Opinion: Why don’t more Americans use PrEP?

From the New York Times

Truvada was approved by the Food and Drug Administration in 2012. But over six years later, the United States is failing miserably in expanding its use. Less than 10 percent of the 1.2 million Americans who might benefit from PrEP are actually getting it. The major reason is quite clear: pricing. With a list price over $20,000 a year, Truvada, the only PrEP drug available in the United States, is simply too expensive to become the public health tool it should be.

[…] The disparities in PrEP access are astounding: Its use in black and Hispanic populations is a small fraction of that among whites. In the South, where a majority of H.I.V. infections occur, use is half what it is in the Northeast. Women use PrEP at drastically lower rates than men, and while there’s no national data on PrEP and transgender Americans, it’s almost certainly underused. The issue of PrEP access has become an issue of privilege.

The ability of PrEP to greatly reduce new H.I.V. infections is no longer in question. In New South Wales, Australia, a program providing free access to PrEP led to a drop in H.I.V. diagnoses in the most vulnerable communities by a third in just six months, one of the fastest declines recorded since the global AIDS crisis began.

Read the full article on New York Times online.

A side-effect of preventing HIV with PrEP: Less condom use

As condom use falls, will other infections spread?

From NBC News online

A pill that protects people from the AIDS virus may be driving down use of condoms, Australian researchers reported Wednesday. They found that as more people used the daily pill, called PrEP, the less likely they were to use condoms.

It’s not clear what this means, the researchers wrote in the Lancet medical journal. But the fears are that availability of the pills could feed a false sense of security, and that dropping condom use will help fuel the already widening epidemics of other sexually transmitted infections (STIs) such as syphilis and gonorrhea.

There are also fears that rates of new HIV infections could go back up if people stop using condoms and do not use PrEP consistently. But some activists said it’s a positive trend and will help remove the stigma surrounding gay and bisexual sex.

PrEP stands for pre-exposure prophylaxis. Researchers found that taking HIV drugs can protect people who are not infected from acquiring HIV. The most common brand name is Truvada, a once-a-day pill. This pill can prevent HIV. But use remains low.

PrEP can reduce the risk of catching HIV by 90 percent if people use it consistently. It’s been on the market since 2012 and has been recommended by the Centers for Disease Control and Prevention since 2014.

“PrEP has been heralded as a game-changer for HIV, but declining condom use may impede its long-term population-level effectiveness,” Martin Holt at the University of New South Wales in Sydney said in a statement.

Holt and colleagues surveyed nearly 17,000 gay and bisexual men in Sydney and Melbourne between 2013 and 2017, before and after a large campaign to encourage PrEP use. By 2017, 24 percent of HIV-negative men were using PrEP, they found. Between 2013 and 2017, the consistent use of condoms fell from 46 percent of men in 2013 to 31 percent in 2017.

“A rapid increase in PrEP use by gay and bisexual men in Melbourne and Sydney was accompanied by an equally rapid decrease in consistent condom use,” Holt and colleagues wrote. Their findings fit with other research done, especially a 2016 study in San Francisco that found similar trend.

Read the full article.

Gilead Sciences will begin airing television ads for PrEP

From NBC News

In a major shift, pharmaceutical giant Gilead Sciences will begin airing television ads for PrEP, its HIV prevention medication. The company said the ads, which will start in June and run through August, are “designed to encourage candid conversations around sexual health and promote public awareness of HIV prevention.”

PrEP, or pre-exposure prophylaxis, involves taking a daily pill to prevent HIV transmission. Major clinical trials have shown that PrEP — also known by its brand name, Truvada — is safe and effective at preventing HIV if taken daily. The pill is also recommended by the Centers for Disease Control and Prevention for at-risk groups.

A still from Gilead Science’s new advertisement for PrEPGilead Science

Since the Food and Drug Administration (FDA) approved Truvada for HIV prevention in 2012, Gilead has leaned on public health agencies to promote the drug. New York City has for years placed advertisements on subways and buses to promote PrEP, and the District of Columbia’s health department aired its own racy HIV PrEP television ad earlier this year.

Read the full article.

Gay Men Still Don’t Believe Undetectable = Untransmittable

From Logo online

Last September, on National Gay Men’s HIV/AIDS Awareness Day, the Center for Disease Control (CDC) declared that men with HIV who have an undetectable viral load—levels of HIV in the blood that are below the threshold of detection—are unable to transmit HIV to their partners. This is often summarized with the phrase Undetectable = Untransmittable or U = U.

The CDC came to this conclusion after evaluating three studies that included thousands of couples engaging in unprotected sexual acts in which one partner was HIV-positive with an undetectable viral load, and the other was HIV-negative and not on pre-exposure prophylaxis (PrEP).

“No HIV transmissions to an HIV-negative partner were observed when the HIV-positive person was virally suppressed,” the CDC reported.

When levels are this low, the virus is so suppressed that it’s impossible to pass on the virus to a partner sexually. Consequently, HIV treatment is now being used as a form of prevention, commonly referred to a TasP (Treatment as Prevention).

It’s been over 30 years since the inception of the virus, and still, there is so much shaming and stigma surrounding people living with HIV. This in large part due to misinformation and fear of contracting the virus. That’s what led Drs. Jonathon Rendina and Jeffrey Parsons of Hunter College to explore whether gay, bisexual, and other men who have sex with men actually believe that undetectable = untransmittable.

After the AIDS epidemic there was “a sense that nobody could be trusted that had negative effects on guys with and without HIV,” Dr. Rendina tells Newnownext.

Read the full article.

Grindr app to offer H.I.V. test reminders

From New York Times Health

In an effort to shrink the global AIDS epidemic, the world’s largest gay dating app is changing its software this week to urge millions of users to get frequent H.I.V. tests.

Grindr, which claims to have 3.3 million daily users from every country in the world, will send men who opt into the service a reminder every three to six months, and simultaneously point them to the nearest testing site. It will also let clinics, gay community centers and other testing sites advertise for free.

The company is making the move to “reduce H.I.V. transmission and support our whole community — regardless of H.I.V. status — in living long and fulfilling lives,” said Jack Harrison-Quintana, Grindr’s director for equality.

H.I.V. experts greeted the announcement enthusiastically.

“Wow — that’s great!” said Dr. Jeffrey D. Klausner, a former chief of sexually transmitted disease prevention in San Francisco who has used Grindr to promote testing. “For a company of this magnitude to do this is groundbreaking.”

Perry N. Halkitis, dean of the Rutgers School of Public Health and an expert in gay male behavior, called the decision “excellent.”

Read the full article.

Health Alert: HIV rate among gay and bi men between the age of 25 to 34 rose 45% between 2008 and 2015

During that time, the rate dropped 15 percent nationally and rose 25 percent among Latino men who have sex with men.

From Poz Magazine online

While the national annual HIV infection rate dropped by an estimated 15 percent between 2008 and 2015, a few key subgroups saw a rise in yearly new HIV infections, also known as HIV incidence. During this period, HIV incidence among 25- to 34-year-old men who have sex with men (MSM) increased by an estimated 45 percent while the rate increased 25 percent among Latino MSM.

These figures come from the Centers for Disease Control and Prevention’s (CDC) new, in-depth analysis of epidemic trends in the United States. Published in the Annals of Internal Medicine, the report is a more precise and granular version of reports on epidemic trends that CDC officials presented at the 2017 Conference on Retroviruses and Opportunistic Infections (CROI) in Seattle a year ago.

At that time, the agency estimated that HIV incidence declined 18 percent between 2008 and 2014. This new estimate, therefore, represents a disappointing reduction in that hopeful figure.

Prior to 2008, HIV incidence was essentially stable in the United States for the two decades since the beginning of the modern era of combination antiretroviral (ARV) treatment.

Read the full article.