June 9, 2021
Cynthia Robles is no stranger to helping patients get the help they need. From starting out at Venice Family Clinic in 2018 as a medical case manager with the HIV care team to now serving as our PrEP medication navigator, Cynthia is focused on helping prevent as many new HIV infections as possible. Based at Common Ground, the Clinic’s HIV prevention and treatment program, Cynthia helps to expand the knowledge of medications that can help deter new infections. As part of the Clinic’s harm reduction approach, Cynthia provides client-centered care to best serve the patients she meets.
VFC: What are these medications that can help people avoid being infected with HIV?
CR: PrEP and PEP are two highly effective treatments in preventing HIV infection. PrEP is short for pre-exposure prophylaxis, a pill that when taken daily is very effective at preventing HIV infection. It reduces the risk of infection from sex by about 99% and by at least 74% among people who inject drugs. PEP stands for post-exposure prophylaxis and is medication that can be taken in emergency situations after an HIV exposure. PEP is most effective at preventing infection when started within 72 hours of known or suspected exposure. It consists of a medication regimen that must be taken for 28 days. Both PrEP and PEP are accessible at any of our clinics.
VFC: Why might someone take PrEP or PEP?
CR: Even though we always encourage individuals to use condoms, the reality is that some people have multiple sex partners or prefer to have sex without condoms. Ultimately, anyone who is having unprotected sex or sharing needles or drug paraphernalia is at risk for HIV, so it’s important for them to know that PrEP and PEP exist. Being on PrEP helps reduce their chances of an HIV infection, but it does not protect against other sexually transmitted diseases nor does it prevent pregnancy. At Common Ground, we tell anyone who comes through our doors about these medications. Even if it doesn’t benefit that person directly, they could share that information with someone who might.
VFC: How does someone get a prescription for PrEP or PEP?
CR: If someone decides they want to take PrEP and are already connected to the Clinic or would like to become a patient, I can help them make an appointment with a clinician, who will order tests for HIV, hepatitis B, sexually transmitted diseases and overall kidney function, to confirm that PrEP is safe for them to use. The most important part before someone gets on PrEP is to make sure they are HIV-negative. After the initial lab results come back, that’s when they’ll get a prescription.
If someone needs PEP, I make an urgent appointment with one of our clinicians. Because of the 72-hour time frame, it’s important the person be connected to the medication as soon as possible. From there, I follow through with the patient to ensure they pick up the medication and take the first pill within those first 72 hours.
VFC: What happens next?
CR: For PrEP, I make sure patients keep their follow-up appointments since they have to get these same blood tests done every 3 months. I make sure our clinicians get a heads-up as to when those appointments are going to be so they can order the labs, then I call patients to make sure they come in for their labs. Sometimes there might be minor side effects to the PrEP medication that usually go away within the first month, so I’ll check up on patients to see how they’re doing. If there are any issues with a patient’s preferred pharmacy or with their insurance, especially if someone is underinsured or uninsured, I make sure they’re connected to the right patient assistance program so the cost of the medication is covered. Without insurance or coverage, PrEP is really expensive, about $2,000 a month.
VFC: Why is it important to have a PrEP navigator on the Westside?
CR: As far as I know, I’m the only PrEP navigator on the Westside. Having someone in this area to educate and connect people to PrEP and PEP increases the chances that people will get the information they need about these much-needed services.
Even though PrEP has been available since 2012 and PEP since 2016, a lot of people don’t know about them. According to the CDC, about 1.1 million people in the United States could be candidates for PrEP, but only 8% are actually using it. So it’s important that as many people as possible know about their options so we can slow the spread of HIV.
I hope the people I give PrEP and PEP information to will tell others that I’m here to help, and we can connect as many people as possible to these treatments who want to be on them. I want to spread that knowledge and destigmatize conversations around sex, intravenous drug use, and HIV/STI testing and prevention.
VFC: What do you like most about your job?
CR: I love interacting with patients. I like to get to know them and build relationships so they can feel that there’s someone at the Clinic who they can call directly. If they call my direct number, I can get the message right away and get urgent matters taken care of as soon as possible. I like that patients can feel at ease with me and know that for however long they’re on PrEP, even if they decide to go off of it and go on it again, they can call me for help.
VFC: How do you see your role evolving in the future?
CR: Right now, if someone comes into Common Ground and is interested in PrEP, I give them information and answer their questions. If they are here for HIV or STI testing, all of our HIV testers inform patients about PrEP and PEP. If further information is needed, they provide a warm handoff to me. I’ve also given presentations internally, including to the Clinic’s health educators and our substance use team, so those clinicians can also share that information with patients who might need it. In the future I hope to do more of this and would like to go out to other organizations, too, so we can inform even more people about these tools and help prevent as many new HIV infections as possible.
VFC: What would you like people to know about our HIV services?
CR: Get tested. You can walk in; you don’t even have to make an appointment at Common Ground. Have conversations with me or any of the Clinic’s HIV testers. Even doing just that is important. And take advantage of the resources we have that are available to you. Let’s move forward in the HIV epidemic.