Rates of new HIV infections in the United States are declining — except among men who have sex with men. Rates are particularly high among African-American and Hispanic men and especially in the South.
Currently, one in six men who have sex with men can expect to be diagnosed with HIV in their lifetime. Among gay and bisexual African-American men the risk is even higher — 50 percent.
It doesn’t have to be that way. Today there are effective ways to prevent HIV infection. One of them is pre-exposure prophylaxis (PrEP), a combination of two HIV drugs taken as a daily pill that can reduce the risk of getting HIV from sex by more than 90 percent.
PrEP has been FDA-approved since 2012. While accessibility has increased in Nashville over the past few years, several barriers are holding back widespread adoption of the regimen, say Sean Kelly, M.D., and Katie White, M.D., Ph.D., infectious disease experts at Vanderbilt University Medical Center (VUMC).
“A lot of patients are afraid … that their sexual practices will come out in the open,” said Kelly, assistant professor of Medicine.
There’s also a widely circulated but false “urban myth” that asserts the drug combination, called Truvada, encourages people to engage in more frequent sexual activity, further increasing their risk of becoming infected. “It’s not true,” Kelly said.
On the contrary, patients who request Truvada generally tend to be actively committed to improving their health. “They have stronger relationships with their partners,” he said. “They have fewer sexual partners, lowering their risk for HIV.”
The number of primary care physicians in the area who offer PrEP is also limited. Physicians may be reluctant to prescribe Truvada if they don’t have the ancillary support network to help them make this affordable for their patients.
“Being on PrEP requires quarterly visits to ensure the patient is HIV-negative,” Kelly said. That’s because Truvada alone is not an effective way to treat people who already are infected.”
Physicians can contract with a specialty pharmacy to help with financial support to cover drug costs if they don’t have that capability in their offices, said White, an instructor of Medicine. Offering PrEP also provides an opportunity to counsel patients about avoiding risky behaviors, she said.
PrEP is available to many individuals at high-risk for HIV. It is exceptionally effective and can be safely used. Yet lack of awareness, perhaps more than anything else, has slowed widespread acceptance of the regimen.
“We have everything available to actually end this pandemic,” Kelly said. But patients and their physicians will have to re-commit to do the work to get there. “I think we’re in need of a second wind,” he said.