New York will investigate reports of gay men denied insurance

From the New York Times

State financial regulators in New York said Wednesday that they would investigate reports that gay men have been denied insurance policies covering life, disability or long-term care because they were taking medication to protect themselves against H.I.V.

Such denials would amount to illegal discrimination based on sexual orientation, and the companies doing so could be penalized, said Maria T. Vullo, the state’s superintendent of financial services.

The investigation was triggered by an article published Tuesday by The New York Times, she said.

The Times reported that various insurers around the country had denied policies to gay men after learning they took Truvada, a cocktail of two anti-AIDS drugs, to avoid catching H.I.V. through sex. To get insurance, some men even stopped taking the protective drugs.

The practice — known as “pre-exposure prophylaxis,” or PrEP — is recommended by the Centers for Disease Control and Prevention. Studies have shown that people who take the drug every day have nearly a zero chance of becoming infected, even if they are in a long relationship with an H.I.V.-infected person or have sex with many strangers without condoms.

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Many at-risk men still don’t take HIV prevention pill

From The Associated Press…

From gritty neighborhoods in New York and Los Angeles to clinics in Kenya and Brazil, health workers are trying to popularize a pill that has proven highly effective in preventing HIV but which — in their view — remains woefully underused.

Marketed in the United States as Truvada, and sometimes available abroad in generic versions, the pill has been shown to reduce the risk of getting HIV from sex by more than 90 percent if taken daily. Yet worldwide, only about a dozen countries have aggressive, government-backed programs to promote the pill. In the U.S., there are problems related to Truvada’s high cost, lingering skepticism among some doctors and low usage rates among black gays and bisexuals who have the highest rates of HIV infection.

“Truvada works,” said James Krellenstein, a New York-based activist. “We have to start thinking of it not as a luxury but as an essential public health component of this nation’s response to HIV.”

A few large U.S. cities are promoting Truvada, often with sexually charged ads. In New York, “Bare It All” was among the slogans urging gay men to consult their doctors. The Los Angeles LGBT Center — using what it called “raw, real language” — launched a campaign to increase use among young Latino and black gay men and transgender women.

“We’ve got the tools to not only end the fear of HIV, but to end it as an epidemic,” said the center’s chief of staff, Darrel Cummings. “Those at risk have to know about the tools, though, and they need honest information about them.”

In New York, roughly 30 percent of gay and bisexual men are using Truvada now, up dramatically from a few years ago, according to Dr. Demetre Daskalakis, a deputy commissioner of the city’s health department.

However, Daskalakis said use among young black and Hispanic men — who account for a majority of new HIV diagnoses — lags behind. To address that, the city is making Truvada readily available in some clinics in or near heavily black and Hispanic neighborhoods.

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Erie County Health Department: A little-known prevention tool can help reduce infection

From Lisa Szymanski, R.N. public health nurse with the Erie County Department of Health (via…

On the heels of World AIDS Day, I can think of no better time to talk about HIV prevention.

HIV is no longer the death sentence it once was. Today, people infected with the virus are living healthier and longer lives; there are well over 300 people living with HIV in Erie County alone.

But HIV can still have serious health consequences.

A little-known HIV prevention tool is available. We call it PrEP, or pre-exposure prophylaxis.

PrEP helps HIV-negative adults greatly reduce their risk of infection. It consists of a medication, Truvada, taken once a day.

If used as prescribed, the U. S. Centers for Disease Control and Prevention states that daily PrEP reduces the risk of getting HIV from sex by more than 90 percent or higher if combined with other risk-reducing behaviors. Among people who inject drugs, it reduces the risk by more than 70 percent.

The CDC is recommending PrEP for people who are HIV-negative and diagnosed with a sexually transmitted disease in the past six months. It is also recommended for those who have an HIV-positive sexual partner, heterosexual men and women who do not regularly use condoms during sex with partners of unknown HIV status, and gay or bisexual men unless in a mutually monogamous relationship with a partner who recently tested HIV-negative.

PrEP is also recommended for people who have injected drugs and have shared needles or been in drug treatment in the past six months.

You must take an HIV test before beginning PrEP and every three months while you’re taking it. There are several health-care providers in the Erie area who are now prescribing PrEP to their patients.

The cost of PrEP is covered by many health insurance plans, and a commercial medication assistance program provides free PrEP to people with limited income and no insurance to cover PrEP care.

Talk with your doctor or health-care provider to determine if PrEP is right for you. For more information, you may contact the Erie County Department of Health.

No evidence of stigma towards people using PrEP on dating apps


The study, published ahead-of-print in the Journal of Acquired Immune Deficiency Syndromes, monitored reactions on dating ‘hookup’ apps to see whether negative stereotypes of people on pre-exposure prophylaxis (PrEP) led to unfavourable reactions to people who said they were using PrEP.

The research was carried out in response to damaging labels that described PrEP users as promiscuous and irresponsible, which have surfaced in recent years on social media.

Just over 200 respondents from the USA viewed four fake dating profiles displaying identical pictures and information, with one crucial difference. The profiles described themselves as either HIV-negative, HIV-positive, a PrEP user, or a recreational substance user. Participants were then asked to rate each profile on a number of factors, including attractiveness, desirability and trustworthiness.

The study found participants rated profiles of people on PrEP as positively as HIV-negative profiles. However, HIV-positive profiles and profiles where people indicated they used substances were rated significantly less attractive and desirable than HIV-negative or PrEP profiles.

Crucially, when the sample was split by history of PrEP use, those who had not taken PrEP before rated HIV-positive profiles as significantly less attractive and less desirable, compared to HIV-negative profiles.

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Does PrEP use lead to higher STI rates among gay and bi men?


Rates of new sexually transmitted infections (STIs) are much higher among men who have sex with men (MSM) taking Truvada (tenofovir disoproxil fumarate/emtricitabine) as pre-exposure prophylaxis (PrEP) than among other MSM. More research is needed, however, to determine whether starting PrEP leads to higher STI rates among MSM.

Publishing their findings in the journal AIDS, researchers conducted a meta-analysis of 18 studies of MSM in which new STI diagnoses were reported. Five of the studies included MSM given PrEP, and 14 were conducted with MSM who were not given PrEP. (One study, the PROUD study, included both a group given PrEP immediately and a group given PrEP on a deferred basis and thus fell into both the PrEP and the non-PrEP categories of studies.)

The researchers found that the rates of new diagnoses of STIs among MSM given PrEP were 25.3 times greater for gonorrhea, 11.2 times greater for chlamydia and 44.6 times greater for syphilis, compared with the rates among MSM not given PrEP. After repeating the analysis but excluding studies conducted before 1999, the researchers found that the results were similar.

Looking to parse apart the contributing factors to the higher rate of STI diagnoses among MSM given PrEP, the meta-analysis’s authors theorized that the regular STI testing that is part of taking PrEP might have led to a higher rate of STI detection. A greater number of sex partners and a higher rate of condomless sex among those given PrEP might also have contributed to their higher STI diagnosis rate.

The study is limited by the fact that, except in the case of PROUD, the researchers compared different populations of MSM from study to study. They also compared groups that tested for STIs at different frequencies and used different variations of STI tests. Additionally, the PrEP studies specifically sought out participants engaging in high-risk sexual behaviors, while the other studies might have had different criteria with regard to sexual risk taking. However, participants in many of the non-PrEP studies were indeed recruited based on some level of reported sexual risk taking.


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Anti-HIV pill safe among gay, bisexual adolescent boys

From Reuters Health

A pill that protects against the human immunodeficiency virus (HIV) can be safely used by young men who have sex with men, according to a new study.

In a diverse group of teen boys at high risk for HIV infection, pre-exposure prophylaxis (PrEP) in the form of a pill that combines the drugs emtricitabine and tenofovir disoproxil fumarate was well tolerated, researchers found.

“I do hope clinicians increase their comfort with being able to provide PrEP to adolescents,” said lead author Sybil Hosek, a clinical psychologist and HIV researcher at Cook County Health and Hospitals System’s Stroger Hospital in Chicago.

She hopes the new data will be submitted to the U.S. Food and Drug Administration (FDA) and will encourage the agency to approve the pill for use by younger people. The pill is currently approved for HIV prevention in adults.

The drug was first approved by the FDA in 2012 as Truvada, which was marketed by Gilead. Trials found that the drug reduced the risk of HIV infection by over 90 percent.

But little evidence was collected on its use among gay and bisexual adolescent males, who are among those most at risk for HIV infection.

For the study, researchers enrolled 78 gay and bisexual young men, ages 15 to 17, from six U.S. cities. The participants all tested negative for HIV at the start of the study, but were at high risk for an infection.

Participants received a counseling session about HIV risk, plus access to daily doses of PrEP for the next 48 weeks.

Overall, 47 participants completed the study.

Only three adverse events occurred that were possibly related to PrEP, the researchers found.

“I think the safety piece is important,” Hosek told Reuters Health. “It was well tolerated. We didn’t see many complaints about side effects. We did not see many adverse events.”

The researchers also didn’t find an increase in sexually risky behaviors over the study period.

Three young men did become infected with HIV, however. Blood samples suggest they were taking less than two doses of PrEP each week at the time of infection.

The rate of HIV infection in the study was 6.4 cases per 100 people per year, which is about twice as high as the rate seen among men ages 18 to 22 years enrolled in a similar trial, the researchers write in JAMA Pediatrics.

“I shudder to think what the (HIV infection) rate would be if we didn’t offer PrEP,” said Hosek.

She said the high rate of HIV infections is likely due to poor adherence. While more than 95 percent of the young men had evidence of the preventive medication in their blood during the first 12 weeks of the study, by week 48 only about 15 percent of participants had detectible levels of the drug.

Low adherence to medications is a common problem with adolescents, said Hosek.

Dr. Renata Arrington-Sanders writes in an editorial accompanying the new study that making PrEP a success among gay and bisexual adolescents will require effort.

“This work suggests that adolescents may require additional visits than what is currently recommended by national guidelines and suggests a need for multiple team members to address structural barriers to accessing PrEP, assist with youths’ interpretation of HIV risk, and support self-efficacy to swallow and adhere to medications,” writes Arrington-Sanders, of Johns Hopkins University in Baltimore.

Hosek agreed, calling for doctors to be more connected to their young patients on PrEP.

“Clinicians should not be afraid to see adolescents more frequently, maintain a connection with the adolescents and keep them engaged,” she said.

SOURCE: and JAMA Pediatrics, online September 5, 2017.

Can new ‘Smart PrEP Pills’ increase adherence for HIV-prevention medication among young people?

From the Daily Herald online…

How does the smart PrEP work?

“The pill Truvada — the only PrEP drug approved by the Food and Drug Administration — has a sensor tablet encapsulated over it, so that when the pill is swallowed, the sensor tablet comes in contact with gastric fluid in the stomach and creates an electrical signal,” explained Dr. Gregory Huhn, CCHHS’ Associate Professor of Infectious Diseases and principal investigator of the trial. “The electrical signal is less than the frequency of a heartbeat, so nobody is going to feel it. But it transmits a signal in real-time that the pill has been ingested.”

By having a record of when the pill has been taken that goes to both the patient and his or her doctors or providers, the providers can reach out to patients who haven’t been taking the pills as directed and find out if there are any issues they can help resolve-like medication side effects a patient might be having or that they’ve run out of medication, Brothers said.

PrEP is supposed to be taken once a day.

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