Many young U.S. men at high risk for HIV do not take anti-HIV pill

(Reuters Health) - Less than 4 percent of young adult men-who-have-sex-with-men in the U.S. – a population at significant risk of contracting the human immunodeficiency virus (HIV) – reported ever using the pill that protects them from the virus, in a recently published study.

The data were drawn from an anonymous online survey of 2,347 black, white and Hispanic males, ages 18 to 24, who had previously engaged in anal sex with another man and had never had an HIV-positive blood test.

Those at high risk for HIV should ideally take a daily pill to lower their likelihood of infection. So-called pre-exposure prophylaxis (PrEP) cuts the risk of getting HIV from sex by more than 90%, according to the Centers for Disease Control and Prevention (CDC).

“We have had a sense that PrEP is not reaching the communities that could benefit from it most, but the overall level of 3.4% is surprisingly low,” said Dr. Ryan Westergaard, an infectious disease physician at UW Health in Madison, Wisconsin, who was not involved in the study.

PrEP is typically administered in the form of a pill that combines two anti-HIV drugs, emtricitabine and tenofovir. Approved in the U.S. in 2012, the pill is marketed by Gilead Sciences Inc. under the brand name Truvada.

The incidence of HIV, which can be spread through anal or vaginal sex or by sharing needles with an infected person, has been falling in recent years. But men-who-have-sex-with-men bear the greatest burden of risk, the CDC says. In 2015, youth ages 13 to 24 accounted for over a fifth of all new diagnoses, and most occurred in gay and bisexual males, the agency found.

The current study was conducted by Sarah Marks at Alpert Medical School of Brown University in Providence, Rhode Island and colleagues.

The overwhelming majority of participants had at least some college education, health insurance and access to a primary healthcare provider (PCP)/clinic, according to the researchers. Some 65% of survey participants who said they didn’t use PrEP met at least one CDC criterion for PrEP use, primarily condom-less anal intercourse in the preceding six months.

Dr. Margaret Hoffman-Terry, who chairs the board of directors of the American Academy of HIV Medicine, said her biggest takeaway from the study was that the majority of PrEP-eligible men did not receive it.

“Even in those with insurance and a primary care provider, usage was low,” she noted.

“Further bad news . . . . is the finding that PrEP uptake is lowest in communities that have particularly high HIV risk, including youth, people living in the South, and those who aren’t already engaged in regular primary health care,” added Westergaard in an email.

Mirroring national trends, blacks and Hispanics were more likely than whites to lack health insurance and/or a PCP/clinic, which is particularly problematic because HIV infection incidence remains highest among black and Hispanic men-who-have-sex-with-men, the research team reported in the journal AIDS Patient Care and STDs.

The survey participants were recruited on social media platforms in the second half of 2014, but more recent data might look different. Gilead reported at an HIV conference in July that the number of PrEP users in the U.S. now exceeds 100,000.

“The rollout of PrEP took some time, and even early providers like our clinic . . . did not begin offering PrEP until late 2014”, said Jennifer Hecht, senior director of program strategy and evaluation at the San Francisco AIDS Foundation, who was not involved in the study.

The research team acknowledged several other limitations of their study. Although responses were anonymous, answers were self-reported, so their veracity cannot be assured. The survey also did not ask participants whether they were in monogamous relationships in which one partner is HIV negative and the other is HIV positive, or had a sexually transmitted infection in the preceding six months, both of which are indicators for PrEP use.

SOURCE: AIDS Patient Care and STDs, online November 1, 2017.