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The pandemic, caused by the COVID-19 virus between 2020 and 2021, impacted various aspects of society in different ways. Life took an unexpected turn seemingly, and we found ourselves in lockdown in our homes, wearing face masks, practicing social isolation, facing government restrictions, implementing health protocols, and uncertainty about a deadly virus about which we had no information. In the end, it left an estimated close to 15 million deaths worldwide, according to information reported by the United Nations between January 1, 2020, and December 31, 2021. One of the aspects that gained significant importance during the pandemic was travel. Despite the mobility limitations imposed by the COVID-19 pandemic, the migrant population continued to embark on clandestine journeys, fleeing violence and poverty. This is how many stories were woven. One story is of Edgar, a Colombian migrant.  Edgar decided to migrate to the United States in early 2021, His come country faced extreme conditions during COVID. This could be one of the many stories told daily of people leaving South and Central America in search of a better future in the United States. However, this story has an additional ingredient, as Edgar is a patient living with the HIV virus for more than five years. Edgar arrived fleeing his country in mid-2021 with his diagnosis as an HIV-positive patient. For several months, he journeyed through different states of the United States in search of opportunities to start his new life but also to access his Anti-Retroviral (ART) medication treatment. Remaining  “poz-undetectable” was critical for Edgar.  He did not want his health to be affected and he wanted to protect any seual partners from possible infection.  As a migrant, without resources and access to insurance or medical services, Edgar's final destination would be Texas.  Edgar decided to move to the northern part of the state of Texas and begin the search for new opportunities not only to sustain himself but also to access treatment for his diagnosis and undocumented immigrant. After knocking on more doors and seeking different organizations to gain access to his medications, one day, while searching the internet for ways or places to access the type of treatment he needed, he found what he would describe as the "Light at the End of the Tunnel." After an intense search, he came across the CHE Clinic website. Immediately, he reviewed it and found that it offered access to tests for STIs/HIV and taking PrEP.  Edgar contacted CHE Clinic. Without thinking, this became his great opportunity to access his ART treatment, which he still receives through the clinic and has allowed him to remain undetectable for nearly 3 years living in the country. For Edgar, this first experience at CHE Clinic in the city of Dallas became more than just a doctor's appointment; it became a long-term hope. From the first moment at the clinic's facilities, he not only found a place to be treated but also a team of human and capable professionals who understood his needs immediately. As he himself points out, "One of the greatest fears of a person living with the HIV virus is the option to migrate," as the various barriers faced by migrants for access to health and treatments are no secret to anyone. Today, after almost three years as a patient at CHE Clinic, Edgar appreciates the work and assistance provided by the entire medical and professional team that has accompanied him on this journey. He has had no problems accessing health services and his ART treatment. He attends his check-up appointments frequently, and when he has special needs or medical consultations, he knows he has different tools to stay in touch with his treating professional. Immigrants living with HIV constitute a particularly vulnerable population. In addition to the diagnosis as HIV-positive, other negative conditions are added due to the context of stigma, socio-cultural, economic, labor, administrative, and legal factors, simply because they are migrants. According to information from the aidsvu.org portal for the year 2021, there were 100,700 people living with HIV in Texas. Likewise, 4,363 people were diagnosed with HIV in the same year. Although the number of migrants living with the HIV virus is unknown, the CHE Clinic has a proactive attitude for early infection diagnosis. CHE seeks the most appropriate way to implement preventive measures to avoid new cases and provide accessible, tailored, and high-quality healthcare in the cities of Dallas and Austin in the state of Texas.

Two leading Scottish charities have launched a national HIV home testing service in Scotland, in what they say is a unique opportunity to break the chain of transmission and get to zero new HIV transmissions. HIV Scotland and Waverley Care have partnered to provide people in Scotland with a free HIV testing service at a time when access to sexual health services is reduced to emergency and symptomatic testing only. Experts have talked about the opportunity that physical distancing offers to break the chain of transmission by ensuring people have access to a HIV diagnosis – and swift access to effective treatments that can manage the virus so that people can have an undetectable viral load that makes them unable to transmit the virus to their sexual partners. They say that diagnosing people who have HIV but don’t know it will help to break the chain of transmission in their joint ambition for Scotland to reach zero new HIV transmissions by 2030. Commenting, Nathan Sparling, Chief Executive of HIV Scotland said: “HIV Self Test Scotland is a brand new service with the aim of getting HIV tests in to the hands of people who need it, when and where it is convenient for them. “Diagnosing HIV is the most important part of our mission to reach zero new HIV transmissions, so it’s important that we’re launching this service for people to access a test when the advice is to stay at home. “For most people. self-testing is fast, safe, accurate and convenient – and it provides people with another option that can help people get swift access to treatment if needed. It’s important for everyone to know their HIV status so they can protect their health, and that of their partners too. “With HIV Self Test Scotland, we can play our part in the global mission to get to zero by 2030.” Grant Sugden, Chief Executive of Waverley Care said: “There are still around 500 people living with HIV in Scotland that don’t know they have it. Diagnosing people living with HIV is the first part in preventing new transmissions, as people can access effective treatment which supresses the virus to levels which can’t be transmitted through sex. “HIV Self Test Scotland is a great new project, as part of a new partnership that provides many people in Scotland with a new option for testing. Regardless of someone’s HIV status, they’ll also be able to access dedicated support that will help them access treatment, or stay negative. “However, while this service makes HIV testing available to many people in Scotland, we must not forget that people who use drugs are less likely to access services online and still need specialist support from our teams. This is particularly important in areas such as Glasgow, where people affected by Glasgow’s HIV outbreak continue to be at heightened risk of HIV during COVID-19. That’s why our HIV Street Support team are carrying out testing in Glasgow city centre, making sure we’re taking a multi-level approach to HIV testing in Scotland. “Anyone can get one of the HIV self-tests for free, regardless of why they might want to test – so this service can really play an important part in helping to diagnose everyone who might have been at risk of HIV.” SOURCE: https://www.hiv.scot/news/charities-launch-hiv-home-test-during-unique-opportunity-to-get-to-zero

The National LGBT Chamber of Commerce (NGLCC), the business voice of the LGBT community, has publicly announced its endorsement of Joseph R. Biden for President of the United States. NGLCC has only endorsed for president once previously in its nearly twenty-year history and the vote was unanimous by the organization’s Board of Directors. “The NGLCC is proud to endorse a champion for inclusion. We need to elect a president with a commitment to LGBTQ equality, ending racism and racial violence, promoting small businesses and entrepreneurship, and ensuring a safe and equitable society for every American. Joe Biden is that candidate,” said NGLCC Co-Founder & President Justin Nelson. “Joe Biden proudly affirms an essential core value of the NGLCC: that we all deserve our shot at the American Dream, and that our economy only succeeds when it is available to all LGBT and allied Americans.” Vice President Biden has denounced LGBT discrimination as not only immoral but fundamentally bad for business in his long career. NGLCC leadership considers his election imperative to the well-being of America’s economy and the monumental gains achieved in recent years for the LGBT community, such as recent victories for LGBTQ workplace protections, the passage of the Equality Act in the US House of Representatives, the upholding of DACA, and more. Among the policies NGLCC cites for their historic endorsement are his commitments to an economic recovery plan that strengthens our small businesses, especially as they recover from COVID-19; as well as preserving and expanding President Obama’s LGBT equality executive actions, seen essential to NGLCC’s work toward the full federal inclusion of Certified LGBT Business Enterprise® (Certified LGBTBE®) suppliers. The organization serves as the exclusive certifying body and for LGBT businesses seeking contracts and economic opportunities with Fortune 500 corporations as well as LGBTBE inclusion in state and municipal contracting, now nearly two dozen, ahead of full nationwide inclusion. “The stakes have never been so high for the future of our country and the LGBT business community. Joe Biden is the champion our businesses and our families need to thrive,” said NGLCC Co-Founder and CEO Chance Mitchell. “The LGBT community has come too far to lose its seat at the table, and we are certain that a President Biden will continue fighting for the collective economic and social longevity of America’s 1.4 million LGBT business owners and the more than $1.7 trillion they add to the US economy despite ongoing discrimination.” With this public announcement NGLCC will continue its voter registration campaign using #LGBTBizVotes, which will now also include #LGBTBizForBiden.

Gay and bisexual men taking PrEP before and after sex — known as the 2-1-1 regimen — reported good adherence and none were diagnosed with HIV, according to a new study from Kaiser Permanente San Francisco. Based on these findings, on-demand PrEP could be an attractive option for men who can plan ahead for sex. "Some of our patients have been reluctant to take a daily medication, and enabling our patients to choose the dosing strategy that is right for them is very empowering," study co-author Dr. Jonathan Volk, of the Permanente Medical Group, said in a press release. "We now have different dosing strategies that can meet the needs of different patients." PrEP 2-1-1 involves taking two doses of Truvada (tenofovir disoproxil fumarate/emtricitabine) between two and 24 hours before anticipated sex, one dose 24 hours after the initial double dose, and a final dose 24 hours after that. A pair of French studies has shown that PrEP taken before and after sex is highly effective for men who have sex with men, regardless of whether they have sex frequently or less often. But so far, there has been little data from the United States. Although the World Health Organization and the International Antiviral Society-USA have endorsed on-demand PrEP for gay and bi men, this regimen is not yet approved by the federal Food and Drug Administration. The 2-1-1 regimen has not yet been studied in women or transgender men who have vaginal or frontal sex. Study results for cisgender (non-trans) gay and bi men only apply to Truvada, not the Descovy (tenofovir alafenamide/emtricitabine) pill that was approved last year as a second daily PrEP option. Kaiser San Francisco began offering on-demand PrEP in February 2019. Volk and his colleagues followed 279 men who were prescribed the new regimen through the end of August 2019. Clients who were already on daily PrEP were told about PrEP 2-1-1 and given the opportunity to switch, while those starting PrEP could choose between the on-demand or daily regimen. More than half of the men (56%) were white, 22% were Asian, 12% were Latino and 3% were African American. (The proportions of these groups in the San Francisco population are about 52%, 36%, 15%, and 6%, respectively). Three-quarters had previously used PrEP, including 11 men who had used the 2-1-1 regimen before Kaiser started offering it and six who had used other nondaily schedules, such as taking PrEP only when on vacation. The most common reason for wanting to use PrEP 2-1-1 was infrequent sex, reported by 58% of the men. Other less common reasons included concerns about the potential side effects of daily dosing, the cost of daily PrEP, and difficulty with daily adherence. About 14% of the men reported challenges using the 2-1-1 regimen, including issues related to adherence or getting the dosing pattern right, difficulty planning sex in advance, and side effects. More than half of these men switched to daily dosing on their own. Twenty men discontinued PrEP altogether due to loss of health insurance, reduced sexual risk, or side effects. All but six of the men who were prescribed on-demand PrEP completed their three-month follow-up visit. Of these, 51% exclusively used the 2-1-1 regimen during that period, while 19% opted to take Truvada daily, 15% used a combination of the two regimens and 3% never actually started PrEP. Among the 181 men who used the 2-1-1 regimen exclusively or in combination with daily dosing, only 4% reported missing a dose of Truvada the last time they had sex. On average, they used one course of PrEP 2-1-1 — or four pills — during the past month. No one was newly diagnosed with HIV. "Our findings suggest that 2-1-1 is an appealing alternative for some men, especially those who have infrequent sex," said study co-author Carlo Hojilla, RN, Ph.D. "Offering 2-1-1 alongside daily PrEP will help provide individuals with an additional option to tailor their HIV prevention strategy based on their needs." Kaiser is not the only San Francisco provider offering PrEP 2-1-1 prior to FDA approval. As the Bay Area Reporter previously reported the San Francisco AIDS Foundation's Magnet sexual health service at Strut in the Castro began offering the new regimen in March 2019. "In France, almost half of the people starting PrEP elect this strategy," former Strut director of nursing Pierre-Cédric Crouch, RN, NP, Ph.D., wrote in a Facebook post at the time. "We've been behind in the USA and we need to catch up!" Since then, about 23% of Magnet clients have opted to use the 2-1-1 method at least part of the time, SFAF director of clinical services Janessa Broussard, NP, told the B.A.R. "With proper counseling on how to take it, it's been easy for clients to understand and use," Broussard said. "During the shelter-in-place order [due to COVID-19], some clients have transitioned to 2-1-1 dosing with the intention of switching back to daily dosing once they feel safe to resume a more normal sexual routine." SOURCE: https://www.ebar.com/index.php?id=293303&fbclid=IwAR33-mGLuMUgd8LCFfGdQts6-xeqrkmxAbzUypFn3kBsz9hCRuDeR3ZBVxI

Among a group of women who inject drugs in Philadelphia, many saw pre-exposure prophylaxis (PrEP) as a beneficial way of preventing HIV infection, resulting in a decision to accept free PrEP. Women who believe that PrEP is beneficial see HIV as a severe threat to themselves personally. However, for a small number of women in the study, barriers such as HIV-related stigma, fear of side effects and worry regarding continued PrEP access outweigh perceived benefits and result in a decision to decline free PrEP. This research was published in Archives of Sexual Behaviour by Marisa Felsher at Drexel University and colleagues. While people who inject drugs represent only 3% of the US population, they represented 6% of all new HIV infections and 28% of AIDS-related deaths in 2017. Women who inject drugs report more drug and sex-related behaviours that place them at risk for contracting HIV than men. Using male condoms and clean injection materials consistently often require negotiation with male partners – factors that women who inject drugs cannot easily control. PrEP offers an effective means of preventing HIV infection that is more readily controlled by women who inject drugs. However, there has been little research with this key population to understand the beliefs that they have about HIV, and how these beliefs influence their decision to accept or decline an offer to use PrEP. The study From 2018 to 2019, as part of a larger study which offered PrEP to women who inject drugs enrolled in a syringe services programme, a smaller group of women were interviewed in order to explore beliefs linked to HIV risk and how these affected PrEP uptake. Interviewees needed to be considered at-risk for HIV infection and therefore be eligible for starting PrEP (engaging in transactional sex, syringe sharing or having an HIV-positive partner). Interviews were conducted with 25 women, either face-to-face or by telephone. Eighteen of these women had chosen to start PrEP, while the other seven had declined the offer of free PrEP. The median age was 37, over 80% were white and nearly half had not completed high school. Over half of the women were homeless at the time of the study. Over two-thirds of the sample rated their health status as either poor or fair, while just under half saw themselves as extremely or very likely to contract HIV. Seventy-two per cent reported transactional sex, 76% reported inconsistent condom use, 52% of women reported sharing injecting material and 40% had been sexually assaulted in the past year. Interview questions dealt with women’s perceived HIV risk, how useful they believed PrEP would be, potential barriers to using PrEP and reasons for accepting or declining a PrEP prescription. HIV susceptibility and severity = perceived threat Women believed that they were at risk for HIV infection because of factors both within and outside their control. Some indicated that if they consistently engaged in harm reduction behaviours (such as using clean needles), their HIV risk was reduced. However, there was an acknowledgement that this was not always possible, due to their opioid addiction and the need to avoid painful withdrawal symptoms. “I’m not very vulnerable [to HIV]. I’m pretty safe. I don’t have sex with random people and I do not share any type of [injection drug] supplies.” “It gets real [hard]. I don’t like to be dope sick…When you’re sick you don’t care. You ask your girlfriend, ‘Do you have a set of works?’ and you’ll use ‘em.” Women were most concerned about risk factors outside their control, especially sexual assault. PrEP was seen as something that would work all the time, and be within the women’s control. “I work— [do] street [sex] work, so yeah [I’m] very vulnerable to HIV...Just the fact I’ve gotten raped a few times, that impacted my decision [to get on PrEP].” “There’s needles all over the streets…In the summertime, wearing flip-flops, you step on a needle…You could fall, shit happens. So...I need [PrEP] regardless of how I’m living.” Women who saw HIV as a life-threatening illness with severe health consequences, or who knew someone who living with HIV, were more likely to see PrEP as an attractive preventative option. “I don’t want to die from HIV. I don’t want the doctor to come and tell me, ‘You’ve got HIV. You’re gonna die in a horrible death.” Benefits of starting PrEP Despite the fact that not all participants opted to start PrEP, all participants recognised that PrEP is a beneficial prevention tool for anyone at risk for HIV. “In actuality, if you only have to take a pill once a day to protect yourself, and not getting the [HIV] virus, it’s a miracle…” For the women who opted to accept PrEP, the main benefit reported was that it is a tool that is within their control and does not require any co-operation from sex partners. This was especially relevant in the context of sex work. “[PrEP] is awesome...in prostitution, jerks take the condoms off. You tell them to use a condom and they don’t...So we can protect ourselves with PrEP.” Barriers to starting PrEP The seven women who opted not to start PrEP cited various reasons for their decision. One was a fear of potential side effects and adverse reactions due to other conditions. As many had reported poor or fair health, this appeared to be a significant factor for some women. Fear of side effects from PrEP could be an important factor for women who inject drugs because of their experiences of opioid withdrawal and perceived similarities between these. “I didn’t take PrEP because I was worried about the stomach side effects… I’m already having a lot of stomach problems, so I didn’t want to put that on top of it. I was thinking about taking [PrEP], but then I didn’t want to risk getting sick…” Another barrier to starting PrEP was HIV-related stigma. Some women were afraid that they would be seen as having HIV as a result of taking pills for PrEP. Women also feared that this could lead to conversations about why they were taking PrEP and the kinds of behaviours they engaged in that made them susceptible to HIV infection. “I actually did [want a PrEP prescription] at first….But I was scared that if someone seen [my prescription] they… would put a label on it. Some people might think that’s the pill [you take] because you have HIV.” While women valued being able to get PrEP through the study at the syringe programme, they thought that getting PrEP outside of the context of the study would be challenging. Some feared that they would no longer be able to access PrEP once the study came to an end. “I come, and when my prescription’s done, I get my prescription, I take it to the pharmacy to fill it. I have no problem with it…[Getting PrEP on my own] probably wouldn’t be as easy. It’s hard for people like myself to make appointments.” Conclusion The authors acknowledge that while PrEP was acceptable to most women in the study, it may not be the right choice for all women who inject drugs, especially those concerned about events outside their control. “The fear of event-driven unintentional exposures may indicate that post exposure prophylaxis (PEP), which involves taking HIV medication within 72 hours of a potential HIV exposure, may be a more appropriate HIV prevention option for some women, especially those who decline PrEP,” they say. They conclude by stating: “Our results highlight the importance of removing barriers to care in order to promote uptake among a highly vulnerable population of women who inject drugs. Most women recognized their HIV risk, believed they would benefit from PrEP, and thus, initiated PrEP. However, one-third declined PrEP primarily due to their concerns about PrEP-related side effects and stigma. In order to increase initiation, additional interventions that effectively decreases the saliency of these barriers will be necessary.”

HIV health care professionals and advocates have been struggling with how to reach the populations that could most benefit from pre-exposure prophylaxis (PrEP) and, when and if these patients access it, help them take their medication daily. A variety of new mobile-friendly online portals and apps are taking on two of the biggest barriers to getting people on PrEP: the lack of doctors who are willing to prescribe it, and the perceived—and often real—difficulties in obtaining it. People who use PrEP on a regular basis need four visits to a doctor every year, with an average of four hours, including time off work. Telemedicine apps and mobile-friendly platforms allow users to consult with (judgment-free) doctors, obtain PrEP, and even get lab tests (in some cases) without setting foot in a brick-and-mortar medical facility or pharmacy. Overcoming Rural Barriers In rural Iowa, telehealth is one solution. Launched in 2017, the University of Iowa’s TelePrEP program was the first in the nation to provide access to PrEP through secure video conferencing. Patients visit with a University of Iowa Health Care pharmacist using a secure, HIPAA-compliant app on a smartphone, laptop, or tablet. Users can get tests at a local lab or through Iowa’s network of public health providers. In most cases, meds can be delivered by mail. Funded by the Iowa Department of Public Health, the TelePrEP service points out the lack of PrEP prescribers in many rural communities across the country. From the website: “We believe that every Iowan who wants/needs PrEP should be able to get it without having to spend a whole day in the car and without risking a loss of privacy.” Between February 2017 and October 2018, Iowa’s TelePrEP received 186 referrals and completed 127 initial video visits with clients. Ninety-one percent of clients with video visits started PrEP, and the retention rate for TelePrEP at six months was 61%. Telemedicine can be helpful for high-risk populations in rural communities and for people in cities who don’t have time to go to the doctor—or, just like in rural areas, can’t find one who knows about or advocates for PrEP. Direct-to-Patient Telehealth Three direct-to-consumer platforms are available for obtaining PrEP, all developed to circumvent the obstacles keeping many people from getting on PrEP. They can also help users navigate the payment maze and, in many cases, find out how to pay little or nothing for the medication. Once on PrEP, customers can get SMS messages reminding them to take the medication and to renew. One mobile-friendly telemedicine platform, PlushCare, is like an “online doctor’s office,” according to its chief medical officer. PlushCare offers end-to-end medical care, if needed, so a patient can come for PrEP and also get diagnosed and treated—through face time and messages with a doctor—for any other acute illnesses. It has 100,000 total users and 10,000 accessing PrEP. Unlike the similar platforms Nurx and Mistr, there is no in-home testing option, so users must physically go to a lab for HIV tests as well as ongoing testing while on PrEP. Started as a telemedicine platform for women’s reproductive health, with 200,000 current patients on birth control, Nurx now offers HIV and kidney function home testing kits needed for PrEP, and additional testing kits for sexually transmitted infections (STIs). A Nurx spokesperson said one benefit of the platform is allowing patients to consult with doctors to determine if PrEP is right for them. Nurx also connects patients with a navigator team to assist with insurance coverage and payment-assistance programs. Mistr is a mobile-friendly site exclusively for PrEP, and it’s marketed to gay-identifying men and other men who have sex with men. Since going live last year, Mistr now has more than 10,000 users on PrEP. Anyone wanting PrEP can log in and schedule all lab tests to be done at a local lab—or order an in-home testing kit—and have the results fed back into the Mistr system. A doctor reviews the results and consults with the patient through video chat. If you do want PrEP, the doctor sends a prescription to a partner pharmacy. Mistr will also send PrEP renewal and testing reminders. The founder of the company, Tristan Schukraft, said Mistr has a PrEP adherence rate approaching 95%. All three platforms offer security through encrypted messages and log-in time-outs. Representatives from each company say health files are as secure as those in a doctor’s office, with software sometimes more advanced than in an office. All companies say they don’t sell health or financial information. However, with all digital platforms, data and privacy protection are important, especially so with sensitive health information. TheBody urges readers to read the privacy policy on any health-related consumer app you use where you will be disclosing your health status or prescription information. Companies will often send you a prompt when they’ve updated their user and privacy policy, and TheBody urges you to read that information. How a PrEP App Can Address the Whole Patient One more app for accessing PrEP and increasing adherence—E2PrEP—will be available in the fall of 2020, and a web-only version will be launched before the summer. Jesse Thomas, project director at Los Angeles–based RDE Systems, the company behind E2PrEP, told TheBody that the app won’t be direct-to-consumer, but rather, it will focus on “connecting local resources to priority populations, give them tools to better serve clients.” Those priority populations, Thomas said, are those with more than just a need for PrEP. “There will be tools built in for navigators and counselors to follow up. These services can be mental health, housing, places where there are structural barriers,” Thomas said. “Current reporting systems present a fragmented view of the person. When you enroll a patient through a normal PrEP navigator, there’s one more database to track. And those data systems are not integrated and sometimes not user friendly or culturally appropriate. But we want to give integrated view across all systems, with proactive alerts. And we want to make it user-friendly enough to put patient and client in control of their information. “E2PrEP takes on how to address all of a client’s needs,” Thomas said. “Maybe they’re not concerned with PrEP now because they lost their apartment, for example. We have worked on clinical and social services to address the whole person.” The client-to-patient E2PrEP app is funded through several health departments and a grant from the Centers for Disease Control and Prevention (CDC). Come for PrEP, Stay for Health Care Like Thomas, John Huckaby, CEO of AIDS Foundation Houston, sees mobile tech as potentially game-changing in getting the most vulnerable populations on, and staying on, PrEP. “The CDC analysis of those indicated for PrEP shows tremendous disparity,” Huckaby said. “We have had PrEP for five years, so why are we not seeing significant declines in HIV new cases? We know anecdotally when large population areas adopt PrEP by big numbers, it has an impact. Why is there a gap, still?” Huckaby cites stigma and sex-shaming, the misperception of cost, and a need for more passionate PrEP advocates in the LGBTQ community. While trying to address those hurdles, Huckaby and AIDS Foundation Houston recently tried out one online PrEP portal—Mistr—to see whether customizing the app would bring in more potential patients to the foundation’s walk-in clinic. “We liked many things [about Mistr]. It can be accessed in privacy, in a safe space, and users don’t have to go into a doctor’s office for an initial visit. You can process all paperwork online. You can consult with doctors online to review results and ask questions, and you can opt for home delivery.” Beyond those benefits, Mistr allowed its PrEP navigators and other health care workers to begin an ongoing relationship with a client. “Houston is a big, spread-out city, so having an online option is great for increasing engagement. Some patients just want PrEP. Others, maybe they learn that they test positive for an STI, and they will make appointments to see a counselor. So, it’s come for the PrEP, stay for the health care.” AIDS Foundation Houston’s customized Mistr app went live Dec. 1, and word has spread through local social-media channels and a local gay publication. Soon they will reach out to college campuses in the area. So far, there have been 100 new registrations, meaning those who have enrolled to get to the point of ordering a home test kit. “That’s pretty phenomenal, considering the low-key rollout,” Huckaby said. SOURCE: https://www.thebody.com/article/how-telehealth-platforms-make-it-easy-to-get-prep

By Emily Langer July 13, 2020 at 4:55 p.m. CDT Flossie Wong-Staal, a molecular virologist who led research that helped produce seminal findings about HIV — its genetic structure, the insidious manner in which it invades the immune system, and ways of detecting and treating it, died July 8 at a hospital in San Diego, Calif. She was 73. The cause was complications from pneumonia not related to the novel coronavirus, said her daughter Stephanie Staal. Dr. Wong-Staal came to the United States from Hong Kong as a university student and joined the National Cancer Institute, a division of the National Institutes of Health in Bethesda, Md., in 1973 as a postdoctoral fellow in the laboratory led by virologist Robert C. Gallo. Over the next 17 years, she became a section chief in the laboratory of tumor cell biology and one of NIH’s leading researchers. In 1990, the publication the Scientist identified her as the most cited woman in science of the 1980s, with 7,772 citations in academic journals during that decade. “She was on the forefront of molecularly defining” the human immunodeficiency virus and explaining “how this virus caused AIDS and what was needed to combat it,” Beatrice H. Hahn, a molecular virologist who worked under Dr. Wong-Staal as a postdoctoral fellow and is now a professor of medicine at the University of Pennsylvania, said in an interview. “This was a man’s world at the time — this was 40 years ago — and she certainly held her own.” When Dr. Wong-Staal joined NIH, Gallo was engaged in groundbreaking research on retroviruses, a group of viruses that infect their victims by inserting their genetic material into the host’s DNA. Healthy immune systems can attack and vanquish a standard virus, such as influenza, by recognizing and attacking it as a foreign invader. A retrovirus, on the other hand, becomes part of the host’s genome and is therefore much more difficult to defeat. Gallo made scientific headlines by discovering the first human retrovirus, the leukemia-causing HTLV-1, for which he said Dr. Wong-Staal provided molecular analysis. “At the time, there was no indication that such viruses existed in humans. Most of the hardcore scientists didn’t believe in human retroviruses and called them ‘human rumor viruses,’ ” Dr. Wong-Staal told the publication Genomics and Proteomics in 2003. “It wasn’t a very pleasant atmosphere at the time, but we persisted.” The study of retroviruses took on extreme urgency in the early 1980s as AIDS — a disease soon shown to be caused by the retrovirus HIV — emerged and grew quickly into an epidemic. Gallo and the French virologist Luc Montagnier, the principal figures in a long-running dispute over whose laboratory deserved greater credit for identifying HIV, are today recognized as its co-discoverers. Working under Gallo, in concert and in competition with scientists in the United States and around the world, Dr. Wong-Staal led a team of scientists who produced a string of breakthroughs in the study of HIV in the 1980s. In an NIH oral history, she recalled it as a “dizzying” time — a period of “intense discovery” that was the “highlight” of her career. Under Dr. Wong-Staal’s leadership, researchers including Hahn were the first to clone HIV. “To have in hand a pure copy of the genetic information of that virus,” Hahn said, “was a critical first step in understanding the molecular biology — the genetics of the virus, if you will.” Dr. Wong-Staal described HIV as a disease that “breaks many rules.” She and her colleagues were among several groups of scientists who performed nucleotide sequencing on HIV to map its entire genetic makeup, or genome, and to elucidate its many variations. Such research helped lead to second-generation HIV tests and provided the scientific basis for the so-called drug “cocktails” that have significantly improved the medical outlook for millions of HIV/AIDS patients around the world. Yee Ching Wong was born in Guangzhou, China, on Aug. 27, 1946. Her father worked in the import-export business, and her mother was a homemaker. In the wake of the Chinese Communist Revolution, the family moved to Hong Kong, where Dr. Wong-Staal attended an all-girls school run by English-speaking nuns. She credited her parents with encouraging her studies, even though few Chinese women of her generation had the opportunity to pursue higher education. She was initially interested in literature, she said, but decided to study science because it was considered a more prestigious field. Dr. Wong-Staal changed her first name on the suggestion of the nuns at her school. “Since I did not want to be another Mary or Theresa, I asked my father to choose something unusual,” she told the publication Psychology Today in 2010. “He saw a list of names for typhoons that hit Southeast Asia, and picked Flossie.” She came to the United States to attend the University of California at Los Angeles, where she received a bachelor’s degree in bacteriology in 1968 and a doctorate in molecular biology in 1972. After a postdoctoral fellowship at the University of California at San Diego, she joined Gallo’s lab, where, in addition to her work on HIV/AIDS, she contributed to research on cancer-causing oncogenes. In 1990, Dr. Wong-Staal left NIH and returned to UC-San Diego, where she led the Center for AIDS Research and investigated approaches to gene therapy as a treatment for HIV/AIDS. She later became co-founder, chief scientific officer and vice president of Immusol, a pharmaceutical company now known as ­iTherX, where she pursued treatments for hepatitis C. She retired in 2017. Her marriage to Stephen Staal ended in divorce. Survivors include her husband of 18 years, Jeffrey McKelvy of San Diego; a daughter from her first marriage, Stephanie Staal of Brooklyn; a daughter from a relationship with Gallo, Caroline Vega of San Diego; a sister; two brothers; and four grandchildren. Dr. Wong-Staal received numerous honors, including induction into the National Academy of Medicine and the National Women’s Hall of Fame. George N. Pavlakis, a scientist at the National Cancer Institute who collaborated with Dr. Wong-Staal in the 1980s, compared the international mobilization against HIV/AIDS at that time to the current battle against the coronavirus. “There was a sense of urgency, it was a collective effort and Flossie was at the center of it,” he wrote in an email. “Flossie and all of us benefited from this early spirit and there were a lot of great discoveries and advances done in record time (with much more primitive technology).” Pavlakis is among the researchers who continues today to pursue possibilities of a vaccine for HIV, which so far has proved elusive. “We still use the lessons we learned through Flossie’s work,” he said. Source: https://www.washingtonpost.com/local/obituaries/flossie-wong-staal-pioneering-hivaids-researcher-dies-at-73/2020/07/13/8ddd088a-c2e9-11ea-b178-bb7b05b94af1_story.html

Krishen Samuel 7 January 2020 Both relationship-specific and structural factors influence whether coupled gay men living in New York City choose to use pre- and post-exposure prophylaxis (PrEP/PEP) for HIV prevention. Some men – particularly those in monogamous relationships – felt that discussing PrEP and PEP in the context of a relationship could threaten the relationship by raising issues of trust, while others felt that it had the potential to enhance sexual health and satisfaction. Stigma from the gay community and healthcare providers around promiscuity also presented barriers to PrEP uptake. This qualitative research was conducted by Stephen Bosco, Dr Tyrel Starks and colleagues at City University New York and published in the Journal of Homosexuality. Gay and bisexual men accounted for 66% of all new HIV diagnoses in the US in 2017. It is estimated that 35 to 68% of these infections happen within the context of a long-term relationship. This indicates that coupled gay men have the potential to benefit significantly from biomedical prevention strategies, such as PrEP (taken on an ongoing basis) and PEP (taken shortly after a suspected infection). However, only 7% of the potential 1.1 million gay and bisexual men who could benefit from PrEP were prescribed it in 2016. Black and minority men in the US remain most at-risk for HIV infection, while also having the lowest rates of PrEP uptake. While PrEP is recommended to men in serodiscordant relationships (where one partner is HIV positive and the other negative) and those in non-monogamous relationships, there is limited research looking at coupled men’s use of biomedical prevention strategies. The study Semi-structured interviews were conducted with ten gay male couples in New York City in 2017 regarding barriers and facilitators around PrEP and PEP use within the context of their relationships. Each couple was interviewed together. As part of the recruitment criteria, all couples included at least one partner aged 18 to 29; at least one HIV-negative partner (in fact only one couple included a partner with diagnosed HIV); and at least one partner who reported recent drug use. Of the 20 participants, half were Latino and 20% were African American. Most participants (65%) were college educated. Five interviewees were on PrEP at the time of the interview. In terms of sexual agreements, 30% said they had a monogamous relationship, 30% a non-monogamous relationship, and 40% had an agreement that sex with outside partners was only permitted when both members of the couple were present. In nine of ten couples, both members agreed about whether they were monogamous or non-monogamous. The average duration of relationships was approximately two years. Relationship-specific factors Many couples discussed relationship-specific challenges that arose when considering the use of PrEP or PEP. Using biomedical prevention was often associated with mistrust and infidelity within a relationship, especially for those in monogamous relationships. Using PrEP could call a partner’s intentions into question and was usually associated with promiscuity or the desire to have many sexual partners. A need for PEP could reveal that infidelity had taken place or that they had had sex with someone who was HIV positive or with an unknown status, thereby violating the relationship agreement. This was observed from exchanges between different partners: Partner 1: "Probably because their partner would think, ‘Oh you wanna go on PrEP so like—’ ". Partner 2: "You’re gonna have all this unsafe sex … they might think ‘Oh, like if we’re monogamous like why would you even need that.’" Partner 1: "Cheating". (Monogamous couple). Partner 1: "I think PEP over PrEP also has the fear of, ‘oh no it’s also post exposure, so you also have to admit to this behaviour.’" Partner 2: "I also feel like, if you need to have a conversation with your partner that you took PEP, or that you need PEP, it might be outside of the relationship ground rules." (Non-monogamous couple). PrEP could provide peace of mind regarding sexual encounters that happened outside the relationship. However, couples also pointed out the benefits of taking PrEP or PEP within the context of a relationship. The main benefits cited were that PrEP could act as an additional layer of protection; it could provide peace of mind regarding sexual encounters that happened outside the relationship; and it could add to sexual health and satisfaction for the couple as a whole. In this sense, biomedical prevention strategies were seen as sexually liberating. Partner 1: "It’s [PrEP] very useful, you never know who is lying about their status, so it’s extra protection for yourself." Partner 2: "It’s also, you know the spontaneity risk where it may be on your mind, but you just don’t realize at the time what you’re doing. So, as long as you are being regular with your medication, your PrEP, then it’s very useful." (Non-monogamous couple). The one serodiscordant couple also highlighted additional benefits: "Well especially for our relationship, I think it’s good because we decided not to use condoms. I’m HIV positive. He’s negative. Even though I’m taking my medication, even though I’m undetectable, he feels like he’s taking his PrEP for me and I’m taking my medication for him. For him, he feels he’s doing something for himself too." (Non-monogamous relationship). Structural factors Apart from relationship-specific factors impacting upon couples’ decisions, structural factors also had a bearing on whether or not they would use PrEP or PEP. In addition to healthcare access and costs, stigma was a recurring theme. Stigma came from two main sources: healthcare providers who were either seen as unknowledgeable regarding PrEP/PEP or were judgemental regarding their use, as well as from within the gay community. Biomedical prevention evoked notions of promiscuity and being irresponsible. "I think it’s getting rid of that stigma … So, you’re at the ER [emergency room] asking for PEP and you’re wondering what’s this doctor thinking. For instance, one time I went to the health department and they ask you how many sexual partners you’ve had in the last 3 months and I gave the doctor a number, and they had a lot to say about the number that I gave them." (Non-monogamous relationship). "I believe it is the stigma of ‘oh why are you on PrEP? Are you having sex outside of your relationship? You wanna be a hoe?’" (Non-monogamous relationship). Couples related that a reduction in stigma related to biomedical prevention would be an important step in increasing uptake. This would include supportive and well-informed conversations in the relationship, as opposed to judgement and shaming. Partner 1:"I guess like the benefits it would bring to a couple. Like how it can, help couples even if they’re not in an open relationship, as extra security, even if you are in a monogamous couple." Partner 2: "Trying to remove the stigma that is also on PrEP."(Non-monogamous couple). Conclusion These findings highlight the unique challenges that couples may experience when contemplating the use of biomedical prevention strategies. Often biomedical prevention is associated with infidelity and is viewed negatively within the context of a relationship. “Relationship-specific factors illustrate a potential for dissonance between the desire to adopt PrEP and PEP to reduce HIV risk at the couple-level, and concerns that doing so will diminish relationship functioning,” say the authors. The authors conclude by emphasising the need for couple-specific interventions and stigma reduction in order to increase the uptake of biomedical intervention strategies: “PrEP and PEP messaging needs to be tailored toward gay men in relationships through addressing their potential risk of HIV transmission without attacking the quality of their relationship.” Source: https://www.aidsmap.com/news/jan-2020/trust-and-stigma-affect-gay-couples-choices-prep-and-pep

A US online survey has found that although gay and bisexual men who used PrEP had significantly more condomless sex with non-primary partners than men who didn’t use PrEP they were less likely to be anxious. A relationship seen in previous studies between higher rates of condomless sex and more anxiety did not seem to operate for PrEP users. The survey The survey was conducted by Dr Robert Moeller and colleagues from Middlebury College in Vermont. It recruited participants via a gay dating site and was only 'live' on a single weekend in 2016. Its findings therefore are already three years out of date, especially as there are now considerably more PrEP users in the US. The researchers asked demographic questions, about use of PrEP and about sexual behaviour. They asked participants to complete three different validated questionnaires that are commonly used to measure depression, anxiety and internalised homophobia (self-stigma). The PHQ-9 and GAD-7 questionnaires (you can try them yourself if you click on the links) measure depression and anxiety respectively by asking respondents how many times in the last week they have experienced symptoms indicating either condition. The IHP questionnaire for internalised homophobia asks people to what extent they agree with statements such as “I often feel it best to avoid personal or social involvement with other gay/bisexual men” and “I have tried to become more sexually attracted to women”. Results – demographics and PrEP use The researchers divided the 2406 men who answered the survey into four categories: HIV-negative PrEP users, comprising 11% of respondents; HIV-negative men who did not use PrEP (66%); HIV-positive men (11%); and men who did not know their HIV status (12%).  The average age of participants was 34; HIV-positive men (average age 39) and PrEP users (average age 37) were older, and men of unknown status younger (average age 29). Over half (55%) of respondents described themselves as white, 19% as Latino, 7% as black, and 5% as Asian or Pacific Islander. A disproportionate number of black men had HIV (19%). Asian and Pacific Islanders were much less likely to have HIV (4%) and had the highest rates of PrEP use (14%). Latino men were slightly more likely to have HIV (12%), and were much more likely not to know their HIV status (17%) – but were only half as likely as the average respondent to use PrEP (6%). PrEP use was strongly tied to income. Only 5.5% of those earning under $20,000 a year were using PrEP versus 26% of all those earning over $100,000 a year, and 32% of the HIV-negative ones. Not knowing your HIV status was inversely tied to income, with 20% of those earning under $20,000 a year not knowing if they had HIV versus 5% of those earning over $100,000. Having tested HIV positive was not strongly associated with income. Similarly, educational status was also linked to PrEP use. Only 6.5% of those with a high school diploma or less were using PrEP, compared with 17% of those with a postgraduate degree. Perhaps surprisingly, 19% of men defining themselves as married took PrEP, versus 14% of those saying they were dating and 9.5% of those who were single. However, this was largely explained by PrEP use being concentrated among the 31% of married men and 36% of men who were dating who also said they were non-monogamous – and by the fact that not all single men were sexually active. The number of condomless anal sex casual partners during the last three months ranged from zero to 90, with an average number of 2.6. There was a strong dichotomy in the number of casual condomless sex partners in the last three months between, on the one hand, PrEP users and HIV-positive men (average number respectively 5.5 and 5.2 partners) and, on the other hand, men who did not know their status and HIV-negative men not on PrEP (respectively 1.9 and 1.6 partners). Results – mental health In gay and bisexual men, anxiety and depression are roughly twice as common as they are among heterosexual men, with various US surveys reporting 41% suffering from mild to severe anxiety compared to 19% of heterosexual men. Arguably the most striking finding of this survey is that PrEP users had the best mental health of all the respondents, by all three conditions measured (depression, anxiety and self-stigma). Conversely, men who did not know their HIV status had the worst mental health, by all three measures. HIV-negative men not using PrEP and HIV-positive men had average, and similar, levels of mental health. In the PHQ-9 depression scale, possible scores range from zero (not at all depressed) to 27 (maximally depressed). Scores over 5, 10, 15 and 20 are rated as mild, moderate, severe and very severe respectively. In this survey, PrEP users scored 5.7, HIV-negative non-PrEP users 7.0, HIV-positive respondents 7.0 (all mildly depressed), and people who did not know their status 9.7, bringing them close to the 'moderately depressed' threshold. For the GAD-7 anxiety scale, the maximum score is 21 and scores of over 5, 10 and 15 are classed as mild, moderate and severe anxiety. In this survey PrEP users scored 4.5, meaning they had no significant anxiety. HIV-negative non-PrEP users and HIV-positive respondents scored 5.4 and 5.5 respectively, and men who did not know their status 7.3, meaning they had mild anxiety. For the internalised homophobia scale, nine questions were asked with possible scores of 1-5 each (from ‘don’t agree at all’ to ‘fully agree’), so minimum and maximum scores were 9 and 45. PrEP takers had the lowest average score at 15.1; HIV-positive men, interestingly, had the second-lowest scores at 16.4; HIV-negative non-PrEP users’ scores averaged 18.1; and men who did not know their status 20.6. The researchers wanted to see if an association between PrEP use, condomless anal sex and either depression or anxiety remained significant in a regression analysis in which these three factors and self-stigma were progressively controlled for. In particular, they wanted to see if PrEP use changed an association seen in this and other studies between higher rates of depression and anxiety and more condomless sex. This turned out to be the case for anxiety, but was not significantly so for depression. There was certainly an association between more condomless sex and higher rates of depression and anxiety in all non-PrEP users. The average depression score in non-PrEP users who had no condomless casual sex partners in the last three months was 6.8 (out of a maximum 27), while it was 8.2 in those with 20 or more partners. With anxiety, the difference was even larger, with those reporting no condomless sex scoring 5.25 (out of a maximum 21) and those reporting 20 or more partners scoring 7.0. (Note that this association can’t attribute causality to this link; people might be depressed or anxious because they were having more unprotected sex and were worried about their risk; equally, they could be having more unprotected sex as a coping behaviour because they were depressed or anxious.) This association was far less marked for depression in PrEP users, with the depression score only increasing from 6.4 to 6.6 as the number of condomless casual sex partners changed from zero to 20. However, once the fourth factor – self-stigma – was fed into the regression analysis the link between PrEP use and lack of depression about condomless sex was no longer significant. With anxiety, however, the link remained. PrEP users scored consistently below 5 on the anxiety scale regardless of how many condomless sexual partners they had had, and this remained unchanged by self-stigma. Discussion This was a relatively small survey and the difference in mental health scores between PrEP users and others, though consistent, were not especially large. The researchers note that a five-point decrease on the PHQ-9 and GAD-7 scales is regarded as a clinically significant improvement. Across a population, however, it may be important: for instance, the difference between men and women in such scales, despite mental ill-health being a strongly gendered condition, is generally in the region of one point. Even though the differences were not large, the researchers emphasise the finding on anxiety: “While having a higher number of condomless-anal-intercourse partners is associated with increased anxiety among participants who are not on PrEP, whether HIV positive or HIV-negative, the use of PrEP seems to moderate this difference.” They note that a number of other studies have found that depression, anxiety and internalised homophobia are all associated with greater HIV risk via condomless sex in gay men. “These mental health burdens are frequently co-occurring and often function synergistically, as a syndemic,” they note, “[yet] our results indicate lower levels of mental health burden among PrEP users are related to significantly higher rates of condomless anal intercourse.” “Syndemic” is a term that has been used to describe the way that pre-existing trauma, anxiety and depression, condomless and casual sex, chemsex and other drug use, the stigma of HIV itself, and societal disadvantage may all combine to greatly amplify the risk of HIV infection for certain members of already at-risk populations. The syndemic idea explains why certain members of certain populations may be much more likely to risk and catch HIV than others. However, it also implies that it may be very difficult to break the vicious circle that may lead to HIV infection (or to other problems such as addiction). The findings can be added to a series of qualitative studies which found reduced sexual anxiety in PrEP users and a previous quantitative study from Australia. The researchers speculate that, although there might be other factors such as PrEP users having better access to mental health care, this is most likely because PrEP users (correctly, in the case of HIV) do not experience condomless anal intercourse as risky and that the link to anxiety about it is therefore broken. They call for longer-term and longitudinal studies to tease out the causal direction of these changes in gay men’s mental health and risk behaviour in the era of PrEP. SOURCE: https://www.aidsmap.com/news/feb-2020/prep-may-be-breaking-link-between-condomless-sex-and-anxiety-survey-results-suggest

A study of prescriptions for Truvada (tenofovir disoproxil fumarate/emtricitabine, often abbreviated to TDF/FTC) in the USA has found that its use as PrEP by women expanded 12-fold between July 2012, when it was licensed for use by the US Food and Drug Administration, and the end of 2017. The study was presented at the 23rd International AIDS Conference (AIDS 2020: Virtual). This study used the same methodology as a regular series of surveys conducted by the drug's manufacturer Gilead Sciences that have charted PrEP use in the US since it became available. Records of TDF/FTC prescriptions for women were gathered from 80,000 physician practices, 54,000 pharmacies, 1500 hospitals and 800 outpatient clinics. Prescriptions for post-exposure prophylaxis (PEP), HIV treatment or hepatitis B treatment were then removed. ‘PrEP use’ in any one year means at least one prescription in the year from January to December, so if a prescription spanned November to January, this was counted in both years, and evidence that PrEP was used by even one day counted as ‘use’. However, the researchers also acknowledge that this methodology misses many prescriptions. They calculate that their data cover about 80% of PrEP use in any one year. The figures include women starting or restarting PrEP in the year: it does not give the estimate for the number currently on PrEP at any one time. A survey in 2018 calculated that approximately two-thirds of people who start PrEP in one year may be seen as current PrEP users. PrEP starts or restarts expanded from 2770 individual prescriptions in 2012 to 27,556 in 2017, but given population changes, the researchers quantified PrEP use in women as PrEP starts per 100,000 women in the population. In 2012 this amounted to 8.5 per 100,000 or one PrEP prescription in every 11,764 women. In 2017 this had grown 12-fold to 102 per 100,000 women, or one prescription in every 980 women. PrEP use in 2017 was highest in women aged 25-34, where it was taken by 195 in 100,000 women or one in every 513. Women under 25 were only half as likely to take it, and there was very little use by women over 55 (only 18 per 100,000). The was also a strong geographical difference in use: 329 women per 100,000 or one in 304 women took it in the north-east states (from New Jersey and Pennsylvania northwards) while only 140 per 100,000 (one in 714) took it in the southern states. “This area has seen a much slower acceleration of uptake,” Dr Jodie Guest of Emory University said. This is unfortunate because 56% of new infections of HIV occur in the southern states, but less than 30% of PrEP users live there. This means that there is a much lower 'PrEP to need ratio' in female PrEP users in the southern states. This is actually the ratio of PrEP users to new HIV diagnoses, rather than to 'need' as such. This was 25.9 in the western states (because there are fewer HIV diagnoses in the west than in the north-east), but only 7.4 in the southern states. How can more women be encouraged to use PrEP? The US Centers for Disease Control and Prevention recommend PrEP for women with HIV-positive sex partners, who have a high number of partners, rarely or never use condoms, are engaged in sex work, or who have had a bacterial STI in the last six months. This covers quite a wide range of women. However, Dr Guest points out the effectiveness figures that are quoted for PrEP in women may be the 62% figure from the placebo-controlled Partners PrEP study, which was conducted in Africa and published in 2011. It may underestimate the efficacy of PrEP in situations of higher adherence and could deter women from seeking it. SOURCE: https://www.aidsmap.com/news/jul-2020/least-28000-women-united-states-have-started-prep

PrEP, o profilaxis previa a la exposición (pre-exposure prophylaxis), es un método de prevención del VIH en el que las personas que no tienen VIH toman medicamentos contra el VIH todos los días para reducir el riesgo de contraer el VIH si están expuestos al virus. Actualmente, el único medicamento aprobado por la FDA para PrEP es una combinación de dos medicamentos contra el VIH, emtricitabina y tenofovir disoproxil fumarato, que se venden en una sola pastilla bajo la marca Truvada ™. ¿Por qué tomar PrEP? PrEP es altamente efectiva cuando se toma como se indica. Una píldora diaria reduce el riesgo de contraer el VIH a través del sexo en más del 90%. Entre las personas que se inyectan drogas, reduce el riesgo en más del 70%. Su riesgo de contraer el VIH a través del sexo puede ser incluso menor si combina PrEP con condones y otros métodos de prevención. ¿Es PrEP adecuada para ti? PrEP puede beneficiarte si tu eres VIH negativo y CUALQUIERA de los siguientes se aplican a ti: Eres un hombre gay / bisexual y tu: -tienes una pareja VIH positiva -tienes múltiples parejas, una pareja con múltiples parejas o una pareja cuyo estatus de VIH es desconocido –y tu también: -tienes relaciones sexuales anales sin condón, o recientemente tuviste una infección de transmisión sexual (ITS) Eres heterosexual y tu: -tienes una pareja VIH positiva, tienes parejas múltiples, una pareja con parejas múltiples o una pareja cuyo estatus de VIH desconocido –y tu también: -no siempre usas condón para tener relaciones sexuales con personas que se inyectan drogas. Te inyectas drogas y: compartes agujas o equipos para inyectarse drogas con personas que están en riesgo de contraer el VIH a través del sexo

PrEP, or pre-exposure prophylaxis, is an HIV prevention method in which people who don’t have HIV take HIV medicine daily to reduce their risk of getting HIV if they are exposed to the virus. Currently, the only FDA-approved medication for PrEP is a combination of two anti-HIV drugs, emtricitabine and tenofovir disoproxil fumarate, sold in a single pill under the brand name Truvada™ Why Take PrEP? PrEP is highly effective when taken as indicated. The once-daily pill reduces the risk of getting HIV from sex by more than 90%. Among people who inject drugs, it reduces the risk by more than 70%. Your risk of getting HIV from sex can be even lower if you combine PrEP with condoms and other prevention methods. Is PrEP Right for You? PrEP may benefit you if you are HIV-negative and ANY of the following apply to you: You are a gay/bisexual man and you: -have an HIV-positive partner -have multiple partners, a partner with multiple partners, or a partner whose HIV status is unknown –and you also: -have anal sex without a condom, or recently had a sexually transmitted infection (STI) You are a heterosexual and you: -have an HIV-positive partner, have multiple partners, a partner with multiple partners, or a partner whose HIV status is unknown –and you also: -don’t always use a condom for sex with people who inject drugs. You inject drugs and you: share needles or equipment to inject drugs are at risk for getting HIV from sex.