PrEP Use Stagnant Among Gay and Bisexual Men
UCLA researchers concerned about results of survey regarding HIV prevention pill
BY DUNCAN OSBORNE
A nationwide UCLA study found that
gay and bisexual men became more
aware of PrEP — a regimen that is
highly effective at preventing HIV —
between 2016 and 2018, but the use of PrEP
among those men remained low and inconsistent
during that time period.
“We are heartened to see an increase in PrEP
familiarity in this relatively short period of
time,” Ian Holloway, an associate professor at
UCLA’s Luskin School of Public Affairs and the
study’s lead author, said in a written statement.
“But growth in favorable attitudes was modest,
as was the increase in PrEP use among sexually
active gay and bisexual men.”
The study surveyed men who were 18 to 25,
34 to 41, and 52 to 59 in three waves between
March of 2016 and March of 2018 on their familiarity
with and attitude towards PrEP and
their use and discontinued use of PrEP over
that time span.
White men accounted for 63 to 66 percent of
the sample, while Black men accounted for 13
to 15 percent of the sample, and Latinx men
accounted for 21 to 22 percent of the sample,
according to the research.
In 2016, 60 percent of the men reported “familiarity”
with PrEP, but that measure climbed
to 92 percent by the third wave of the study.
Favorable attitudes toward PrEP went from 68
percent to 73 percent over the course of three
waves. PrEP use was at four percent in 2016
and rose to eight percent in 2018, marking is
a signifi cant increase, but still represented a
small number of users. Among men who reported
PrEP use in the fi rst and second waves, 33
percent reported they had stopped using PrEP
in a later survey.
“It’s concerning that PrEP uptake remains
low and that a third of men discontinue PrEP,”
Holloway said in the statement.
Currently, there are two drugs, Truvada and
Descovy, that are approved for use as PrEP. Both
are manufactured and marketed by Gilead Sciences,
a pharmaceutical company, and are also
used to treat people who are HIV-positive. The
PrEP regimen requires that users take a single
pill once a day, but the drugs can also be used
episodically. They are highly effective at preventing
HIV infections when taken correctly.
Truvada was approved by the federal Food
and Drug Administration in 2012. It was seen
as breakthrough in HIV prevention efforts
that previously relied on pro-condom messaging
and sometimes programs that resembled
group therapy that encouraged men to
discuss obstacles they experienced in using
HEALTH
A third of men who have sex with men and take PrEP tend to stop taking it after some time, according to researchers.
condoms. It was diffi cult to measure the success
of those efforts. Descovy was approved
in 2019.
Truvada was to be a linchpin in various efforts
to end the AIDS epidemic in the US that
began in 2013, 2014, and 2015. The widespread
use of Truvada, combined with getting larger
numbers of HIV-positive people on anti-HIV
drugs so they could not infect others, was going
to drive down the annual number of new HIV
infections in the US to the point where every
newly infected person was infecting less than
one other person on average. That would mean
that the epidemic would eventually come to an
end.
While state and local health departments
and AIDS groups across the country have
been successful in moving HIV-positive people
into effective treatment, Truvada uptake has
never reached the numbers needed to end
the epidemic. That is due in part to anti-PrEP
messaging from some parts of the community,
notably the AIDS Healthcare Foundation in
California, and from some law fi rms that specialize
in class action lawsuits suing Gilead
over Truvada side effects. While those lawsuits
REUTERS/BRENDAN MCDERMID
generally recruit HIV-positive people, the recruitment
ads are read by possible Truvada
for PrEP users as well. But other possible PrEP
users may also resist taking a medication for
HIV over stigma issues or concerns for side effects.
While PrEP uptake has been better among
white gay and bisexual men, uptake among
Black and Latino men has been slower due, in
part, to fewer sustained public health efforts to
engage those men.
Newer forms of PrEP that are in development
may address some of the issues with the
prevention mode. An injectable form of PrEP
that is as effective as the daily pill, but is given
once every other month, could be more popular.
Among women as well as some transgender
men and non-binary folks, a vaginal ring that
is intended to last for a month is also currently
in development.
“With new and innovative PrEP modalities
like long-acting injectable PrEP coming online,
we still need to know more about what factors
are key to decision-making around starting
and stopping PrEP,” Holloway added in his
statement.
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