Uptake of PrEP for HIV slow among MSM

Abstract

In July, 2012, the US Food and Drug Administration approved a combination pill of tenofovir and emtricitabine (marketed as Truvada, Gilead Sciences, USA) for pre-exposure prophylaxis (PrEP) for HIV. The oncedaily drug was approved to reduce the risk of sexually acquired HIV infection in high-risk, seronegative individuals. However, uptake of the pill as PrEP in the country—the only nation in the world to license the drug for this indication—has so far been slow. One of the most comprehensive analyses of prescriptions for PrEP produced some surprising findings. The research, presented at last year’s Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) meeting in Denver, Colorado, USA, found that 1774 people had used the tenofovir and emtricitabine pill as PrEP (offlabel and post-approval) between January, 2011, and March, 2013. Of these, 48% were women, and the users were widely spread across the USA. However, despite this slow start, there are signs that the rate of prescription is increasing, with 350 issued in the fi rst 3 months of 2013 alone. 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. Communication challenge “One of the largest challenges PrEP faces is that experts have said for three decades now that condoms are the most eff ective way to prevent HIV infection”, says Mayer. “Many of these same doctors and also charities and advocacy groups are very uncomfortable about anything that changes that message.”