In the Southern United States, there is a disproportionately high rate of HIV diagnoses amongst Black and Latino men who have sex with men. However, these groups are also less likely than their white counterparts to take PrEP, or pre-exposure prophylaxis, which can safely decrease a person’s likelihood of getting HIV through sex by about 99% when taken as prescribed.
Tagged: PrEP
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A new option to transform HIV prevention
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The future of HIV prevention is here. Injectable cabotegravir (CAB) is the most effective, longest-acting option for avoiding the virus. Until now, pre-exposure prophylaxis (or PrEP) medicine taken to prevent HIV has only been available as an oral pill that must be taken daily. CAB needs to be injected only once every two months.
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The Cookie Jar is a Facebook group run by FHI 360’s Accelerating Progress in Communities (APC 2.0) project to support young women in Botswana in shifting social and gender norms. Members talk about issues like HIV risks, gaps in knowledge about infections and access to treatment. Typically, young women like me do not use HIV services despite risks of infection or violence in relationships. In Botswana, many young women engage in intergenerational and transactional sex. The Cookie Jar provides a place for young women to seek information, find out how to get care and receive peer support.
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While much progress has been made to end the HIV epidemic, not enough has been done to put the power of prevention directly in women’s hands. The dapivirine ring, a flexible silicone ring inserted monthly into the vagina, can change this. If approved by regulators, the ring would be the first discreet, long-acting HIV prevention tool available specifically for women. The ring would complement daily oral HIV pre-exposure prophylaxis (PrEP) as another biomedical tool in the fight against HIV.
Recent evidence suggests significant acceptability of and demand for vaginal rings as a drug-delivery platform among women who used the dapivirine ring during clinical trials — and also among policymakers and other stakeholders in countries with a high HIV burden. To better understand these perspectives, the OPTIONS Consortium interviewed policymakers, implementers and civil society leaders in seven sub-Saharan African countries about possibilities for introduction and scale-up of the dapivirine ring. An analysis of the interviews shows widespread enthusiasm for the ring as part of comprehensive HIV prevention programming.
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Later this month, leading scientists and cutting-edge thinkers will gather at the International AIDS Society’s 9th IAS Conference on HIV Science in Paris to discuss the latest scientific discoveries in HIV prevention, care and treatment. These discoveries hold the potential to accelerate progress toward the global 90-90-90 targets set forth by the Joint United Nations Programme on HIV/AIDS (UNAIDS). And, they are especially important for key populations — including men who have sex with men, sex workers, transgender people and people who inject drugs — who shoulder a disproportionate burden of HIV. UNAIDS estimates that 45 percent of all new HIV infections among adults worldwide occur among these key populations and their sex partners. Reaching these groups with new technologies and approaches is essential to ending the epidemic.
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Now that the U.S. Food and Drug Administration has approved the use of the antiretroviral drug combination of tenofovir disoproxil fumarate and emtricitabine (Truvada®) for HIV prevention, its success will depend on user adherence to the daily drug regimen.
Several trials of Truvada as pre-exposure prophylaxis (PrEP) showed it is most effective when adherence is high. Two trials, VOICE and FEM-PrEP, were unable to determine whether Truvada worked, likely because most participants did not take the study pills daily as directed.
One explanation for low adherence to PrEP is that study participants might have thought they were not at risk of HIV infection.
A study from FHI 360’s Preventive Technologies Agreement (PTA) explored this possibility. Our analysis of data from a randomly assigned cohort of 150 participants who received Truvada in the FEM-PrEP trial yielded some intriguing results, presented in a late-breaker poster this week at the International AIDS Society conference (IAS 2013) in Kuala Lumpur, Malaysia.