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This year’s International Conference on HIV Treatment and Prevention Adherence brought researchers, advocates and others in the HIV field to Miami from June 28-30 to discuss the role of antiretroviral therapy (ART) in preventing new infections and supporting the health of people living with HIV. Pre-exposure prophylaxis (PrEP), the use of HIV treatment drugs by an HIV-negative person to prevent HIV, was one of the hottest topics of the conference. Common to most PrEP sessions was this overarching question: How do we make sure that the people who most need PrEP know about it, want to use it and can access it?
Here are just a few of the recommendations offered to answer that question:
Stop counting transgender women as men who have sex with men. Just one PrEP trial (I-PrEX) out of the seven conducted has confirmed transwomen participants. The other trials categorized transwomen as men who have sex with men. Lumping transwomen in with gay men makes transwomen invisible while also failing to examine their unique needs and concerns. Understanding factors like potential interactions between PrEP and hormones is critical to ensure we meet transwomen’s health needs and desires. How do we do that? Design studies that aim to specifically address these issues and identify transwomen as transwomen, not as men.
Promote the non-HIV prevention benefits of PrEP. Yes, PrEP is a highly effective way for a person to reduce their risk of HIV infection. But it offers a number of other benefits as well. Users report feeling less anxious and depressed and enjoying a greater sense of psychological well-being. PrEP can also serve as a gateway to primary care for people were not previously engaged in care. One New York City study found that 29% of its participants had no primary care before getting on PrEP, and that nearly half were uninsured. Enrolling in the PrEP program resulted in 68% of these same people now accessing insurance coverage through the Affordable Care Act and Medicaid. Highlighting these other aspects of PrEP shows that it’s about even more than just HIV — it’s about health as whole.
Consider the local landscape. Having a safe and effective way to reduce HIV is not enough. Its existence alone does not ensure access. This sentiment rang throughout the sessions and was discussed in the AIDS Foundation of Chicago’s talk about its Mapping Pathways project. There is no question that thoughtful consideration of myriad political, economic, social and cultural factors is essential for PrEP to be implemented in a way that meets the needs of people most vulnerable to HIV. Actively and authentically engaging diverse stakeholders in this effort will help us get this important tool into the hands of those who need it most.