Six in 10 gay and bisexual men in a recent study didn’t know that a once-daily pill can dramatically reduce their risk of contracting HIV.
Only 40 percent of men without HIV in the study, conducted in Baltimore, were aware of the benefits of pre-exposure prophylaxis medication, known as PrEP. Even many of those who had recently visited a doctor or been tested for a sexually transmitted disease were in the dark, according to the study.
The lack of PrEP awareness in Baltimore may reflect the situation among HIV-negative gay and bisexual men nationwide, putting an onus on physicians to do a better job of spreading awareness of the drug regimen, the study’s leader says.
“The Centers for Disease Control and Prevention recently reported that one third of US primary care providers have not heard of PrEP,” says Julia R.G. Raifman, a postdoctoral fellow in epidemiology at the Johns Hopkins University Bloomberg School of Public Health.
“It is likely that primary care providers across the country are missing opportunities to discuss and provide PrEP for patients at risk of HIV.”
Doctors aren’t suggesting PrEP
Studies have shown that PrEP, a once-daily pill, reduces HIV incidence by 92 percent in HIV-negative people who are at high risk for HIV, including men who have unprotected sex with men. The CDC recommends it for that group.
In 2011, incidence of HIV—the virus that causes AIDS—among gay and bisexual men nationally was 18 percent. (In Baltimore, it is estimated at 31 percent.) Still, since the US Food and Drug Administration approved PrEP in 2012, only 5 percent of high-risk individuals have taken it for HIV prevention.
The new findings, published online in the American Journal of Preventive Medicine, suggest that many health care providers don’t discuss PrEP even with high-risk patients they know are gay or bisexual.
“Doctors have limited time with their patients, but with gay and bisexual male patients, physicians definitely need to make it a point to discuss HIV risks and whether PrEP is a good option,” Raifman says. “PrEP could be a game-changer for HIV in the United States, where there are more than 44,000 new cases of HIV every year—but only if people know about it.”
Like a daily birth control pill
When people are diagnosed with HIV, they are typically given a three-drug regimen to combat the virus. PrEP is made up of two of those medications combined into a single pill to take once a day. Side effects are generally mild.
The study used 2014 Baltimore MSM National HIV Behavioral Surveillance data. There were 401 HIV-negative participants, of whom 168 (42 percent) were aware of PrEP. Having seen a doctor (82 percent had) and having a test for another sexually transmitted disease (46 percent had) in the prior year did not increase the likelihood that a gay or bisexual man knew about PrEP. Those who had been tested for HIV in the prior year, however, were more likely to know about PrEP.
Once study participants were told about PrEP, which has been likened to a birth control pill taken daily to prevent an unwanted outcome, 60 percent said they would be willing to use it.
The researchers found that twice as many black participants as white participants in the study were unaware of PrEP. Raifman says that is troubling since statistics suggest that one of every two gay black men will get HIV in their lifetimes.
PrEP costs and hurdles
There are barriers to wider PrEP use. The medication is expensive, though doctors can direct patients to programs that fully or partially cover the cost. People who take PrEP must visit a doctor for monitoring every three months, which can be a challenge for some.
Educating doctors and patients will be a key to expanding the use of PrEP, Raifman says.
“A lot of providers who remember the early days of the AIDS crisis, when high doses of AZT caused horrible side effects, may be intimidated by PrEP,” she says. “The most common symptoms of PrEP are mild nausea and fatigue, which usually go away after the first month. Physicians may not understand that PrEP is nothing like the high doses of AZT initially used to treat HIV.”
Raifman says a full-scale physician education program is needed.
“This is a new, safe, and effective tool in our toolbox to prevent HIV,” Raifman says. “But it does us no good if no one is using it.”
The CDC funds the National HIV Behavioral Surveillance System. Baltimore activities receive funding through an agreement with the Maryland Department of Health and Mental Hygiene. Raifman’s study had support from the National Institute of Allergy and Infectious Diseases and National Institute of Mental Health.
Source: Johns Hopkins University