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.

State-level PrEP utilization data now available from AIDSVu

From HIV.gov

Since PrEP is one of the newer HIV prevention tools, understanding more about who is using it is important to better tailoring HIV prevention efforts at the national, state, and community levels. PrEP, or pre-exposure prophylaxis, is when people at high risk for HIV take HIV medicine daily to lower their chances of getting infected with HIV. AIDSVu has released the first-ever publicly available data and interactive maps of PrEP use by state from 2012 through 2016, stratified by sex and age.

The new maps from AIDSVu show more than 77,000 people were prescribed PrEP in 2016, with an average 73 percent increase year over year in persons using PrEP across the U.S. from 2012 – when the drug TDF/FTC was approved by the FDA for use as PrEP – to 2016. However, approximately 1.1 million people in the U.S. are at substantial risk for HIV exposure and could benefit from PrEP, according to analysis presented by the Centers for Disease Control and Prevention (CDC) at CROI 2018 earlier this year.

The data presented on AIDSVu reveal that the growth and distribution of PrEP use has been inconsistent across different sexes, age groups, and geographic regions. For example, the Southern U.S. accounted for more than half (52 percent) of all new HIV diagnoses in 2016 but represented only 30 percent of all PrEP users in 2016. That same year, women comprised 19 percent of all new HIV diagnoses but made up only seven percent of all PrEP users.

Read the full article.

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.

Read the full article.

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.

Read the full article on Newsday.com.