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.

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 goErie.com)…

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

From Avert.org

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.

Read the full article.

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

From POZ.com

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.

 

Read the full article.