New CDC initiative educates providers about PrEP and PEP

From HIV.gov

CDC’s Act Against AIDS initiative recently launched Prescribe HIV Prevention, a new initiative for healthcare providers that focuses on HIV pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP). The target audience includes primary care providers, infectious disease and HIV specialists, nurses, and public health practitioners.

PrEP is a way for people who are HIV-negative but at high risk for getting the virus to prevent HIV infection by taking a pill every day. PrEP is highly effective when taken as prescribed. PEP is the use of antiretroviral drugs after a single high-risk event to prevent HIV. It must be started within 72 hours of a possible exposure.

Prescribe HIV Prevention educates providers and patients about these biomedical prevention tools and encourages providers to consider PrEP and PEP for patients at high risk for HIV. It includes resources such as a guide for discussing sexual health with patients, brochures and posters to educate patients about PrEP and PEP, continuing medical education programs, and a medication guide for patients.

PrEP regarded as a social problem by some gay and bisexual men

From aidsmap.com

[A]ccording to US research published in Sociology of Health & Illness. A series of focus groups conducted in New York City showed that some men regarded PrEP users as irresponsible, naïve, vectors of disease and a social problem. In contrast, other men articulated PrEP as a beneficial new option for preventing the spread of HIV, and also had a nuanced view about the effectiveness of condom-based prevention campaigns and the epidemiology of sexually transmitted infections (STIs) among gay and bisexual men.

“By framing PrEP use as enabling gay and bisexual men to violate subcultural norms of sexual etiquette espoused in previous HIV prevention efforts, claims makers were able to present PrEP users as social problem villains,” write the authors. “Countering claims makers’ framing PrEP as a social problem, some men constructed PrEP as a helpful prevention tool in the fight against the HIV epidemic within gay an bisexual communities. Much of their discourse was couched within a harm reduction model in which PrEP medication is framed as significantly reducing the harm associated with engaging in risky sexual behavior.”

The use of emtricitabine/tenofovir (Truvada) as PrEP was approved in the US in 2012. Studies have shown that, with good adherence, this treatment can reduce the risk of infection with HIV by over 90%.

Read the full article.

New study finds 4% of HIV-negative gay/bi men are using PrEP

From OUT Magazine online…

A mere 4% of gay and bisexual men reported using Truvada as PrEP in a new study, recently published in PLOS ONE.

Led by Psychology Professor Phillip Hammack of the University of California Santa Cruz, the study examined HIV testing and use, familiarity, and attitudes toward pre-exposure prophylaxis (PrEP) among HIV-negative gay and bisexual men in the United States.

Truvada is a daily pill that reduces the likelihood of acquiring HIV by almost 100%. Currently, it is the only FDA-approved form of pre-exposure prophylaxis, or PrEP, which is recommended by the Centers for Disease Control and Prevention (CDC) for those at high risk of HIV/AIDS.

“The extremely low rate of PrEP use, while not surprising given barriers to access in various parts of the country, is disappointing,” said Hammack.

The study used a national probability sample of 470 men ages 18-59. Participants completed the survey between March, 2016 and March, 2017.

Other key results of the study included:

— The majority of gay/bi men between the ages of 18-25 are not tested for HIV annually, as recommended by the CDC.

— 25% of young men in the same age group have never been tested for HIV.

— Approximately 8% of men over 25 had never been tested for HIV.

— Visiting an LGBT health clinic and searching online for LGBT resources were associated with greater likelihood of PrEP use.

— Bisexual and non-urban men were less familiar with PrEP compared to gay-identified and urban men.

— Attitudes were positive among most men (68.4%) who were familiar with PrEP, despite low usage of the drug.

“I worry especially about younger men who didn’t grow up with the concerns of HIV that men of older generations did,” said Hammack. “The low rate of HIV testing probably reflects a degree of complacency and cultural amnesia about AIDS.”

Principal investigator Ilan H. Meyer said of the study, “Our findings suggest that health education efforts are not adequately reaching sizable groups of men at risk for HIV infection. It is alarming that high-risk populations of men who are sexually active with same-sex partners are not being tested or taking advantage of treatment advances to prevent the spread of HIV.”

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.