Trust and stigma affect gay couples’ choices on PrEP and PEP

From aidsmap.com

Both relationship-specific and structural factors influence whether coupled gay men living in New York City choose to use pre- and post-exposure prophylaxis (PrEP/PEP) for HIV prevention. Some men – particularly those in monogamous relationships – felt that discussing PrEP and PEP in the context of a relationship could threaten the relationship by raising issues of trust, while others felt that it had the potential to enhance sexual health and satisfaction.

Stigma from the gay community and healthcare providers around promiscuity also presented barriers to PrEP uptake. This qualitative research was conducted by Stephen Bosco, Dr Tyrel Starks and colleagues at City University New York and published in the Journal of Homosexuality.

Gay and bisexual men accounted for 66% of all new HIV diagnoses in the US in 2017. It is estimated that 35-68% of these infections happen within the context of a long-term relationship. This indicates that coupled gay men have the potential to benefit significantly from biomedical prevention strategies, such as PrEP (taken on an ongoing basis) and PEP (taken shortly after a suspected infection). However, only 7% of the potential 1.1 million gay and bisexual men who could benefit from PrEP were prescribed it in 2016. Black and minority men in the US remain most at-risk for HIV infection, while also having the lowest rates of PrEP uptake.

Read the full article.

Latino and Black men less likely to use PrEP

Research says that men who have sex with other men make up 67% of new HIV infections. Then on top of that, 25 percent of Latino men who have sex with other men (MSM) will be infected with HIV in their lifetime. And, 50 percent of Black MSM will experience the same. That’s compared to 12.5 percent of white men. That said, men of color are less likely to use the HIV preventive drug pre-exposure prophylaxis or PrEP. Why is this?

A recently published study in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report tries to understand why this is happening. The study, led by Dafna Kanny of the CDC’s Division of HIV/AIDs Prevention looked through interviews with 4,000 men who took part in a 2017 HIV Behavioral Surveillance Survey.

As NBC writes, researchers believe the problem lies in accessibility issues to health care. Studies show health care providers are not prescribing Black and Latino men to PrEP. In addition, men of color are less aware of PrEP’s very existence. The CDC’s study found that 95% of white men, 87% of Latino men, and 43% of Black men are knowledgeable about PrEP. Then even worse, only 58% of white, 44% of Latino, and 43% of Black men said they discussed the preventative medication with a physician.

As Kanny told Reuters Health,“This type of research is critical to finding—and correcting — missed opportunities to offer PrEP to people at risk of HIV, particularly among African American and Latin gay and bisexual men.”

He said further: “It’s important for providers to take sexual histories of gay and bisexual men and to discuss PrEP as an option for HIV prevention with those who could potentially benefit from it,” said Kanny. “These discussions also help to destigmatize PrEP use, which is particularly important for increasing PrEP use among African American and bisexual men.”

Generic Truvada coming in the next year

From out.com

Get PrEP-ared for generic Truvada in the next year, according to an official document that Gilead, the pharmaceutical company that manufactures the drug, released on their website.

According to a quarterly report filed to the Securities and Exchange Commission, Gilead announced that it reached an agreement to allow a generic version of Truvada to be manufactured in the United States on September 30, 2020.

In a statement, Aaron S. Lord, a physician and member of PrEP4All, called the decision a “victory for the LGBTQ+ community, for HIV activists, and for U.S. taxpayers,” and cautioned that the fight for widespread PrEP access is not over. Lord specifically pointed to the fact that only Teva will be allowed to manufacture generic PrEP.

“This will do little to reduce price in a way that will increase access and PrEP4All remains suspicious of the terms and lack of transparency surrounding the Teva settlement,” Lord wrote in the statement. “I have to ask, what’s to stop them — other than a desire for profit margins — from releasing the rights now?”

Read the full article.

Research continues to show AIDS drugs prevent sexual transmission of HIV in gay men

A European study of nearly 1,000 gay male couples who had sex without condoms – where one partner had HIV and was taking antiretroviral drugs to suppress it – has found the treatment can prevent sexual transmission of the virus. After eight years of follow-up of the so-called serodifferent couples, the study found no cases at all of HIV transmission within couples.

The study, which was conducted by researchers from the University College London and the University of Copenhagen, was published in The Lancet journal.

PrEP use up 35% among gay and bi men at risk

From NBC News

Thirty-five percent of gay and bisexual men at high risk of HIV infection were using PrEP, or pre-exposure prophylaxis, the daily pill that prevents HIV infection, in 2017, according to data released Thursday by the Centers for Disease Control and Prevention. In 2014, just 6 percent of these men used PrEP.

However, despite the nearly 500 percent jump in PrEP use among men who have sex with men, the CDC notes “PrEP use remains too low, especially among gay and bisexual men of color.”

The study was presented Thursday in Seattle at the 2019 Conference on Retroviruses and Opportunistic Infections, a major annual HIV/AIDS conference, and was based on more than 8,000 interviews in 20 American cities.

Read the full article.

Study shows high HIV prevalence in Black, gay men taking PrEP

From thevitalvoice.com

Black men who engage in sex with men have a 1 in 2 chance of getting HIV in their lifetime, according to the National Institutes of Health. This is unconscionable when a drug called PrEP (a once-a-day pill that prevents HIV) exists. However, as recently published in the Journal of AIDS, black men who have sex with men on PrEP had a higher incidence of HIV than those not on PrEP, due to poor adherence to the drug. The study suggests that PrEP alone is not enough to stop the spread of HIV. The study does not, however, challenge the efficacy of PrEP itself but rather the uptake of the surrounding preventative package including behavioral risk reduction support, STI treatment, and medication adherence counseling.

Two health technology startups, UrSure and Healthvana, have separately made enormous strides in reducing HIV. UrSure improves adherence to HIV medications with diagnostic tests, while Healthvana’s platform/app is being used by clinics and their 250,000 patients who are at high-risk for HIV or are HIV positive. Collaboratively, the two startups are now working to build the most technologically innovative PrEP programs in the 48 counties in the U.S. with the highest prevalence of HIV, as identified last week by HHS Secretary Azar.

AIDS Resource Alliance offers education, support, prevention services in State College

From centredaily.com

Though HIV is treatable today, the challenges of navigating the health care system can be stressful for anyone, let alone an individual living with a chronic illness. AIDS Resource Alliance utilizes a team of case managers who are trained to help their clients with insurance, housing, treatment and other issues that impact the lives of persons living with HIV. Twice-monthly support groups give clients a chance to share their experiences and struggles within a safe space where judgment and stigma are not allowed.

AIDS Resource Alliance also provides prevention services to the communities they serve. HIV and STI testing are available free of charge during office hours, as are condoms and other harm reduction materials. Each testing client is also provided with risk-reduction education, and general education services are available to local agencies and organizations who want their members to learn more about HIV and sexual health.

Much has changed since the earliest days of the epidemic, and the staff at AIDS Resource are preparing for the future with programming that addresses the new landscape of HIV in America. PrEP, the daily medication that can prevent HIV infection, is prescribed free in the Williamsport offices, as are the required testing and physical examinations necessary to continue the medication (the cost of the drug is the responsibility of the patient, but the AIDS Resource team can assist the client in applying for programs that assist in covering the cost of the drug.) As the population of people living with HIV enters their 60s and beyond, support group and other focused social activities enable clients to maintain positive social connections. Counseling services are provided free of charge to clients who request them.

Find out more.

Experts debate if HIV prevention pill contributes to rise in other STDs

Prevention program manager Adam Weaver talks about sexually transmitted diseases in the testing room at Palmetto Community Care in North Charleston

From postandcourier.com

The STD explosion has led to a debate over a possible connection since the introduction of the HIV prevention pill.

PrEP is not a cure for HIV, and it also is not 100 percent effective, but, taken as directed at the same time once a day, it comes pretty close — up to 99 percent successful in preventing HIV, according to Palmetto Community Care, formerly Lowcountry AIDS Services, in North Charleston.

The drumbeat of safe sex practices hasn’t changed among health officials. Abstinence, using condoms and being in a monogamous relationship are still the best ways to help prevent STD infections.

But the naked truth is people don’t always follow that advice.

“After they start taking PrEP, we don’t see a great shift in risk behavior,” said Aaron O’Brien with Roper Hospital’s Ryan White Wellness Center.

Aaron O’Brien, quality and development manager of Roper Hospital’s Ryan White Wellness Center.

He puts condom users into two groups: those who use them regularly and those who don’t, and, based on his talks with patients, that doesn’t change much once they start taking the pill.

Adam Weaver, prevention program manager at Palmetto Community Care, agrees with O’Brien.

“What we are finding is that the people we are putting on PrEP aren’t changing their condom use,” he said.

They also don’t believe PrEP’s introduction, in and of itself, contributed to the explosion in STDs.

They say it has more to do with better reporting since people taking PrEP must check in with their doctor or provider every three months or so for regular testing.

Read the full article.

HIV infections among black gay men taking PrEP, probably due to poor adherence

From aidsmap.com

Awareness and use of HIV pre-exposure prophylaxis (PrEP) among black gay, bisexual and other men who have sex with men (MSM) in the United States increased significantly between 2014 and 2017, according to research published in the 1 November edition of the Journal of Acquired Immune Deficiency Syndromes. The study also showed that PrEP was reaching individuals with high levels of sexual risk, sexually transmitted infections (STIs) and substance use, the very individuals most in need of this highly effective form of HIV prevention.

However, HIV prevalence was significantly higher among PrEP users compared to individuals who were not on PrEP. The investigators stress this does not show PrEP failure but is likely due to factors such as poor medication adherence and lack of engagement with healthcare providers.

“It is imperative to recognize that our findings reflect challenges to maintain proper usage of PrEP rather than biological failure of PrEP to protect against HIV,” write the authors. “HIV infections that have occurred among PrEP users are the result of suboptimal levels of drug concentrations because of challenges in adhering to PrEP medical regimens.”

Black MSM account for the largest proportion of new HIV infections in the US. If current epidemiological trends continue, 60% of black MSM will be HIV positive by the age of 40. Tackling the HIV epidemic among black MSM is therefore an urgent public health priority.

Read the full article.

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.

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.