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PrEP use rising among high-risk gay men in Washington State
Liz Highleyman, 2016-02-16 07:50:00
More than 20% of gay and bisexual men in
Washington State considered to be at high risk for HIV infection were taking Truvada pre-exposure prophylaxis (PrEP)
in 2015, and a large majority of both higher- and lower-risk men were aware of
it, according to a study published in the January 28 edition of AIDS.
Daily Truvada (tenofovir/emtricitabine) PrEP has been shown to be more
than 90% effective in preventing HIV infection among people who take it
consistently. The US Food and Drug Administration (FDA) approved Truvada for
PrEP in July 2012, but uptake was initially slow, as most people either did not
know about PrEP or had concerns about its safety and efficacy. But PrEP use has
accelerated in recent years in conjunction with community advocacy,
especially among men who have sex with men (MSM).
Julia Hood of the Seattle and King
County Public Health Department and colleagues assessed
trends in PrEP awareness and use among gay and bisexual men in the US state of Washington – home to Seattle – which has the country's first PrEP drug assistance programme
and a Medicaid programme that pays for PrEP.
The researchers conducted a
cross-sectional survey annually at the Seattle Pride Parade between 2009 and
2015. The Gay Pride survey collects data on respondents’
demographic characteristics, access to healthcare, risk behaviours, HIV and
sexually transmitted disease testing, and awareness of HIV prevention strategies
and campaigns. The anonymous survey could be done by an interviewer or
self-administered in English or Spanish, and respondents received condoms,
information about local services and a $5 gift card.
This convenience sample included 2168 gay
and bisexual men who reside in Washington State and said they had never tested
HIV-positive. Most (71%) were white and the median age was 32. About half had a college
education and a third reported an annual income over $50,000. The majority
(70%) lived in King County, which includes Seattle, the state's largest city.
About a quarter of the men met the health department's
criteria for 'high risk' for HIV infection, which included having at least ten
anal sex partners, condomless anal sex with a man who was HIV-positive or of
unknown status, having a bacterial sexually transmitted infection, or using
methamphetamine or poppers.
Prior to FDA approval of Truvada for PrEP in 2012, only five men reported having ever used
PrEP (< 1% of 2009-2011 respondents). Yet by 2015,
26 out of 115 high-risk MSM – or 23% – said they were currently taking PrEP; 72%
of men who reported ever using PrEP were currently doing so.
The percentage of high-risk men who
reported ever taking PrEP increased from 5% in 2012 to 31% in 2015. PrEP use
among lower-risk gay and bi men remained low and stable, between 1 and 3% during the period of 2012 to 2015.
In multivariate analyses PrEP use was
associated with later calendar years (adjusted relative risk 2.29) and higher
HIV risk (adjusted relative risk 2.29).
The percentage of high-risk gay and bi men
who had heard of PrEP increased from 13% in 2012 to 86% in 2015, while the
proportion of lower-risk men who were familiar with it rose from 29 to 58%.
"PrEP awareness is high and the use
has rapidly increased over the last year among MSM in Seattle, Washington,
USA," the study authors concluded. "These findings demonstrate that
high levels of PrEP use can be achieved among MSM at high-risk for HIV
The researchers added that a number of
factors distinguish the survey area from much of the rest of the US, including
a relatively well-educated and affluent population, a large number of medical
providers offering PrEP, the state PrEP drug assistance programme and a Medicaid
programme that pays for PrEP without co-payments, and a state health department
campaign to raise PrEP awareness among gay men.
However, they noted that despite the dramatic recent
increase in PrEP use among high-risk MSM, only 7% of all 2015 survey
respondents said they were currently taking PrEP. As a limitation of the study,
they said that gay and bi men who attend Pride events may differ from MSM who
do not, and the survey included a relatively small number of black and Latino
men – populations disproportionately affected by HIV nationwide.
"Achieving a population-level effect on HIV
transmission may require substantially higher levels of use than we
observed," the researchers wrote. "At the same time, modelling
studies in the USA and Australia have suggested that given current drug costs,
PrEP is only cost-effective if targeted to high-risk MSM. Our findings suggest
that such targeting is occurring in King County, Washington, USA."
"However, some MSM categorized as being low risk in our analysis may be at
significant risk for HIV acquisition," they continued. "Future
efforts should focus both on increasing PrEP uptake among high-risk MSM and
developing better criteria to identify segments of the MSM population that
would benefit most from PrEP."