Promising Regimen Could Fight HIV in Communities of Color, but Not Everyone Is on Board

Despite years of high-profile outreach campaigns, celebrity-backed charities, and a health care industry that has worked tirelessly to get the word out about how to prevent transmissions, about 50,000 Americans per year become infected with HIV. The disease has hit gay and bisexual African American and Latino men particularly hard. That’s why health care organizations and LGBT groups are working to get the word out to them about PrEP, or pre-exposure prophylaxis, a treatment program aimed at preventing HIV transmission.

Back in May, the Centers for Disease Control and Prevention rolled out the first-ever comprehensive clinical practice guidelines for PrEP. The effort involves giving HIV-negative individuals a drug that improves immunity and helps guard against contracting the disease. Though the treatment sounds revolutionary, it’s been around for years.

“Pre-exposure prophylaxis is not a new concept. We’ve used pre-exposure prophylaxis, or some type of prophylaxis, for malaria and mothers who were HIV-positive,” says Christopher Chauncey Watson, clinical research site director at George Washington University. “In the past few years we’ve moved to the novel concept of treating HIV-negative individuals with some type of prophylaxis, in this case Truvada, which would ideally prevent them from acquiring HIV.”

While HIV is no longer the automatic death sentence it once was, ensuring that men of color begin taking Truvada could make a real dent in HIV infection rates.

According to the CDC, in 2010, Latinos were 17 percent of the U.S. population, but they were 21 percent of all new HIV infections. The data on infection rates for African Americans is even more startling. While black people made up only 12 percent of the U.S. population, they were 44 percent of all new HIV infections. In New York City, 45 percent of new infections are black and Hispanic men, and it’s estimated that in Los Angeles County, one-third of gay black men are infected.

“We’ve seen a significant increase [in HIV transmissions] among young, black gay men ages 18-30,” says Watson. “Research tells us it’s not because of the risk factors, drug use, or how often they’re having sex. It’s really just that the prevalence of HIV in the African American MSM [men who sleep with men] community is greater.”

Bolstered by clinical trials that showed a person’s risk of contracting HIV was reduced by as much as 92 percent when Truvada was taken consistently, health care professionals across the country are hoping PrEP will keep those at the greatest risk of contracting HIV safe.

“We have an additional tool in the toolbox that can help individuals protect themselves outside of condoms and abstinence, which historically has been the way we’ve treated HIV prevention,” Watson says. “As a practitioner, my goal is to understand the epidemic overall, but to provide resources and options to combat the disease and live healthy lives.”

In spite of the promising benefits, Truvada has its critics. The AIDS Healthcare Foundation, the largest HIV treatment provider in the country, has come out in opposition to the CDC’s plan to roll out PrEP to more than half a million high-risk individuals. Earlier this week, the AIDS Healthcare Foundation published an open letter to the public health agency asking, “What If You’re Wrong About PrEP?”

“The Centers for Disease Control and Prevention (CDC) recently recommended that half a million gay men in the United States receive Truvada for the prevention of HIV,” reads the letter. “Further, they changed their wording from ‘unprotected sex’ to ‘condomless sex’ to describe intercourse without a condom, thus saying that sex without a condom could still be safe if accompanied by medication while ignoring the transmission of all other STDs besides HIV. AIDS Healthcare Foundation (AHF) regards these decisions as dangerous to the public health of the country.”

The letter goes on to note that although the foundation believes that “Truvada may work to protect a small segment of the population of HIV-negative individuals, all of the scientific studies have shown that it will not work on a community-wide basis because of consistently bad adherence by study subjects—even under ideal circumstances.”

While the AIDS Healthcare Foundation opposes Truvada because it asserts it will encourage people to engage in unsafe sex, thereby contracting the disease anyway, Watson says the drug is just one important tool in the fight against HIV.

“It can benefit a lot of communities, but it’s an individualized option based on seasons of risk,” he explains, noting that the likelihood of an individual contracting the virus changes based on if they’re sexually active or not, or if they’re in a monogamous relationship. And though Truvada is most effective when paired with condoms, Watson isn’t so sure prescribing the drug will cause folks to stop using protection.

“We don’t know how often people use condoms, but the data suggests people are not using condoms. If you’re consistently seeing increases in the number of infections, it’s because of unprotected sex,” he says. He admits that some people may take Truvada and skip wearing a condom, but he still believes getting the drug into the hands of those who are at the greatest risk of contracting HIV, men of color, is a good idea. “I struggle to think that offering an additional tool to individuals to protect themselves would increase the amount of non-condom use.”

Whether or not Truvada will have a significant impact on the spate of transmissions in communities of color remains to be seen. But considering the HIV diagnosis rate, it’s worth a shot.

“This is really our cry to advocate for African American health quality,” Watson says, driving home the point of just how important PrEP can be to the black community. “And this is the time to do it.”