Preparing for PrEP
September 7, 2011
The future of pre-exposure HIV prophylaxis (PrEP) was the topic of a lively forum at the National HIV Prevention Conference in Atlanta in August. In November 2010, an international trial involving high-risk men who have sex with men, and transgender women, found that the most-adherent users of tenofovir plus emtricitabine (branded as Truvada) were 91 percent less likely to become HIV-infected compared to those taking a placebo.
"Building new systems of delivery in isolation just to provide PrEP is not a sustainable option," said Dr. Grant Colfax, San Francisco's HIV prevention director. "Moving forward the question is, Where are the sites where this is most likely to be delivered? Is it STD clinics, HMOs, primary care settings? How do we integrate it into a medical structure that is sustainable over time?'"
"One of the fears I have is that PrEP will be looked at as this thing that is being put upon given populations rather than something that the populations themselves are asking for," said David Evans with San Francisco-based Project Inform, citing the infamous Tuskegee syphilis experiment. Evans also wondered how PrEP would fare under non-trial conditions.
Carl Dieffenbach of the National Institutes of Health raised the possibility that "PrEP, even in San Francisco, will not reach the people who will truly benefit from it." HIV testing is critical in advance of using PrEP; however, this could present an additional barrier, since the people at highest risk of infection often avoid testing, he said. Poor medication adherence and increased risky behavior also might offset the protective effect of PrEP, said a representative of the New York-based Gay Men's Health Crisis.
Many people expressed concern that PrEP could exacerbate HIV disparities, especially for African Americans. In addition, some said it could be hard to justify funding PrEP when more than 9,000 HIV patients are on waiting lists for state AIDS Drug Assistance Programs.
Bay Area Reporter (San Francisco)
08.25.2011; Bob Roehr
This article was provided by CDC National Prevention Information Network. It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update.
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