Yearly Archives: 2018

This excerpt originally appeared in an article on VICE. You can read the full article here.

Since the FDA first approved pre-exposure prophylaxis (PrEP) for those at high risk of acquiring HIV in 2012, its rollout has been mired in contradictions. The treatment—in which HIV-negative men take the HIV-fighting drug Truvada once daily, which studies have shown to be more than 99 percent effective in preventing infection—has been called a “miracle.” And despite initial opposition to the treatment from some concerned that it would lead to riskier sex within the gay community overall, public health organizations have trumpeted PrEP with great fanfare, in dozens of highly visible (and expensive) awareness advertising campaigns across the country.

But though more gay men and clinicians are aware of PrEP than ever, few are actually taking the drug. A March 2015 CDC survey of gay and bisexual men found that though 68 percent were aware of PrEP, and 50 percent would take it, only 4.9 percent of respondents had actually used it. In another 2015 survey of young California men who have sex with men, conducted by UCLA and AIDS Project Los Angeles (APLA), only 9.6 percent of respondents had taken the drug; of those who hadn’t, 73 percent were aware of it.

Those who respond to such studies, however, may be self-selecting—the type of people who are better informed to begin with. The actual number of PrEP prescriptions written since the drug was approved in 2012? As of last summer, the best estimate is around 79,000 nationwide, with about 60,000 of those for men. It’s unknown how many are still taking the drug or have adhered consistently. But given a 2012 study estimated there are around 4.8 million American men who have sex with men (MSM), that represents around 1.25 percent of them—a trifling number, considering the CDC believes that one in four should be offered the drug by their doctors. For PrEP to counter the spread of HIV at a meaningful level, it needs to reach a much larger percentage of MSM than it currently has.

There are a variety of reasons uptake has been slow, but one major factor lies in stigma surrounding the drug. Studies have found that clinicians may be hesitant to prescribe it to MSM who practice risky sex, and perceived discrimination among MSM themselves may be preventing more of them from taking the pill. Deeply ingrained cultural biases and attitudes are hard to change, no matter how many pro-PrEP billboards you erect.

The most troublesome aspect of PrEP’s rollout lies in its lack of uptake among MSM who are people of color. Last February, the CDC estimatedthat if current infection rates continue, half of African American and 25 percent of Latino MSM will end up infected in their lifetime. Those figures are nothing short of staggering. The larger problem is one of treatment access and quality for HIV-positive Americans in general: only half of positive Americans are currently receiving adequate HIV treatment. But among HIV-negative Americans, black and Latino MSM are among those using PrEP the least.

The 2015 UCLA/APLA survey found that while 13.9 percent of white young MSM respondents were on PrEP, only 6.6 percent and 9.8 percent of Latino and Black MSM were, respectively. And an estimate by Gilead Sciences, Truvada’s manufacturer, found that only 9 percent of PrEP prescriptions written have been for African Americans. It’s been called “a tough sell” among the gay Latino community, and critics have cited everything from healthcare access to the drug’s cost (estimated to be upward of $1,500 monthly without insurance) to larger, systemic barriers in explaining away its low usage among black and Latino MSM.

But one reason behind the disparity in PrEP adoption that’s not cited enough is the importance of physically knowing someone like you who’s on the drug. Dr. Ronald Brooks, an assistant professor in UCLA Health’s Department of Family Medicine, is leading a study called the LA PrEP Stories Project, designed to solicit stories from and interviews with black and Latino MSM who are or are not on PrEP. Launched on January 23, the project is recruiting those men to share their experiences with the drug, with the hope of gaining a more nuanced understanding of what’s impeding access and what role stigma is playing in their decision to take it (or not)….

This excerpt originally appeared in an article on VICE. You can read the full article here.

 

Across the world, over 36 million people live with HIV, many in places where HIV/AIDS is unspeakable. So, how do you find love & marriage when you are HIV+? 

In 1986, Dr. Suniti Solomon discovered India’s first case of HIV. But without medicines, she could only console patients who “other doctors weren’t even willing to touch.” She quit her prestigious academic post in microbiology and founded YRG CARE, today India’s premier HIV/AIDS clinic.

Fast forward 25 years: India now produces its own generic anti-retroviral medications, enabling Dr. Solomon’s to patients live longer – and face the pressure to marry. At 72, and in the twilight of her career, Dr. Solomon has taken on a new role: marriage matchmaker.

LOVESICK interweaves Dr. Solomon’s unconventional personal and professional journeys with the lives of two patients: Karthik, a reticent bachelor, and Manu, a bubbly IT professional who, like many women in India, was infected by her first husband. As Karthik and Manu search for love, they learn how to survive under the shadow of HIV.

Like other Indian matchmakers, Dr. Solomon matches by the religion, education, and income; but she also matches by white blood cell counts (CD4) and viral loads. For her, this isn’t just about romance – it is a way to stem the spread of HIV and fight stigma.

Eight years in the making, LOVESICK is a surprising portrait of modern love in the age of AIDS.

Watch the trailer below and catch a screening of LOVESICK at the 2018 Indian Film Festival in Downtown Los Angeles on April 14th at 3PM.

Check out the event page for more details and tickets or visit their website for more information

 

This article originally appeared on AIDSVu. You can see the full original article here.

New Maps Show More Than 77,000 People Prescribed HIV Prevention Medicine in 2016

AIDSVu has released the first-ever interactive state-level maps visualizing a 73 percent increase year over year in persons using PrEP across the U.S. from 2012 to 2016, with 77,120 PrEP users in 2016. PrEP, or pre-exposure prophylaxis, is when people at high risk for HIV take HIV medicine daily to lower their chances of getting infected with HIV. AIDSVu’s maps visualize the growth in PrEP use at the state-level by year, and break down the data by age and sex. These data and maps offer important information and tools to public health officials, policymakers, and researchers to inform efforts to improve PrEP awareness and increase uptake where it is needed most.

The Centers for Disease Control and Prevention (CDC) has estimated that approximately 1.2 million people are at high-risk for HIV exposure and could benefit from comprehensive HIV prevention strategies, including PrEP. Data presented on AIDSVu reveal that the growth and distribution of PrEP use has been inconsistent across different sexes, age groups, and geographic regions. For example, the Southern U.S. accounted for more than half (52 percent) of all new HIV diagnoses in 2016 but represented only 30 percent of all PrEP users in 2016. That same year, women comprised 19 percent of all new HIV diagnoses but made up only seven percent of all PrEP users.

“PrEP is a revolution in HIV prevention and has the potential to dramatically reduce new HIV infections; however, significant disparities in the use of PrEP exist across the country,” said Patrick Sullivan, Ph.D., Professor of Epidemiology at Emory University’s Rollins School of Public Health and Principal Scientist for AIDSVu. “Expanding access to PrEP is a core component of Getting to Zero campaigns in cities and states across the country and is one of four key focus areas in the National HIV/AIDS Strategy. We hope that the newly available data on AIDSVu will allow health departments, elected officials, medical professionals, and community leaders to better understand and visualize the realities of who has access to this important prevention tool so they can develop programs and policies to decrease barriers.”

The AIDSVu maps illustrate the following key trends:

The number of PrEP users has increased by 880 percent since 2012, an average 73 percent increase year over year from 2012 to 2016.

• In 2016, there were 77,120 PrEP users in the U.S., up from 8,768 PrEP users in 2012.

 Men and 25- to 44-year olds were more likely to be PrEP users.

• 93 percent of all PrEP users in 2016 were male, which is about 14 times higher than the number of female PrEP users. Men accounted for 81 percent of all new HIV diagnoses in 2016.
• In 2016, 64 percent of all PrEP users were 25- to 44-years old. This age group represented more than half (54 percent) of all new HIV diagnoses during the same period.

 Nearly 50% of PrEP users in 2016 were located in just five states: New York, California, Florida, Texas, and Illinois.

• When looking at the rate of PrEP use—the number of people in a state using PrEP per 100,000 population—the five states with the highest rates in 2016 were New York, Massachusetts, Rhode Island, Washington, and Illinois.
• In 2016, the Northeast region of the U.S. had approximately twice the rate of PrEP use (47.4 PrEP users per 100,000 population) compared to the West (28.1 PrEP users per 100,000 population), the South (22.6 PrEP users per 100,000 population), and the Midwest (23.5 PrEP users per 100,000 population) regions.

The South is the region with the highest number of new HIV diagnoses in the U.S. but has disproportionately fewer people using PrEP.

• The Southern U.S. accounted for only 30 percent (23,091 persons) of all PrEP users in 2016. The region represented more than half (52 percent) of all new HIV diagnoses in 2016.

Data on PrEP users displayed on AIDSVu represent the number of unique persons who had at least one day in a calendar year of prescribed tenofovir [TDF]/emtricitabine [FTC] (TDF/FTC) for PrEP. TDF/FTC is the only medicine currently approved by the U.S. Food and Drug Administration (FDA) for PrEP use. De-identified, aggregate data were obtained from Source Healthcare Analytics, LLC (SHA) with the support of Gilead Sciences, Inc., and compiled by researchers at the Rollins School of Public Health at Emory University. SHA collects data from over 54,000 pharmacies, 1,500 hospitals, 800 outpatient facilities, and 80,000 physician practices across the U.S. SHA’s dataset contains prescription, medical, and hospital claims data for all payment types, including commercial plans, Medicare Part D, cash, assistance programs, and Medicaid. From this overall sample, AIDSVu presents a subset of data comprising prescriptions for TDF/FTC for PrEP.

There is currently no single data source that includes data on all unique users of PrEP across the U.S. SHA’s dataset is an open sample of commercially available data, which excludes entities that do not make their data available, such as closed healthcare systems.  As a result, the data displayed on AIDSVu underestimates the total number of PrEP users in the U.S. Other publicly shared data on PrEP utilization have used estimates from multiple data sources to project for the total number of unique persons using TDF/FTC for PrEP in the U.S. at a given point in time. This method, however, does not provide state-level estimates.

Now in its eighth year, AIDSVu continues to advance its mission to make HIV data widely available, easily accessible and locally relevant to inform public health decision making. State-level PrEP data on AIDSVu can be viewed alongside social determinants of health and other HIV data, such as new diagnoses, prevalence, and mortality. Additionally, AIDSVu provides downloadable PrEP datasets at the state- and ZIP3-level for researchers and health departments to utilize in their own analyses. ZIP3 refers to the three digit ZIP code prefix assigned by the U.S. Postal Service. AIDSVu is also an inaugural user of the PrEP Locator, a national directory of providers of PrEP in the U.S. developed by Emory University’s Rollins School of Public Health with support from M•A•C AIDS Fund.

About AIDSVu
AIDSVu was developed by Emory University’s Rollins School of Public Health in partnership with Gilead Sciences, Inc. The project is guided by an Advisory Committee, a Prevention and Treatment Advisory Committee, and a Technical Advisory Group with representatives from federal agencies, state health departments, and non-governmental organizations working in HIV prevention, care, and research.

About the Rollins School of Public Health
The Rollins School of Public Health is part of Emory University in Atlanta, Georgia. The school houses six academic departments, 20 multidisciplinary centers – including an NIH-supported Center for AIDS Research – and more than 160 full-time doctoral-level faculty members.