My PrEP Plea!

It is exciting that we are on the brink of a new era – the advent of pre-exposure prophylaxis (PrEP) to reduce the risk of getting HIV. At the moment, PrEP is on the uptake in certain communities, and there are many efforts to make it widely available. But I have a concern.

Youth under the age of 18 need parental consent/consent of legal guardian to access PrEP in New York State. This is problematic and presents a barrier. Youth under the age of 18 may be the ones MOST at risk and that could benefit most from PrEP in their toolbox for making informed sexual and reproductive health (SRH) choices for themselves, as they may have limited to no access to relationships with adult guardians for a variety of complicated and often traumatic reasons.

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State of the Science Round Up

State of teh Science Heading

April 29, 2014

Welcome again to our new Blog Series that brings you state of the science and health equity findings, as well as community reactions to scientific breakthroughs.  Keep us posted of what you are reading and we will do the same!

This week we have a special focus on the HIV Prevention Pill or PrEP (Pre-exposure Prophalaxis). This is a relatively new HIV prevention tool where people who are at high risk of becoming infected can take a daily medication to lower the chance that they will get infected. This has been approved by the US Food and Drug Administration (in 2012) and the Centers for Disease Control and Prevention has published guidance on prescribing PrEP; while research has shown evidence of its effectiveness, is still a lot to understand in terms of how people use the pill, access, adherence and stigmatization (which was highlighted in our blog last week). Here are some new findings on these issues from the Conference on Retroviruses and Opportunistic Infections (CROI) held this past March, as well as a journal article recently released in the Lancet.

HEARD LogoImplementation of PrEP in STD Clinics and a Community Health Center: High Uptake and Drug Levels among MSM in the Demo Project

Starting with PrEP “uptake”, which these researchers define by looking at how many people agree to be in the PrEP study out of how many people were eligible. For instance, if 100 people were screened and were eligible for the study, and 50 agreed to be in the study, the “uptake” would be 50%.  A few interesting points they have in their tables are that there was a much higher uptake among 1) those self-referred vs. clinic-referred (makes sense); 2) older folks; 3) those with higher risk (also makes sense); and 4) those who already knew about PrEP.

HEARD LogoUptake of PrEP for HIV slow among MSM

“Uptake” in this report is not defined in the same way as in the above study. In fact it is not defined at all. It’s a bit more general. This report discusses challenges, concerns and areas for additional study around barriers for Men who have Sex with Men (MSM) in the US to utilize PrEP as a tool for HIV prevention. The key issues discussed are around communication and messaging, dosage and risk behavior.  A couple of the points that resonated most with me are:

  • 1) the difficulty in communicating with one’s family doctor around sexual experiences and
  • 2) the need to collect more information about dosing – meaning how effective is PrEP if you take it less than once a day?
  • While there is some data on this already, this remains a primary concern that we hear among service providers and needs to be examined further.

    From the article: “Kenneth Mayer, professor of Medicine at Harvard University and the medical research director at Fenway Health, a community centre in Boston, MA, USA, believes that as with other innovations, uptake of PrEP will be slow until knowledge of past and ongoing trials become widely known in both the MSM community and the general population. Mayer also points out that there are many more MSM actually using PrEP, but currently this is within clinical trials. Thus prescriptions could rise substantially once the current crop of clinical studies in the USA comes to an end.”

    HEARD LogoEarly Adopters: Socio-demographic and Behavioral Correlates of Chemprophylaxis Use in a Recent National Online Sample of Men who have Sex with Men in the U.S.

    In line with the previous article, researchers found that only 1.2% of over 9,000 MSM who completed the survey reported using PrEP in the past. The survey took place in August 2013 and participants were recruited from an online sex-seeking network site. The majority of the respondents identified as white (85.7%), with 7.5% identifying as Latino and 3.9% identifying as Black. Although these percentages are low, the sample size is high – thus it would be interesting for the authors to do specific sub-population analyses and see how PrEP use and access is different within Black and Latino MSM communities.

    From the source: “Although MSM in this online survey reported significant HIV risks, their experience with PEP and PrEP was limited. In order to increase PrEP uptake among MSM, PCPs need to be educated to provide culturally competent care, so that patients will be comfortable discussing HIV risks that could be decreased by PEP or PrEP.”

    HEARD LogoWillingness to Use Pre-Exposure Prophylaxis among Community-Recruited Injection Drug Users

    Injection with equipment that has HIV is the most “efficient” way to contract the virus. Meaning, one is at the highest risk of contracting the virus by sharing injecting equipment such as needles, cotton, and water (compared to contracting HIV through sex). Although the rate of HIV among people who inject has dropped dramatically, PrEP may be another tool to help “get to zero,” the slogan representing the global goal of “Zero new HIV infections. Zero discrimination. Zero AIDS-related deaths.” One of the main concerns for this, however, is that one gets the medication through a doctor, and that many people who inject may not have access to a doctor or insurance.  This study interviewed over 300 HIV-negative injection drug users and found two interesting points:

  • 1) About 70% said they were somewhat or very likely to use PrEP if it was free.
  • 2) About 88% said that they would still need to sterilize/clean needles or use condoms during sex if they were taking PrEP.
  • This second point addresses a major concern some people have – that if a person has this prevention pill, then that person wouldn’t use any other protection.  Based on the above article, it doesn’t appear that this should be a primary concern; however, there is plenty of forthcoming research that is looking at this very concern.

    From the source: “A large proportion of active IDUs in Washington, DC reported being willing to use PrEP if it were available at no cost. IDUs who were younger and had more sex partners reported to be more willing to use PrEP, suggesting that these groups could be targeted first to explore the practicality of PrEP use in this population. Further research should be done to explore availability, uptake, and adherence of PrEP among IDUs.”

    Written By: Emily Klukas
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    And then there were a hundred!!!

    We have posted our 100th blog article and we want to take a moment to thank all of our followers! The Institute for Hispanic Health Equity has been blogging for the past year with the intention of raising awareness and discussion on bridging the gap in health disparities throughout the United States and Puerto Rico. A big thank you to all our readers and followers for helping us spread the word!

    In case you missed them, here are the top ten most popular articles as of today:

    Please scroll bellow and take a look at what our followers are saying too…
    THANK YOU!

    Fitting in…

    Fitting in.. (Weekly Photo Challenge: Object)

    Puzzle

    Our days are made up of random pieces… Sometimes they fit together smoothly, sometimes you need to apply some extra pressure and other times they simply are not a match. Not everyone has access to all of the same pieces but we all get the chance to try and build the puzzle of life.

    Photography & Comment By: Gustavo Adolfo
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    And some other submissions:

    1. jaffajakemedia
    2. Weekly Photo Challenge: Object (IV) | Uncle Spike’s Adventures
    3. The look of love | Etcetera Etcetera Etcetera
    4. Weekly Photo Challenge: Object | Lostinthot
    5. Object of Mystery | breathofgreenair
    6. Smell still sweet? | Perspectives on life, universe and everything
    7. 0Perspectives on life, universe and everything
    8. I Was a Villain | Square One Notes
    9. Weekly Photo Challenge: Object | Mama on the Run
    10. herd | yi-ching lin photography
    11. it is true that | y
    12. Weekly Photo Challenge – Object | Survivor | IvyMosquito
    13. Chinese New Year in KL | Ripples of Truth
    14. Weekly Photo Challenge: Object | Irish Noble King
    15. Weekly photo challenge – object | Cajon
    16. Baden Baden in Indiana « Gleaning the Nuggets
    17. Weekly Photo Challenge: An Object in Italy | melanielynngriffin
    18. Weekly Photo Challenge: Object | Sued51’s Blog
    19. WPC: A derelict object on the beach | anotherdayinparadise
    20. Weekly Photo Challenge: Object | lcsoup’s walk today
    21. Variations on a Motel Sign | I see beauty all around by rob paine
    22. Objects of Inspiration | Thirdeyemom
    23. Welcome, Neighbor! | Making Life an Art
    24. Weekly Photo Challenge: object | Giulia Bernini photography
    25. Weekly Photo Challenge: Object | Tiffany Metzger
    26. OBJECT: I’m 26, going on 15. | The Uncustomary Housewife
    27. The Object of our Fascination | The Retiring Sort
    28. Objets d’Art | The Red and the Blue
    29. Weekly Photo Challenge: Object | The Fountain
    30. I’ve Seen The Future…..(It’s Not Just Me!) | Ginger Haired Ape
    31. Weekly Photo Challenge: Object #2(?) | The Amateur Camera
    32. Weekly Photo Challenge: Object (Ceiling) | What’s (in) the picture?
    33. Weekly Photo Challenge: Object | small house/BIG GARDEN
    34. WordPress Weekly Photo Challenge ~ Object | Lakshmi Loves To Shop
    35. Weekly Photo Challenge: Object | parislux
    36. weekly photo challenge: object | FOUND
    37. Weekly Photo Challenge: Object 2 | Khana’s Web

    Hot off the Press…

    Challenge accepted! The bloggers of The Hispanic Health Equity have created a bookshelf containing an array of volumes that express our interests and favorite subjects to be published (crossing fingers here) as part of the BYOB(ookworm) Daily Prompt

    Please scroll and read through, comment and let us know what you think…

    Hispanics as the Sleeping Giant: By Miriam Vega

    Hispanics as the Sleeping Giant
    Written By: Miriam Vega
    Follow @miriamyvega

    We are Latino@ in the Deep South: By Erik Valera

    We are Latin@ in the Deep South
    Written By: Erik Valera
    Follow @LatinoDeepSouth

    Altered States: By Emily Klukas

    Altered States
    Written By: Emily Klukas

    How to Deal with People and Stay Classy!: By Ruben Rios

    How to Deal with People and Stay Classy!
    Written By: Ruben Rios

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