Study shows PrEP has massive impact on HIV among gay & bi men
Researchers found that new infections in this group in New South Wales (NSW) declined by almost one-third following the introduction of the HIV prevention medication in March 2016.
The globally unprecedented reductions provide strong evidence to support the large-scale, targeted provision of PrEP to prevent HIV transmission. The results of the EPIC-NSW trial were published in The Lancet HIV.
When taken daily, PrEP prevents HIV negative people from acquiring the virus. The trial is the first study globally to measure the impact of PrEP on reducing HIV in a large population.
“The speed of the decline we’ve seen in new HIV infections in gay and bisexual men is a world first,” said Professor Andrew Grulich from the Kirby Institute at UNSW Sydney, who led the trial. “In the year following the trial, state-wide new HIV infections in this population decreased by one third. These numbers are the lowest on record since HIV surveillance began in 1985,” explained Grulich.
NSW was the first state in Australia to trial PrEP at a large scale. “The results from EPIC-NSW provide an important evidence-base to inform our response to HIV globally,” noted Grulich. “We now know that PrEP implemented quickly, at a large scale, and targeted to high-risk populations can help turn the HIV epidemic around.”
It is estimated that there more than 150,000 people on PrEP around the world. PrEP is available for free for gay, bi and other men who have sex with men in limited locations in South Africa. It can also be bought through a doctor’s script.
What Trump’s PrEP deal means for the spread of HIV
Top HIV/AIDS researchers and public health advocates say the Trump administration’s new deal to provide uninsured Americans with free drugs to prevent HIV infection is a promising step in America’s fight against AIDS. But actually reaching the very people most in need of the medication — like men who have sex with men and people who use injection drugs — and convincing them to take it, will be a bigger challenge.
The Trump administration announced last week it reached a deal with Gilead Sciences — the maker of Truvada, the only FDA-approved drug to prevent HIV infection — to donate enough pills to treat 200,000 low-income patients for up to 11 years.
The agreement with Gilead will provide the pre-exposure prophylaxis, or PrEP, to uninsured individuals at high-risk for HIV. That includes people in states and counties identified as “priority areas” in President Donald Trump’s blueprint, announced in February, to end the HIV/AIDS epidemic in the next decade.
Science has shown that the world now has the tools to end the HIV/AIDS epidemic — including widespread testing, universal treatment of those living with the virus (which makes it virtually impossible for them to pass the virus to others), and the use of PrEP among the groups most at-risk of contracting HIV. These interventions have been shown to drastically decrease HIV transmission rates — perhaps even enough to bring the epidemic to a halt by 2030, according to UNAIDS, the United Nation’s AIDS advocacy wing.
Yet according to recent estimates from Gilead, only about a fifth of the million Americans most at risk of contracting HIV are taking PrEP — about 200,000 total.
“We believe that PrEP can help achieve the national goal of ending the HIV epidemic in the U.S. by 2030, and we are committed to providing access to all people in need,” a Gilead spokesman told the NewsHour. “This donation is just one example of an innovative approach to expanding access to the preventive medication.”
Watch our globe-spanning series on efforts to end the epidemic
The company said the deal was first proposed in the course of routine conversations with the U.S. Centers for Disease Control and Prevention.
Barriers to accessing this crucial drug are particularly high in the American South.
Robin Lewy, who runs the Gainesville, Florida-based Rural Women’s Health Project, said the government’s drug agreement is “an excellent opportunity for us in the South to have PrEP available to lower-income and uninsured individuals.” The fact that Gilead is making this commitment through 2030 means that there is an opportunity for there to be an impact in the reduction of HIV transmission, she said, “if the rollout is well-thought-through.”
But rampant stigma and even violence against people living with HIV remains a daily reality in many parts of the U.S. And that keeps people from testing, let alone seeking access to a daily prevention pill.
To Lewy, a successful PrEP program would “continue the hard work of addressing stigma and health inequities such as racism, xenophobia and poverty” and will “require collaboration between community partners and providers.”
“To get this medication into the hands of those who can benefit most means we will need to have many intimate discussions with community members and those living with HIV,” she said.
Offering free PrEP to 200,000 patients will make an especially big difference for low-income patients given Truvada’s price tag: $20,000 per year in the U.S. In developing countries, that price is about $60 per year.