Dr. Lisa Sterman, M.D., MPH, is an expert in the field of HIV medicine who has been in private practice in San Francisco for over 20 years. She kindly agreed to sit down and talk with us about pre-exposure prophylaxis (PrEP), an HIV prevention method that's available by prescription.

HIV Health Spotlight: A conversation about PrEP with Dr. Lisa Sterman

This interview has been edited for length and clarity.

Dr. Lisa Sterman, M.D., MPH, is an expert in the field of HIV medicine who has been in private practice in San Francisco for over 20 years. After obtaining her Master’s in Public Health, she completed her training in medicine and HIV at UCSF. She’s been involved in clinical research for HIV medications and has worked in the community as an educator and advocate, including serving on the Board of Directors for the San Francisco AIDS Foundation, for many years. 

Dr. Sterman kindly agreed to sit down and talk with us about pre-exposure prophylaxis (PrEP), an HIV prevention method that's available by prescription. The most important thing she wanted us to know? This conversation is for everyone.

Can you tell us a little about how you got started in your field?

It’s been a long road. I started working with HIV in the ’80s. I was at college in Berkeley, and I do a lot of rock climbing. My friend and rock climbing partner was a nurse at SF General, at their famous HIV ward. I knew I wanted to go into medicine and she said, “You should come volunteer on our ward.” It was the ‘80s, so it sounded totally controversial and dangerous and I was like, “I’m in.” That’s my personality, so that's how I got started. Really, it was the doctors and nurses there that inspired me to go into HIV. They were just incredible. 

What’s something everyone should know about PrEP?

Everyone needs to know that there is a pill that prevents HIV. So many people haven’t even heard of the concept. Nearly everyone is eligible with a short screening set of labs, so talk to your provider and find out if you might want to consider PrEP.

A lot of people may think, “I’m not at risk” or, “that’s not my group of people.” The way I teach it is: if you’ve ever had sex, you’re at risk for HIV. If you’ve ever shared drug needles, you’re at risk for HIV. Everyone should know their status. 

Editor’s Note: To learn more about PrEP and how it works, see our article, “All About PrEP for HIV Prevention.”

If you’re using condoms every time you have sex, would you still recommend PrEP? 

Yes, condoms break or fall off, and then you can have exposure. They are not 100%. I would say we’ve come as far as we can with condoms, that piece of HIV prevention efforts is great, and this is the next step. Condoms may prevent or reduce the risk of other STIs, but they are not the only or appropriate way to protect yourself from HIV if you are at higher risk for HIV.

Some groups of people at risk for HIV can’t always ask their partner to use condoms. They may not have the power in the relationship or they may be under pressure because they’re exchanging sex for commodities like housing, money, food, shelter, or drugs. PrEP helps empower many people who are at risk and can be taken without a partner’s knowledge or consent. In this way, some groups of people have a better chance of protecting themselves against HIV.

How can you go about talking to a doctor about PrEP? 

It would be nice if doctors asked every patient the right questions. I ask anybody who walks through my door, “Do you have risks for x, y, and z?” Part of that is taking a sexual history, but not every provider is going to do that. For a motivated patient who wants to go out and find a PrEP provider, there are great websites like pleaseprepme.org where you can find providers that do video calls, or for other folks, a trusted relationship with an in-person provider. There are more conservative areas in the US where you might perceive yourself to be at risk for HIV, but you can’t talk about who you are having sex with, who your partners are having sex with, or how you exchange all those things. If you worry about feeling stigmatized by your provider, there are other resources out there. It’s just that a lot of people don’t know about them.

Need help finding a PrEP provider? Try: 

If you decide to use PrEP, what does the process look like? 

We need to verify that you’re HIV-negative, but we’ll probably send you off with a prescription for PrEP at the initial appointment. If you’re at high risk, we want to get the medication into you before we even necessarily know the results of your HIV test. We’ve come to find that a rapid start to HIV prevention is important. We don’t want to miss the opportunity to protect someone during the week when their labs are being done. There is very little risk in taking a week’s worth of PrEP even if you are HIV positive.

So, you would start PrEP and then we’d follow up in a week to go over your labs. We’d treat any STIs, make sure your renal function is normal, and then we’d continue these tests on a regular basis while you’re on PrEP. The standard protocol is every three months. Some patients with

very high risk of STI exposures may need more frequent testing for other STIs.

I think the key is to make sure everyone knows it’s out there and for everyone to be able to have that conversation with a healthcare provider they feel comfortable with. People need to understand where they are at risk and where they are not. PrEP for HIV is not for everyone. We think about PrEP as having “seasons of risk.” A person’s need to use it may come and go depending on what their lifestyle is like. You need to be having an ongoing conversation about how your risk changes over time. 

How do you think Alto can be helpful to people on PrEP? 

Alto is a wonderful way for people to access their meds, especially during COVID. It’s convenient. It shows up when you need it. For PrEP and HIV meds I can have them provide all sorts of support for the patients. Everyone is knowledgeable—I’ve worked with some of Alto’s pharmacists in other capacities. I’ve had great experiences with Alto and I think my patients would say the same. 

Is there anything else you’d like to tell our community?

Your relationship with your healthcare provider is so important. If you don’t feel like you can tell them everything that is going on, you need a new provider. If you’re feeling stigmatized and someone is not supportive of your lifestyle, then switch, if possible, to an online pharmacy or a community health center that works with the LGBTQ community and get your PrEP that way. Any online pharmacy that handles PrEP will have someone sensitive to these communities, lifestyles, and risk factors.

Even though I do everything I can to encourage an open dialogue, I don’t always get all the information out of people either. Sometimes people feel embarrassed, but we can’t support someone if we don’t know what they’re doing. The first step is to have a healthcare provider that you really trust. The second step is to be really honest with that person. Help them help you prevent HIV.

For more information about Dr. Lisa Sterman and her practice, you can view her profile here. 

HIV Health Spotlight: A conversation about PrEP with Dr. Lisa Sterman 

We offer the latest advice on how you can access the medications and services you need while protecting yourself from infection with COVID-19.

Navigating HIV Treatment and Prevention During COVID-19

Living with HIV during the COVID-19 pandemic

It’s been over six months since the first stay-at-home orders swept across the country, and we’re just beginning to replace widespread uncertainty about the coronavirus with real-world data. There’s still much we don’t know about how COVID-19 affects those living with HIV, but researchers are working quickly to glean insights from cases over the past months. 

Though our understanding is continually evolving and the data is limited, experts believe that people with HIV who are receiving treatment have the same risk for COVID-19 as the general population. We do know, however, that people with weakened immune systems are more likely to get severely sick from COVID-19, which underscores the already vital importance of preventing new HIV infections and ensuring access to treatment. 

If you are at risk of HIV infection or living with HIV, we encourage you to not put prevention or treatment on hold. It’s also crucial that you stick to the plan outlined by your doctor as closely as possible, especially by taking your medications correctly and on time. As your pharmacy, we’re here to help you overcome any challenges in maintaining your regimen that may arise. Let’s walk through the latest advice on how you can access the medications and services you need while protecting yourself from infection with COVID-19.

Is COVID-19 illness more severe in people living with HIV?

As we mentioned, when HIV is being treated, it does not seem to increase the risk of infection or severe illness. Those who are living with HIV and not on treatment or virally suppressed, however, may be at greater risk of COVID-19 complications. Additionally, older people living with HIV and those with other underlying health conditions may also be at greater risk of serious illness from COVID-19. It’s important to take precautions to protect yourself from COVID-19 infection by following CDC guidelines, such as wearing a mask, social distancing, and washing hands and high-touch surfaces often. 

We know that people living with HIV are more vulnerable to respiratory infections when their HIV is not well managed. That’s because their weakened immune systems may be unprepared to deal with an invading virus. For this reason, it’s incredibly important to continue your antiretroviral treatment (ART) as prescribed. If you are having difficulty continuing your treatment for any reason, talk with your healthcare provider right away.

What additional precautions should people living with HIV take?

The most important actions you can take for your health are to continue your HIV treatment and avoid potential exposure to the coronavirus. Follow the preventative guidelines outlined by the CDC to protect yourself and others from getting sick. Additionally, you should take the following precautions:

Keep your regular medical appointments and discuss ways you can reduce your risk of exposure to COVID-19 during your visits. Use telehealth services whenever possible; your doctor can advise you on the remote options available to you.

Keep at least a 30-day supply of your HIV medications on hand as well as any other medications or supplies you need to manage your health. If possible, ask for a three-month supply and choose a pharmacy that offers home delivery to avoid spending time in close contact with others while standing in lines. (Alto’s couriers will hand-deliver your medications to your doorstep, so you never have to worry about mail delays either!)

People living with HIV are at a higher risk of serious flu-related complications, make sure all your vaccinations are up-to-date, especially your flu shot.

The CDC recommends maintaining a healthy diet, aiming for 8 hours of sleep every night, and taking steps to reduce stress. 

If you start to feel sick, especially if you have a dry cough, fever, fatigue, and/or a loss of smell or taste, stay at home and contact your doctor immediately so you can determine your next steps. You will need to self-isolate to avoid spreading the coronavirus to others as you await instructions from your doctor. For this reason, we strongly recommend having a plan in place for if you get sick, including keeping 30 days’ worth of medications, food, and other supplies on hand.

How can I get tested for HIV during the COVID-19 pandemic?

It’s as important as ever to know your HIV status. If you’re at risk for HIV, talk to your healthcare provider about your options for getting tested. The CDC has stressed the importance of continued access to HIV testing and encourages people who are at risk for HIV infection to get tested in ways that support social distancing and stay-at-home orders (when they are in place), such as self-testing when possible. They have created this resource that lists self-testing services by state. You can also find in-person testing locations here. 

I’ve lost my insurance. How can I continue to get my HIV medication?

As we face this public health crisis, record numbers of people are also losing their jobs and employer-based coverage. If you’re currently uninsured or cannot afford your out-of-pocket costs, there are resources that can help. HIV.gov puts out this list of toll-free helplines that can help you find programs and services in your state to lower your treatment costs. They also list a variety of federal resources here. 

The AIDS Drug Assistance Program (ADAP), which is part of the Ryan White HIV/AIDS Program was created to help cover the cost of HIV-related prescription medications for people who have limited or no prescription drug coverage. Eligibility may vary by state, so find out more by using the ADAP Directory to identify your local program. 

How can I continue to access PrEP during the COVID-19 pandemic?

If you are at risk of HIV exposure, protecting yourself needs to remain a top priority. PrEP, or pre-exposure prophylaxis, is an HIV prevention method that's available by prescription. We explain more in our article, “All About PrEP for HIV Prevention.”

If you are already taking PrEP, talk to your provider about the possibility of telehealth options for the time being and see if you can get a prescription for a 90-day supply of PrEP. To find an in-person or online provider, visit one of the following websites:
PleasePrEPme.org
Greaterthan.org

If you need help paying for PrEP, there are assistance programs available that can cover the costs. PleasePrEPme.org maintains a comprehensive list of available resources here. 

What are some ways to cope with stress and anxiety right now?

It’s normal to experience heightened emotions during times of stress. And, unfortunately, some of the actions we are taking to protect ourselves, such as social distancing, can negatively impact our emotional well-being. Here are some ways you can protect your mental health and cope with the stress and uncertainty of the COVID-19 pandemic.

Unplug when you need to. It’s important to stay informed, however, the constant cycle of news reports and social media updates can become all-consuming and overwhelming. Take breaks from your devices when necessary and try to focus on reliable news sources and avoid social media accounts and websites that may be spreading rumors or false information.

Find soothing activities and practice them daily. Maybe you turn to a calming classic like meditation when you need to recharge or perhaps nothing makes you happier than whipping up a batch of chocolate chip cookies from scratch. Whatever helps you unwind is good for your emotional well-being and overall health. 

Stay on top of your health and wellness. Stress can disrupt your usual healthy habits. Try to move your body frequently, incorporate healthy foods, and get a full night’s sleep. You may not succeed every day and that’s okay. Just do your best to keep up your healthy habits most of the time. 

Seek help if you need it. If feelings of fear, anger, sadness, worry, or numbness interfere with your responsibilities for several days in a row or if you find yourself turning to unhealthy coping strategies like drugs or alcohol, please reach out for help. The CDC offers this list of free and confidential resources.

We are committed to ensuring you receive your HIV medications safely and on time throughout the COVID-19 pandemic. Our pharmacy locations are fully stocked, our couriers are ready, and our pharmacists can assist with coordinating early refills and longer fills. We offer free, contactless delivery, plus ongoing access to support and advice.  

Reach out to our HIV speciality team at 1 (800) 874-5881 (call/text) or send us a message through our mobile app. We’re available from 9 am - 9 pm PT Monday - Friday and 10 am - 6 pm PT on weekends.

This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or another qualified health provider with any questions you may have regarding a medical condition.

If you are one of the thousands of womxn navigating these changes to your coverage, here’s what you should know about your options.

At Alto, we believe that affordable and equitable access to a medication as basic and fundamental as birth control should be protected by law.

A recent Supreme Court decision has changed the rules that employers must follow when determining what medications will be covered at no-cost by employer-sponsored insurance plans. Per the July 8th decision, employers can now opt out of providing no-cost coverage for contraceptives (previously required under the Affordable Care Act). This change may mean that you now have an increased out-of-pocket costs - or may have no insurance coverage at all - for your birth control medications.

Birth control is essential health care - nine in ten women will use contraceptives in their lifetime. At Alto, we believe that affordable and equitable access to a medication as basic and fundamental as birth control should be protected by law. 

If you are one of the thousands of womxn navigating these changes to your coverage, here’s what you should know about your options:

Generic options - If your current medication now has a high out-of-pocket cost, you can ask your healthcare provider if there are generic options or other alternatives to consider that may be more affordable, while still being safe and effective. 

Coupons and discounts - Ask your pharmacy to confirm they’ve checked for any available manufacturer coupons, copay cards, or savings programs that you may be eligible for.

Health savings account - If you have access to a health savings account (usually available with high deductible health plans), pay for your birth control with your HSA funds. HSA contributions are tax-free.

If you live in one of Alto’s service areas, we will automatically apply any available coupons, search for lower cost alternatives, and coordinate any switches with your healthcare provider so you can have affordable access to your medication, on schedule and without delays. 

Our pharmacies stock dozens of birth control options, all available for free, same-day courier delivery. Reach out to our pharmacists with any questions - we’re available seven days a week via phone, text, email or chat in our app.

1 https://www.guttmacher.org/fact-sheet/contraceptive-use-united-states, https://www.plannedparenthood.org/about-us/newsroom/press-releases/planned-parenthood-announces-nationwide-fight-for-birth-control

If you are one of the thousands of womxn navigating changes to your coverage, here’s what you should know about your options.

Tips for Navigating Birth Control Costs

Expires 04/01/2021

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You’ve made a commitment to your health, so here’s our commitment to you: free deliveries, quarterly lab reminders, and expert pharmacist support to answer any of your questions.

Your patient care and pharmacist team at Alto has deep experience in your medication regimen. You’re in this for the long haul, and we are, too.

Alto’s very first deliveries were birth control medications. We’ve grown, but our pharmacies still stock hundreds of options for you.

A new diagnosis can bring both reassurance that there’s a plan and worry about what’s next. Alto has all the medication you’ll need to feel in control and on the path to feeling better.

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My medicine doesn’t seem to be working.

This acne medicine is upsetting my stomach.

When you have questions about side effects, or are worried about missing a dose, or not sure if you’re administering it correctly — we’re here to lend a hand.

With Alto, you won’t have to fight the lines at the pharmacy. Our couriers hand-deliver your medication to your door, whenever and wherever you need it.

Ask your doctor to send your prescription directly to Alto or ask us to transfer refills from your old pharmacy. We’ll look for any savings, including coupons and assistance programs, and reach out when it’s time to schedule your free delivery.

Yes. As a full-service pharmacy, Alto can fill all medications, including specialty, over-the-counter, brand, and generic. Alto’s pharmacists have deep expertise in many clinical areas, including heart and lung health, diabetes, fertility, HIV/PrEP/HRT, and more.

Yes. We accept all major insurance plans, including government-administered plans, and always work to get you the lowest price. Please note that coverage varies by state. For up to date information on coverage in your area call us at 1 (800) 874-5881.

Wellness and prevention, on your terms.

We’re specialists in medication for:

PrEP

Hormone replacement therapy

Birth control

Sexually transmitted infections

"Alto was a lot easier and always a lot more reliable than going to the pharmacy"

Ask your pharmacist, not the Internet.

Free hand-delivery to your door.

FAQs

How does Alto work?

Do you carry my medication?

Will I be covered by my insurance?

Switch to a better pharmacy.

Wellness and prevention, on your terms.

We’re specialists in medication for:

PrEP

Hormone replacement therapy

Birth control

Sexually transmitted infections

"Alto was a lot easier and always a lot more reliable than going to the pharmacy"

From Our Blog

Navigating HIV Treatment and Prevention During COVID-19

Tips for Navigating Birth Control Costs

HIV Health Spotlight: A conversation about PrEP with Dr. Lisa Sterman

Ask your pharmacist, not the Internet.

Free hand-delivery to your door.

FAQs

How does Alto work?

Do you carry my medication?

Will I be covered by my insurance?

Switch to a better pharmacy.