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.
Extensive evidence from HIV prevention research studies has firmly established that “Undetectable Equals Untransmittable,” or U=U. This means that people living with HIV who achieve and maintain an undetectable viral load — the amount of virus in their blood — by taking antiretroviral therapy (ART) as prescribed do not sexually transmit HIV to others. The U.S. Centers for Disease Control and Prevention estimates this strategy is 100% effective against the sexual transmission of HIV.
Now, a new study of nearly 112,000 men who have sex with men in the United States has found increasing acceptance of the U=U message in this population. Overall, 54% of HIV-negative participants and 84% of participants with HIV correctly identified U=U as accurate. The study was supported by the National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health. Study results were published online in the Journal of Acquired Immune Deficiency Syndromes.
“U=U has been validated repeatedly by numerous studies as a safe and effective means of preventing the sexual transmission of HIV,” said Anthony S. Fauci, M.D., NIAID Director. “The increased understanding and acceptance of U=U is encouraging because HIV treatment as prevention is a foundation of efforts to end the epidemic in the United States and around the world. This public health message has the power to reduce stigma, protect the health of people living with HIV and prevent sexual transmission of HIV to others.”
Pre-exposure prophylaxis (or PrEP) medications are prescription medications that people take daily to significantly reduce their risk of acquiring HIV through sex. PrEP can stop HIV from taking hold and spreading throughout the body. Two medications are FDA-approved for use as PrEP: TRUVADA and DESCOVY. When taken daily, PrEP is highly effective for preventing HIV from sex.
The Ready, Set, PrEP program makes PrEP medication available at no cost for qualifying recipients. To receive PrEP medication through this program, you must:
Lack prescription drug coverage
Be tested for HIV with a negative result
Have a prescription for PrEP
Talk to your healthcare provider or find a provider at HIV.gov Locator to find out if PrEP is right for you. If PrEP is a good option for you, click below to apply.
It’s clear that there are discrepancies in the support young men of color have when it comes to accessing key sexual health services. So, what can we do to change this?
One way we can help young people prevent HIV is through providing PrEP on college campuses. Providing PrEP on college campuses gives young people the tools they need, while also eliminating the stigma around HIV. Navigating college as Latinx students can already be difficult enough, especially for first generation students like myself. In my experience, feeling supported by your school is key in creating an environment where all students can thrive, and having your health needs met is a part of that.
Providing PrEP on college campuses also eliminates another barrier many students face in accessing PrEP: transportation. Given that not all schools are located in metropolitan areas, some young people may have to travel unrealistic distances to the nearest clinic to find PrEP. Students attending college outside of their hometowns might not even have access to a car, eliminating the option of transportation altogether.
To Omar Martinez, National Latinx AIDS Awareness Day is about uplifting the voices of Latinx activists and ensuring that Latinx people living with HIV and AIDS receive the best care possible moving forward while remembering Latinx people who died of HIV and AIDS.
“The way to move forward is to really tackle and address the structural issues,” Martinez, an assistant professor at Temple University’s School of Social Work, told HRC. “[This] includes discrimination, the anti-immigration rhetoric, structural racism, cultural imperalism and access and barriers to health care… I would argue that these are the major challenges.”
October 15 marks National Latinx AIDS Awareness Day — a day to raise awareness about how HIV and AIDS impact the Latinx community, educate the public on preventative measures and more. NLAAD’s theme this year is “living with HIV or not… we’re fighting this together,” focusing on ending the stigma around the disease and helping to address HIV in the Latinx community.
PrEP, or pre-exposure prophylaxis, is an HIV prevention method in which people who do not have HIV take medicine on a daily basis to reduce their risk of getting HIV if they are exposed to the virus. Descovy for PrEP should be used as part of a comprehensive strategy, including adherence to daily administration and safer sex practices, including condoms, to reduce the risk of sexually acquired infections.
The safety and efficacy of Descovy for PrEP were evaluated in a randomized, double-blind multinational trial in 5,387 HIV-negative men and transgender women who have sex with men and were at risk of HIV-1 infection. The trial compared once daily Descovy to Truvada (emtricitabine, tenofovir disoproxil fumarate, 200 mg/300 mg), a daily fixed dose combination of two drugs approved in 2012 to prevent the sexual acquisition of HIV; participants were followed for 48 to 96 weeks. The primary endpoint was the rate of HIV-1 infection in each group. The trial showed that Descovy was similar to Truvada in reducing the risk of acquiring HIV-1 infection.
According to the Centers for Disease Control and Prevention, over 1.1 million people 13 years old and over are living with HIV, and nearly 14 percent of them are undiagnosed.
While studies from world health organizations continue to expand deeper realities unseen in the epidemic, transgender men are often excluded from the conversation — especially when it comes to PrEP, an HIV prevention strategy that when practiced routinely makes it impossible to contract HIV. Today, the only FDA-approved drug to be used as PrEP is Truvada, a once-daily pill.
Now, thanks to researchers at The Fenway Institute, a groundbreaking study is the first of its kind to investigate PrEP and other biological/psychological factors (like alcohol or substance abuse, depression, relationship status, needle sharing, and more) specifically among transgender men who have sex with men (MSM).
The study, which was published in the Journal of the International AIDS Society, was conducted online from November 2017 to December 2017 and included 857 trans MSM (aged between 18 to 60, though the majority of them were under 30), all of whom were surveyed by researchers to determine their PrEP use and HIV risk factors.
HIV treatment that leads to viral suppression for at least 6 months is 100% effective in preventing the transmission of HIV, even in the absence of condoms or HIV prevention drugs, according to the Centers for Disease Control and Prevention. But not all care providers tell their patients that.
A survey in the Midwest showed that 22% of HIV physicians still don’t feel comfortable explaining to patients the science behind what is known in the community as U=U, or undetectable equals untransmittable.
And that number is even higher among the physician assistants, nurse practitioners, advanced practice nurses, and traditional registered nurses who serve people living with HIV, said Emily Petran, MPH, from the Minnesota site of the Midwest AIDS Training and Education Center (MATEC) in Minneapolis.
The National Institutes of Health has awarded approximately $11.3 million to 23 institutions across the United States to collaborate with community partners to develop locally relevant plans for diagnosing, treating and preventing HIV in areas with high rates of new HIV cases.
The awards will help enhance the implementation science knowledge base needed for the proposed Ending the HIV Epidemic: A Plan for America. The plan aims to leverage the powerful data and tools now available to reduce new HIV diagnoses in the United States by 75 percent in five years and by 90 percent by 2030. President Donald J. Trump announced this bold new initiative during the State of the Union Address in February. If funds are appropriated by Congress, the 10-year initiative will begin in fiscal year 2020. The awards announced today are one-year awards to support pilot and formative studies to prepare for more extensive implementation science research proposals expected in 2020.
“With existing, powerful HIV treatment and prevention tools, we can end the epidemic in the United States,” said Anthony S. Fauci, M.D., director of the National Institute of Allergy and Infectious Diseases (NIAID) at NIH. “The new initiative is a practical, achievable implementation plan. By working directly with health departments and other community organizations, researchers can find the best ways to use the highly effective methods at our disposal to diagnose, prevent and treat HIV in the United States.”
How do we reduce rates concentrated among black and Latino men who have sex with men? Or meet the needs of HIV-positive patients caught between insurance plans or places to live? To end the epidemic, we must start where we began — by focusing on those most affected, uniting advocacy efforts, pushing for a cross-sector response and focusing on the social determinants of health.
As someone who has spent the better part of my professional career as both an advocate and HIV public health expert, I’ve been reflecting on the decades-long fight for gay rights sparked by people who gathered together at Stonewall in 1969 to demand change for the LGBTQ+ community and put an end to years of discrimination. Not long after, the AIDS epidemic swept across the country, closely intertwining the movement for increased LGBTQ+ rights with the AIDS response. Gay rights groups were relentless in pushing for increased government attention and funding as thousands died from the disease. Activists organized “buyers clubs,” lobbied for faster FDA approval of promising drugs and countered the fear and discrimination people living with AIDS faced.