CDC: We’re not getting PrEP to the men who need it

Ron Johnson · Thursday, March 8, 2018
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Prevention, screening and early treatment for HIV and syphilis are falling short.

The Centers for Disease Control and Prevention reports that gay and bisexual men with HIV are eight times more likely to be diagnosed with syphilis than those who are HIV negative or of unknown status.

And PrEP, the daily pill for HIV prevention, has been prescribed to only a small percentage of Americans who would benefit from it, with African-Americans and Latinos accounting for the smallest percentage of prescriptions to date.

The findings were released March 6 at the CDC’s annual Conference on Retroviruses and Opportunistic Infections in Boston.

The HIV/syphilis data was part of the CDC’s first calculation of syphilis rates by HIV status among men who have sex with men (MSM). In the survey, the rate of P&S syphilis among MSM living with diagnosed HIV was eight times higher than the rate in MSM without an HIV diagnosis (1,203 vs. 155 per 100,000 MSM).

“The analysis further quantifies the dangerous intersection of HIV and syphilis, particularly for gay and bisexual men,” the CDC reported. “Syphilis can increase increase the risk of HIV infection.”

It encouraged healthcare providers who see MSM patients with HIV to expand STD testing and treatment.

The PrEP numbers are stark. Approximately 500,000 African-Americans and nearly 300,000 Latinos across the nation would benefit from PrEP, per CDC guidelines. However, the CDC survey identified only 7,000 prescriptions for African-Americans and only 7,600 for Latinos.

The gap among whites also remains considerable, the CDC said. Of approximately 300,000 whites who could potentially benefit from PrEP, only 42,000 prescriptions were filled.

Presenting the PrEP information was Dr. Dawn Smith, in the CDC’s Division of HIV/AIDS Prevention.

“We know that in addition to risk behavior, the prevalence of HIV in communities plays an important role in a person’s likelihood of infection,” Smith said. “We now have a powerful picture of where PrEP’s potential impact could be greatest.”

The CDC notes that actual PrEP use is somewhat higher than these estimates. The survey focused on PrEP prescribed through U.S. commercial pharmacies — estimated to be 80 to 90 percent of all prescriptions. Some Americans obtain it through demonstration projects or non-commercial pharmacies, including military health plans.

Still, the prescription rate is far from where it should be, said Dr. Jonathan Mermin, who directs the CDC’s National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention.

“One of our most powerful tools for HIV prevention remains largely on pharmacy shelves,” Mermin said.

“PrEP can be a potent prescription that strengthens prevention options for people who are at high risk for HIV infection.”

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