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 Furthermore, young gay and bisexual men and those of color, who are
among the groups most at risk for infection with the human
immunodeficiency virus (HIV), were less likely to be taking the
medication than their older and white counterparts.
Unequal use of the drug, called Truvada, may worsen the disparities
between races in HIV rates, said lead author Henry Raymond, of the
San Francisco Department of Public Health.
"We don’t want to leave anyone behind," he told Reuters Health.
Truvada, manufactured by Gilead, is a combination of two
antiretroviral drugs that work to keep HIV, which causes AIDS, from
replicating in the body. Approved by the U.S. Food and Drug
Administration in 2012, Truvada is often just referred to as PrEP,
which stands for pre-exposure prophylaxis.
Gay and bisexual men who regularly take Truvada reduce their risk of
HIV by 90 percent, according the U.S. Centers for Disease Control
and Prevention (CDC).
For the new study, reported in the journal Sexually Transmitted
Infections, Raymond's team analyzed data from 411 gay and bisexual
men living in San Francisco in 2014.
About three-fourths of the men said they were HIV-negative - and of
those, 64 percent met one of the CDC's criteria for Truvada use.
Those criteria are having an HIV-positive partner, not being in a
monogamous relationship with an HIV-negative partner, having anal
sex without a condom or having a sexually transmitted infection in
the past six months.
But while nearly two-thirds were eligible for Truvada, only about 14
percent of those eligible men said they had used it at some point in
the past year.
When the researchers applied the study's results to the wider
population of gay and bisexual men in San Francisco, they estimated
that 27,745 men met the CDC's guidelines for Truvada but weren't
using the drug.
About 80 percent of young gay and bisexual men between ages 18 and
24 met one of those criteria, compared to about 29 percent of men 55
years old or older, the study found. Yet, none of the younger men
reported using Truvada.
About 23 percent of white gay and bisexual men who met the CDC's
criteria took the pill, compared to about 4 percent of Hispanic men,
7 percent of Asian men and 8 percent of black men, the researchers
found.
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According to the CDC, 44,703 people in the U.S. were diagnosed with
HIV in 2014 - and about 25 percent of new infections were in black
gay and bisexual men. About 18 percent of those new cases were among
gay and bisexual males ages 13 to 24.
"There (are) pretty marked disparities in who is using and who is
not using PrEP," said Dr. John Schneider, who directs the Chicago
Center for HIV Elimination at the University of Chicago.
There could be several reason why certain people are less likely to
use Truvada, he told Reuters Health, including structural factors
like lack of insurance, incarceration rates and how often people see
their doctors.
The researchers caution that the study's results are limited. For
example, the data were collected only two years after Truvada was
approved for PreP.
Raymond also said the results may not reflect Truvada use in other
parts of the U.S.
Schneider, who was not involved with the new study, also cautioned
that the CDC's criteria for PrEP use may not be applicable to all
gay and bisexual men.
"From our data (on) black men who have sex with men who turned
HIV-positive, half of those guys were not eligible for PrEP by the
CDC guidelines, which means the CDC guidelines may be missing the
most vulnerable men," he said.
Continuing to educate people about PrEP, changing the social stigma
around its use and altering some of the public health approaches may
help address some of the disparities, said Schneider.
SOURCE: http://bit.ly/29z0c7S Sexually Transmitted Infections,
online June 28, 2016.
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