EXECUTIVE SUMMARY

Studies have shown that pre-exposure prophylaxis, or PrEP, reduces HIV incidence by 92% in HIV-negative people who are at high risk for HIV, including men who have sex with men (MSM). However, new research indicates that many MSM are unaware of this option.

  • In 2014, gay and bisexual men accounted for 83% of the estimated new HIV diagnoses among all males ages 13 and older and 67% of the total estimated new diagnoses in the United States, according to the CDC. However, nearly one in seven gay and bisexual men living with HIV are unaware they have it and may transmit the infection to others without knowing it.

Studies have shown that pre-exposure prophylaxis, or PrEP, reduces HIV incidence by 92% in HIV-negative people who are at high risk for HIV, including men who have sex with men (MSM). 1,2 However, new research indicates that many MSM are unaware of this option.3

In 2014, gay and bisexual men accounted for 83% of the estimated new HIV diagnoses among all males ages 13 and older and 67% of the total estimated new diagnoses in the United States, according to the CDC.4 However, nearly one in seven gay and bisexual men living with HIV are unaware they have it and may transmit the infection to others without knowing it.5

The rate of HIV infection among gay and bisexual men in Baltimore is estimated at 31%.6 However, research conducted by the Johns Hopkins Bloomberg School of Public Health in Baltimore indicates just four in 10 gay and bisexual men without HIV are aware that PrEP may significantly reduce their risk of contracting the virus.3 This finding held true even among those who had recently visited a doctor or been tested for a sexually transmitted infection, the new data suggest.

Review the Research

To conduct the study, researchers used 2014 Baltimore MSM National HIV Behavioral Surveillance data. A total of 401 HIV-negative men participated in the study, of whom 168 (42%) were aware of PrEP. Data indicate having seen a doctor (82%) and having a test for another sexually transmitted infection (46%) in the prior year did not increase the likelihood that a gay or bisexual man knew about PrEP.

Those who had been tested for HIV in the prior year were more likely to be aware of the drug regimen, which involves use of a daily pill.

When study participants were told about PrEP, 60% said they would be willing to take PrEP for HIV prevention.

Clinicians have limited time with patients, but with gay and bisexual male patients, providers definitely need to make it a point to discuss HIV risks and whether PrEP is a good option, says Julia Raifman, ScD, a post-doctoral fellow in the Bloomberg School’s Department of Epidemiology and lead author of the study.

Viral Suppression, PrEP Key

Healthcare providers may be unfamiliar with PrEP or may be uncomfortable broaching sexual health topics with their patients, notes Raifman.

“Whatever the reason, we need to find a way to get PrEP to the people who can most benefit,” said Raifman in a statement accompanying the research publication. “PrEP could be a game-changer for HIV in the United States where there are more than 44,000 new cases of HIV every year – but only if people know about it.”

Reaching the National HIV/AIDS Strategy targets for HIV testing and treatment and expanding the use of daily PrEP could prevent an estimated 185,000 new HIV infections in the United States by 2020, representing a 70% reduction in new infections, recent research from the CDC indicates.7

If public health efforts could reach the nation’s treatment goal of ensuring 80% of all of those diagnosed with HIV achieve viral suppression, data indicate that an estimated 168,000 infections would be prevented over the next five years. Increasing the use of PrEP among people who are uninfected, but at high risk, could prevent an additional 17,000 infections over the same time span, the research suggests.7

Less than a third of Americans with HIV are on sustained treatment that effectively keeps their virus suppressed, and too few people who are at substantial risk for HIV and who could benefit from PrEP are receiving it, the research notes.

“If we expand the use of our current prevention strategies today, we can significantly reduce new HIV infections tomorrow,” says Jonathan Mermin, MD, director of the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. “This study confirms that we have the right tools to dramatically reduce new HIV infections, but we have a long way to go in order to make those reductions a reality.”

REFERENCES

  1. Grant RM, Lama JR, Anderson PL, et al; iPrEx Study Team. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med 2010; 363(27):2587-2599.
  2. Thigpen MC, Kebaabetswe PM, Paxton LA, et al; TDF2 Study Group. Antiretroviral preexposure prophylaxis for heterosexual HIV transmission in Botswana. N Engl J Med 2012; 367(5):423-434.
  3. Raifman JR, Flynn C, German D. Healthcare provider contact and pre-exposure prophylaxis in Baltimore men who have sex with men. Am J Prev Med 2016; doi: 10.1016/j.amepre.2016.07.031.
  4. CDC. HIV infection risk, prevention, and testing behaviors among men who have sex with men—National HIV Behavioral Surveillance, 20 U.S. cities, 2014. HIV Surveillance Special Report 2016; 15.
  5. CDC. HIV Among Gay and Bisexual Men. Accessed at http://bit.ly/1GBOga1.
  6. CDC. HIV testing and risk behaviors among gay, bisexual, and other men who have sex with men - United States. MMWR Morb Mortal Wkly Rep 2013; 62(47):958-962.
  7. Yaylali E, Farnham P, Jacobson E, et al. Impact of improving HIV care and treatment and initiating PrEP in the United States, 2015-2020. Presented at the Conference on Retroviruses and Opportunistic Infections. Boston, MA; February 2016.