance program. we have to let more people know that. if you are low income giliad will get you access to this drug. >> thank you all very much for being with me today. that brings us to the end of this edition of "inside story." thanks for being with us. in washington i'm ray suarez.

today ray like back at 2014. >> i was not a ham. i am ham and cheese serve odds a platter. i was ridiculous. in the last year, you have heard from icons pool is a makers and people creating national debates. the war on drugs has done more than anything we can think of. those at the frontlines for the battle of marriage equality. >> and it was the pop began at that filled with lies and