These data provide additional evidence that HIV prevention efforts in the U.S. are moving in the right direction. Earlier this year, CDC published data that showed accelerated progress in reducing new HIV infections over the past five years, likely due to expanded testing, treatment, and PrEP. This progress is promising, and efforts must be further strengthened and expanded to reach all populations equitably and achieve our national goals.
Overall in 2022, 36% of the 1.2 million people who could benefit from PrEP were prescribed it, compared to 23% in 2019, the year that EHE was announced. Today’s data also show progress in increasing PrEP uptake in virtually all EHE jurisdictions, despite the unprecedented public health challenges funding recipients faced during this period with the COVID-19 pandemic and outbreaks of mpox, which consumed considerable resources as EHE efforts were just getting underway.
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Long-acting injectable cabotegravir (Apretude) offered greater protection than daily pre-exposure prophylaxis (PrEP) pills for Black gay and bisexual cisgender men and transgender women, but Black people still had higher HIV incidence rates compared with their white peers regardless of which type of PrEP they used, researchers reported at the 30th Conference on Retroviruses and Opportunistic Infections (CROI).
Adherence was higher with the every-other-month injections than with daily pills in both groups, suggesting long-acting PrEP could help close the racial gap in HIV rates. “[Apretude] is a powerful HIV prevention tool to increase access to PrEP and address continued racial disparities in HIV incidence in the United States,” Hyman Scott, MD, MPH, of the San Francisco Department of Public Health, and colleagues concluded.
Although African Americans make up about 13% of the U.S. population, they account for more than 40% of all new HIV diagnoses, so effective and acceptable prevention interventions are urgently needed. While white gay and bi men have readily adopted oral PrEP using tenofovir disoproxil fumarate/emtricitabine (Truvada and TDF/FTC generic equivalents) or tenofovir alafenamide/emtricitabine (Descovy), uptake has been lower among Black men.
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The U.S. Department of Health and Human Services (HHS) recently enhanced mail-order delivery options for participants to receive PrEP HIV prevention medication at no cost to eligible individuals without prescription drug coverage. Ready, Set, PrEP participants can choose to have their PrEP medication sent directly to their home or healthcare providers (in participating states) when they enroll or continue to use the more than 32,000 participating co-sponsoring pharmacies.
The option of having PrEP delivered to a preferred location is not only convenient for participants, but it also allows Federally Qualified Health Centers (FQHCs) and Indian Health Service (IHS) facilities, Tribal Health Programs, and Urban Indian Organizations to provide “one stop shopping” for potential enrollees. They can now get tested, receive their PrEP prescription and get the prescription sent via mail in one visit by enrolling with a healthcare provider’s assistance through or the call center by calling 855-447-8410.
“This option allows our IHS, Tribal and Urban facilities the ability to provide a wholly integrated service inclusive of HIV testing, PrEP prescriptions and now the ability for our healthcare providers to offer mail-order for Ready, Set, PrEP enrollees,” said Darrell LaRoche, director of the Office of Clinical and Preventive Services at IHS. “The convenience of getting tested, enrolled and prescriptions mailed in one visit, sent to their home or a healthcare provider, is particularly important in Indian Country where a health center or pharmacy may be hours away.”
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In a 2018 survey of men who have sex with men taking pre-exposure prophylaxis (PrEP) in three U.S. cities, about 10% reported sharing their medication with others.
This finding raises concerns that gay, bisexual and other men who have sex with men (MSM) may be accessing PrEP without receiving the medical monitoring that is supposed to go hand in hand with taking Truvada (tenofovir disoproxil fumarate/emtricitabine) or Descovy (tenofovir alafenamide/ emtricitabine) for HIV prevention—namely, HIV tests every three months and routine screening for sexually transmitted infections and kidney function.
As described in JAMA Network Open, Gordon Mansergh, PhD, a senior behavioral scientist in the Centers for Disease Control and Prevention’s Division of HIV and AIDS Prevention, conducted a cross-sectional analysis of responses from a 2018 smartphone-based survey of 755 HIV-negative MSM living in Detroit, Atlanta and New York.
Read the full article on Poz.com.
Levels of sexual health screening among gay men taking PrEP fall well below recommended levels, investigators from the United States report in the online edition of Clinical Infectious Diseases. Rates of testing for sexually transmitted infections (STIs) in the rectum and throat – which can be asymptomatic – were especially low, so too testing coverage in south-eastern US states which have an especially high burden of HIV and STI infections among gay and other men who have sex with men.
“Consistency of STI screening at PrEP care visits was lower than recommended, especially for rectal and pharyngeal infections that are mostly asymptomatic,” write the authors. “Our findings also highlight the regional variation in gaps between recommendations and PrEP clinical practice overall, and raise concerns about whether comprehensive PrEP care as currently practiced would be effective for STI control.”
Tenofovir-based PrEP is highly effective at preventing infection with HIV but the treatment provides no protection against STIs. Pre-existing research shows elevated STI rates among PrEP-using gay men, probably the result of increased surveillance and sexual risk behaviour. The Centers for Disease Control and Prevention (CDC) therefore recommends that gay men taking PrEP should have comprehensive check-ups for bacterial STIs every three to six months. These sexual health screens should include tests for chlamydia, gonorrhoea and syphilis, with swabs or samples taken from the urethra, throat and rectum.
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Taken every 2 months, the long-acting injectable drug cabotegravir (CAB-LA) prevented more HIV infections than daily oral pre-exposure prophylaxis (PrEP) with tenofovir/emtricitabine (TDF/FTC), according to newly announced results from a major Phase 3 study. The results were released originally in May due to the overwhelmingly positive data on CAB-LA for PrEP, but researchers presented their final data in early July at the 23rd International AIDS Conference (AIDS 2020).
The data show that the experimental drug is superior to the current standard-of-care PrEP regien, which may open the door for a new biomedical HIV prevention option aimed at those who would prefer a shot six times a year over taking a daily pill.
“The HPTN 083 results demonstrating the superiority of CAB to TDF/FTC have the potential to transform the landscape of HIV prevention for cisgender MSM and transgender women,” said HPTN 083 protocol chair Raphael J. Landovitz, M.D. “We know that some people have difficulty with or prefer not to take pills, and an injectable product such as long-acting CAB [cabotegravir] could be a very important option for them. We want to thank the study participants and research staff, as this study would not have been possible without their dedication and commitment.”
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The Centers for Disease Control and Prevention (CDC) understands that its partners in HIV prevention are facing unprecedented challenges and demands as we continue to battle the COVID-19 pandemic together.
While some clinics and HIV prevention providers have adapted to changing circumstances by offering expanded phone triage and telehealth services, other clinics that provide pre-exposure prophylaxis (PrEP) services have had to reduce hours, eliminate or reallocate staff resources, or temporarily close.
CDC has developed guidance for providing PrEP when facility-based services and in-person patient-clinician contact is limited. For programs experiencing disruption in PrEP clinical services, CDC offers the following guidance for clinics to consider in the context of local resources and staff availability.
Beginning April 1, 2020, patients enrolled in the U.S. Department of Health & Human Services (HHS) Ready, Set, PrEP program will fill their prescription for pre-exposure prophylaxis (PrEP) medication at no cost at their choice of Avita Pharmacy , CVS Health , Health Mart , Longs Pharmacy Solutions , Rite Aid , and Walgreens locations or through mail.
Ready, Set, PrEP is a nationwide program led by HHS and an essential component of the Ending the HIV Epidemic Initiative. Ready, Set, PrEP provides PrEP medications to individuals who qualify, increasing access to PrEP medications, reducing new HIV infections, and bringing us one step closer to ending the HIV epidemic in the United States.
Recognizing the importance of expanded access to HIV PrEP medications, these pharmacies are donating their dispensing and mailing services at over 24,500 pharmacy locations nationwide. This represents about a third of all the pharmacies in the United States, with locations in all 50 states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands. The donation provides a valuable service to those using PrEP and results in substantial cost savings to the federal government.
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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.
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From the Washington Post…
Facebook has quietly started removing some misleading ads about HIV prevention medication, responding to a deluge of activists, health experts and government regulators who said the tech giant had created the conditions for a public-health crisis.
The ads at issue — purchased by pages affiliated with personal-injury lawyers and seen millions of times — linked drugs designed to stop the spread of HIV with severe bone and kidney damage. Lesbian, gay, bisexual and transgender advocates long have said such claims are “false,” pointing to multiple studies showing the class of medication, known as PrEP, is safe.
After initially declining to disable the ads, Facebook began on Friday retroactively labeling some of them as rule violations in its archive, limiting their visibility. The company’s third-party fact-checkers concluded the ads were misleading and lacked context, according to a copy of an email sent by those fact-checkers to LGBT groups that was shared with The Washington Post, which first reported on the matter earlier this month.
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