This discouragingly low figure notwithstanding, estimated PrEP use has risen swiftly since that 12-month period.
By Benjamin Ryan
A recent study of a representative, yet small sample of HIV-negative men who have sex with men (MSM) in the United States found that just 4 percent took Truvada (tenofovir disoproxil fumarate/emtricitabine) as pre-exposure prophylaxis (PrEP) during the 12-month period between March 2016 and March 2017. Additionally, a troublingly high proportion of younger MSM reported that they had never been tested for HIV.
The Centers for Disease Control and Prevention (CDC) has estimated that about 25 percent of MSM between the ages of 18 and 59 years old are good candidates for PrEP.
While the low rate of PrEP use among the new study’s participants is concerning given the high rate of HIV transmission among MSM, Gilead Sciences estimates that a fast increasing population of people use Truvada for prevention in the United States. It is likely that the vast majority of PrEP users are MSM; the prevention modality has not taken off in significant numbers among women.
According to Gilead estimates, 125,000 U.S. residents were taking PrEP as of the first quarter of 2017, when the new study’s enrollment period ended. The pharmaceutical company estimates that by mid-2018, this figure had increased by about 45 percent, to 180,000 people.
A separate recent study found that the proportion of PrEP-using MSM participants of studies that reported on the use of Truvada for prevention has about doubled annually since 2012.
Publishing their findings in PLOS ONE, researchers behind the new study analyzed data from a national probability sample of 470 HIV-negative MSM from three age cohorts, those 18 to 25 years old, 34 to 41 years old, and 52 to 59 years old. The men, who were participants in the Generations Study and were recruited from all 50 states and Washington, DC, completed surveys between March 2016 and March 2017.
A total of 25.2 percent of the men in the younger cohort said they had never been tested for HIV, compared with 7.7 percent of those in the middle cohort and 7.8 percent in the older cohort. A respective 45.3 percent, 58.5 percent and 36 percent of the men in each cohort reported testing for the virus annually, as the CDC recommends for sexually active MSM.
After adjusting the data for various factors, the study authors found that, compared with the men in the older cohort, the men in the younger and middle cohort were each 2.1-fold more likely to test for HIV annually. Blacks were 4.4 times more likely than whites to test for the virus each year.
Men who perceived themselves as at risk for HIV, who visited an LGBT-specific clinic, and who were out of the closet to their health care providers were a respective 1.9-fold, 2.8-fold, and 3.2-fold more likely to test annually for the virus compared with men who did not meet each of these specifications.
Twenty-one, or 4.1 percent, of the respondents said they were taking PrEP, with no significant variations in this proportion based on age cohort. Bisexual men were 90 percent less likely than gay men to use PrEP. Also, visiting an LGBT clinic was associated with a 9.2-fold increased likelihood of using Truvada for prevention.
A respective 52 percent, 79 percent, and 57 percent of those in the younger, middle and older age cohorts said they were familiar with PrEP. Having a high school education versus less education and being tested for HIV versus non being tested were associated with a respective 2.9-fold and 4.2-fold increased likelihood of being familiar with PrEP. Identifying as bisexual versus gay or other sexual identities and living in a nonurban area versus an urban area were associated with a respective 80 percent and 70 percent reduced likelihood of being familiar with Truvada’s use as HIV prevention.
Among those men who said they were familiar with PrEP, 68.4 percent had a positive attitude about it, a rate that did not vary significantly between age groups. However, after the researchers controlled the data for various variables they found that younger men were 3-fold more likely to express a positive attitude about PrEP than older men.
Compared with gay or bisexual men, those who expressed a different sexual identity, such as queer, were 70 percent less likely to express a favorable attitude about PrEP. And compared with white men, Latinos were 70 percent less likely to express a positive attitude about Truvada’s use as prevention. A feeing of connection to the LGBT community was associated with a 2.3-fold greater likelihood of looking favorably upon PrEP, compared with not having such a connection.
“Our findings suggest the need to reinvigorate HIV prevention efforts to promote testing and awareness of PrEP, especially among younger gay and bisexual men and those who may not have access to LGBT communities and LGBT health providers,” the study authors concluded. “[T]here are many barriers to access to [PrEP], including affordability and lack of knowledge or access. PrEP awareness may increase with access.
“In the meantime,” the authors continued, “public health efforts focused on promoting HIV testing and PrEP awareness need to be more inclusive of diverse populations of gay and bisexual men, especially those in rural areas who are less affiliated with the LGBT community, so that they and their health care providers can make informed decisions about PrEP use in managing risk for HIV.”
For a complete archive of PrEP reporting, go to benryan.net/prep.