HIV/AIDS disproportionately affects members of the LGBT community, and despite 30 years of research, there are still 50,000 new cases of HIV each year, two-thirds of which are among gay and bisexual men. - HRC Blog
On July 16, 2012, Truvada PrEP became the first FDA-approved drug for reducing the risk of sexually-acquired HIV in HIV-negative individuals who are at high risk for contracting HIV.Truvada is an oral pill that contains two medicines that are useful in preventing HIV: tenofovir and emtricitabine. Covered by both Medicaid and most private insurances, Truvada has been proven to reduce the risk of HIV infection by 99% when taken daily, 96% when taken 4 or more times per week, and 76% when taken twice per week (US Centers for Disease Control).
In San Francisco and Miami, two cities with large LGBT populations, pilot studies proved that Truvada usage significantly reduced the incidence of new HIV cases. A Kaiser PrEP study followed 657 mostly gay and bisexual men who were referred for evaluation and decided to start PrEP. To date, there have been no new HIV diagnoses among the 657 participants during the 2 and 1/2 years of follow up (Kaiser Permanente).
The Kaiser study is promising for HIV prevention because it extends what is known about PrEP from the controlled setting of clinical trials and shows that it can work in the "real-world". (Volk, 1202).Communities of Color
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| Black males account for 1-in-4 new HIV infections in the United States though they only make up 1-in-500 Americans, overall. - Reuters.com |
PrEP's success has significant implications for communities of color, which experience disproportionately high rates of HIV infection and mortality due to AIDS. Heterosexual black women and black gay and bisexual men are two groups most at risk for contracting HIV in the United States. Of the 1.1 million Americans infected with HIV, almost 50% (510,000) are Black (Centers for Disease Control).
The stark statistics concerning HIV and communities of color reflect large systematic and structural barriers and health disparities that underserved, minority communities face every day. Historical and contemporary inequalities in housing, education, employment, health care, and the rate of mass incarceration only reinforce these disparities.
Truvada Usage Gap
Thus, despite Truvada's life-changing benefits, lack of knowledge among health care providers, poor media coverage, and stigma have slowed the adoption of the drug, particularly in communities of color. In addition, many potential users have been driven away from health care and other services by negative experiences, overall distrust, and homophobia.
The persistence of abstinence-only education, failed incarceration policies, and resistance to harm-reduction programs combine to make the risk of acquiring, transmitting, and dying of HIV/AIDS higher in communities of color. Stigma is part of the problem as well. Many people within the Black community - particularly regular churchgoers - report that they would delay diagnosis and treatment due to embarrassment about sexually transmitted infections (Robinson).As a result, many of the people who could benefit from Truvada are not using it, either voluntarily or because they don't know that it exists. This creates a critical gap between Truvada's potential and actual usage and begs the question: What needs to be done to spread awareness, increase usage, and ultimately close the gap?
Closing the Gap: A Call to Action
Much of the burden of closing the gap and reaching the LGBT community rests on health care providers; however, an equally yoked portion of these endeavors necessitates grassroots efforts in which individuals work within communities to spread awareness and reach people where they are.
YES, YOU CAN BRIDGE THE GAP!
Two Simple Ways to Advocate
1. Get informed: Know your status, read unbiased literature, find out where to refer friends and family members for more information, ask your health care provider about Truvada PrEP.
2. Share information: Adopt the "Each One Teach One" mindset by telling family and friends about the information that you've learned (particularly those that are high-risk for HIV), join advocacy or information groups such as PrEP-O-Licous, and share relevant updates and information on social media.
SOURCES
Kaiser Permanente San Francisco. Division of Research - HIV Care and Prevention. Large Study of PrEP Use in Clinical Practice Shows No New HIV Infections. Kaiser Permanente Share. N.p., 1 Sept. 2015. Web. 29 Oct. 2015. <http://share.kaiserpermanente.org/article/large-study-of-prep-use-in-clinical-practice-shows-no-new-hiv-infections/>.
Robinson, Russell, and Aisha Moodie-Mills. "HIV/AIDS Inequality: Structural Barriers to Prevention, Treatment, and Care in Communities of Color." Center for American Progress. University of California, Berkeley, 27 July 2012. Web. 29 Oct. 2015.
Volk, Jonathan, Julia Marcus, Tony Phengrasamy, Derek Blechinger, Dong Nguyen, Stephen Follansbee, and C. Bradley Hare. "Clinical Infectious Diseases." No New HIV Infections with Increasing Use of HIV Preexposure Prophylaxis in a Clinical Practice Setting 61.10 (2015): 1601-603. No New HIV Infections with Increasing Use of HIV Preexposure Prophylaxis in a Clinical Practice Setting. Oxford University Press. Web. 29 Oct. 2015.
United States. Centers for Disease Control. Department of Health and Human Services. PrEP Guidlines. N.p.: n.p., 2014. Centers for Disease Control. Web. 29 Oct. 2015. <http://www.cdc.gov/hiv/pdf/prepguidelines2014.pdf>.
