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Drug to treat alcohol addiction also helps with suppression of HIV    

A half-completed jigsaw puzzle depicting a beer bottle on its side.

A medication commonly prescribed to treat alcohol use disorder also appears to help maintain or improve suppression of HIV among individuals at risk for relapse receiving HIV antiretroviral treatment, Yale researchers said.

In a new study, a research team led by Dr. Sandra Springer conducted a placebo-controlled, randomized trial involving individuals incarcerated in Connecticut who had both HIV and alcohol use disorders. Upon release, the 100 study participants were given either extended-release naltrexone — an FDA-approved drug that treats alcohol addiction — or a placebo. The researchers followed the individuals for six months from the time of release.

At the end of the study period, the research team found that the study participants taking extended-release naltrexone were more likely to have either maintained or improved suppression of HIV.

The study findings confirm the added benefit of extended-release naltrexone for people who have alcohol use disorders and HIV disease, and demonstrate its effectiveness in helping patients to meet the goals of HIV treatment. The paper is published in the Journal of Acquired Immune Deficiency Syndrome.

Author: Ziba Kashef


These Gay Men Have Spent 30 Years Learning How To Be Long-Term HIV Survivors

“It was hell to watch people die in the ’80s, but my personal hell was when long-term survivors were forgotten.”
Long-term HIV survivor Sean McKenna today.

Long-term HIV survivor Sean McKenna today.

Sean McKenna, 55, was diagnosed with HIV in 1992. He takes 22 pills a day and deals with diarrhea, joint pain and HPV. He’s been on disability, unable to work, for over 20 years.

Luigi Ferrer, 59, has been HIV-positive since 1985, but he works full time and takes only one pill a day.

McKenna has survived bouts of pneumocystis pneumonia and other HIV-related complications that have killed many of his peers. Ferrer has never had a life-threatening complication.

Scott Kramer, 50, was diagnosed in 1988. He survived a bout of PCP in 1992 but was able to return to work full time.

“There’s no one way to be a long-term HIV survivor,” said Kramer, a therapist who specializes in people with HIV and runs support groups in New York City for gay men with the virus. “We’ve all been through trauma, but with a mix of support and luck, we’ve survived longer than we ever imagined.”

Long-term HIV survivors ― generally defined as those diagnosed before lifesaving drugs were released in 1996 ― face their own set of physical and emotional challenges as they age. Some were lucky to have relatively mild bodily symptoms. Others became isolated by illness, stigma and the inability to work. But all dealt with a terrifying diagnosis at a time when doctors had little to offer.

In recent years, a few survivors have emerged to speak up for their peers, whose lives and stories they say are unappreciated or forgotten by today’s gay community.

Sean McKenna shortly after learning he was HIV-positive in 1992.

Sean McKenna shortly after learning he was HIV-positive in 1992.

On June 5, 1981, the Centers for Disease Control and Prevention reported cases of young gay men dying from a rare pneumonia, later identified as PCP. It was the first official recognition of the HIV/AIDS epidemic.

For five years now, June 5 has been designated HIV Long-Term Survivors Day by the advocacy group Let’s Kick ASS (AIDS Survivor Syndrome), which estimates there are some 34,000 long-term survivors in the U.S.

Long-term survivors face challenges generally not shared by those diagnosed after 1996. Many continue to experience a cascade of physical symptoms in part because they spent years taking early drugs that were either ineffective or harmful. Emotionally, they suffer from the trauma of years of watching their friends die painfully while expecting they would be next.

At the beginning, no one knew long-term survival was possible, much less what it would look like.

In 1996, McKenna survived his second PCP hospitalization and went on antiretroviral drugs, known as ARTs. His condition was no longer life-threatening, but persistent symptoms, some debilitating, meant he couldn’t hold a full-time job.

Many of his friends had either passed away or were too sick to socialize, and without a job, he’d often spend weeks or months without any meaningful social interactions.

During the worst days of the plague, when he’d attend about eight funerals a month, McKenna said there was more support for people living with HIV. But once better treatments became available, he said the gay community moved on to new issues, like marriage equality.

“In the beginning, people would check on me, but around the late ’90s, people stopped dying from HIV like they used to. And then the calls and visits stopped,” he recalled. “It was hell to watch people die in the ’80s, but my personal hell was when long-term survivors were forgotten.”

When Ferrer was diagnosed, he went through an initial phase of denial. He didn’t seek treatment or take medication and continued pursuing his Ph.D. in oceanography. He didn’t have any symptoms for some eight years.

But that changed in 1993 when he developed minor infections. “It started with bronchitis, but I was always running to the doctor for something,” Ferrer said. “I saw the writing on the wall.” He assumed the worst was coming.

Luigi Ferrer in 2018.

Luigi Ferrer in 2018.

He gave up oceanography to become the executive director of an AIDS service organization, and he has worked in HIV/AIDS advocacy and support since then. He’s now the community relations manager at Miami’s Pridelines, where he spends his days administering free HIV testing and passing out information.

“There’s days where I miss being out on the ocean diving,” he said. “But I didn’t feel like I had a choice: I was drafted into this work. At the time, I never thought I’d still be here doing this.” His health has been mostly stable since 1996.

His career shift had one welcome result: the new connections he made with the queer community.

In his first AIDS service job, Ferrer shared an office with a local bisexual support and advocacy group. Through them, he embraced his own bisexuality and became an advocate. He’s currently on the board of BiNet USA, a national bisexual network. He also got involved with the Radical Faeries, a community he describes as gay hippies who reject society’s norms. Since 1998, he’s attended their 10-day festival in a forest outside Nashville every year.

“Nudity is not frowned upon,” he said, laughing. “People come and share art and stories of their communities. For me, it’s a family of older queers.” He said that some of the festival-goers are fellow long-term survivors as well, but he doesn’t know how many. “There’s no stigma there, so we don’t talk about it much or count the numbers.”

Activism and the need for community eventually called McKenna as well.

He said he received a wakeup call in 2012 when prominent HIV activist Spencer Cox died after he stopped taking his medication. Cox had what advocates call “pill fatigue,” when long-term survivors lose the motivation to stay on their meds, generally because of depression.

In the beginning, people would check on me, but around the late ’90s, people stopped dying from HIV like they used to. And then the calls and visits stopped.Sean McKenna

McKenna felt obligated to speak up for long-term survivors, but he said it wasn’t easy.

“People didn’t want to pay attention to me at first. They wanted to think ARTs had solved everything,” he said. “It was like, you’re alive, isn’t that enough?” He said there were barely any services for long-term survivors even in New York City.

He focused his efforts on the Gay Men’s Health Crisis, a pioneering nonprofit founded in 1982 to respond to the AIDS epidemic. McKenna urged them to pay more attention to the needs of long-term survivors, and in 2015, after three years of lobbying, they implemented a buddy program.

Susan Rowley, who runs the program, said in an email that the phrase “long-term survivors” wasn’t in use until recently, and it took some time to adjust programming to meet the specific needs of that community.

“They’re still dealing with the stigma of HIV, societal ageism, and the increasingly challenging physical and medical conditions that come with age,” she said. “We know that face-to-face meetings in a social setting or even a weekly phone call can be a significant help.”

The program currently has 28 survivors, with two on the waiting list.

Kramer, the therapist, said community support is absolutely essential for people with HIV. “That’s why I do what I do, to create a sense of community,” he said.

Like Ferrer, Kramer spent some years in denial after his diagnosis. But in 2005, he decided to leave his career as a graphic designer and become a social worker, specifically to help others diagnosed with HIV.

Scott Kramer, seen on a Gay Men's Health Crisis ID card.

Scott Kramer, seen on a Gay Men’s Health Crisis ID card.

All three survivors spend time talking to younger gay men about HIV and safe sex. Ferrer said there’s not nearly enough awareness about the virus, noting that Miami has the highest infection rate in the country.

Kramer said the younger men he encounters are reasonably well-informed, although they could know more. “When I was their age, I wasn’t so concerned with what happened 30 years ago either,” he said.

McKenna said he tries to explain to younger men that PrEP, the HIV prevention drug that’s become widely used in the last few years and encouraged many gay men to stop using condoms, doesn’t protect against other sexually transmitted diseases. He cautions that unprotected sex still carries risk ― a message that often falls on deaf ears.

“They tell me, ‘You’re slut-shaming us,’” McKenna said.

He’s heard that before.

In 1981, in the early days of the epidemic, writer Larry Kramer, who co-founded the Gay Men’s Health Crisis, began to sound the alarm about unprotected sex, but many gay men saw that as a fear tactic that would diminish their newly found sexual liberation. McKenna listened to the warning and volunteered to pass out condoms at a Pride parade. It was a tough sell.

“The first person I gave one to threw it back at me, spit in my face and accused me of slut-shaming,” he recalled.

“I just want young people today to be safe. They don’t realize ― my generation, we were the guinea pigs, we put faith in bad drugs that failed us,” he said.

Whether people want to listen or not, McKenna will keep speaking up. After his success with the buddy program, he knows he has more to give.

“No one ever asks about my future,” he said. “I don’t know how much longer I’ll live, but my future is not sealed.”


T cells alone are sufficient to establish and maintain HIV infection in the brain

T cell
Scanning electron micrograph of a human T lymphocyte (also called a T cell) from the immune system of a healthy donor. Credit: NIAID

A new study by University of North Carolina School of Medicine researchers has found that T cells, a type of white blood cell and an essential part of the immune system, are sufficient by themselves to establish and maintain an HIV infection in the brain.

“These results are paradigm changing,” said co-corresponding author J. Victor Garcia, Ph.D., Oliver Smithies Investigator, professor of Medicine and a member of the UNC Institute for Global Health and Infectious Diseases, the UNC Center for AIDS Research and the UNC Lineberger Comprehensive Cancer Center. “We have demonstrated for the first time that infection of the  can be established and maintained by both human macrophages and T .”

The study, published today in the Journal of Clinical Investigation, builds upon previous work by the same group of researchers, which found that the virus persists in HIV-infected macrophages and demonstrated the ability of tissue macrophages to support HIV replication in vivo in the total absence of human T cells. Macrophages are large  found in tissues throughout the body including the liver, lung, bone marrow and brain.

HIV/AIDs researchers long believed that  are critical for HIV infection of the central nervous system. But more recent research indicates that HIV infection in cerebral spinal fluid can originate from both T cells and/or macrophages.

To directly address whether or not T cells contribute to the seeding and persistence of HIV infection in the brain, researchers in the laboratories of Angela Wahl, Ph.D. and Garcia used a humanized T-cell only mouse model to determine whether or not myeloid cells are essential for HIV infection of the brain.

The study’s lead author is Jenna B. Honeycutt, Ph.D., a postdoctoral research associate in the division of infectious diseases at UNC and the UNC Center for AIDS Research.

“In our studies we show that T cells are a major target of HIV infection in the brain, both in the presence and in the absence of ,” said Honeycutt. “In addition we describe a previously unknown phenomenon that occurs in the central nervous system rapidly after infection—specifically, a significant depletion of CD4 T cells within 1-2 weeks of infection in the brain.

“This has previously been reported for mucosal tissues, but has not been reported previously in the brain. We also report that the depletion of CD4+ T cells in the brain can be efficiently reversed by antiretroviral therapy,” said Honeycutt, whose work on this research recently led to her being awarded the Lineberger Comprehensive Cancer Center’s Pagano Award.

Another significant aspect of this work is that it establishes that the brain is not an immune-privileged site as previously thought, and that the possibility of a persistent reservoir for HIV in the brain has been severely underestimated.

“Despite effective suppression of HIV virus in the blood by antiretroviral therapy, we were still able to detect virus in the brain in more than 65 percent of the brains analyzed,” said Wahl, who is co-corresponding author of the study. “These results indicate that the brain may be an important reservoir for HIV in patients that should be targeted by HIV cure approaches. Future studies will be needed to determine if the virus that persists in the brain during ART is able to re-ignite the  if ART is removed.”


Gilead takes HIV prevention message to TV, pushing PreP awareness with hipster ad

Gilead pushes HIV prevention in a new awareness commercial in which young adults get honest about sex and health. (Gilead)

‘Emotional closeness’ key to successful HIV treatment support

The type of relationship someone living with HIV has with both their social network and a nominated ‘treatment partner’ is likely to influence whether they are virally suppressed, research from Botswana suggests.

large family sitting on the ground in Botswana

As more countries recommend the use of treatment partners to help people living with HIV adhere to their antiretroviral treatment, there is a need to understand better what makes these partnerships succeed. A recent study conducted in Botswana, suggests that individuals whose partners provided more holistic, non-medical support, were more likely to be virally suppressed.

The researchers interviewed 131 adults living with HIV and their treatment partners attending an HIV clinic in Gaborone, Botswana. Participants had been on antiretroviral treatment for at least six months and half (51%) of those selected were virally suppressed.

Participants and their treatment partners were interviewed separately. Wherein they provided details of the nature of their relationship and the characteristics of the HIV-positive person’s social network overall.

The findings suggest people who selected spouses or other intimate partners as treatment partners, and who trusted and felt close to members of thei social network as a whole, were more likely to be virally suppressed.

This is because a treatment partner who was in a close and trusted relationship with someone living with HIV has more frequent opportunities to observe that person and provide on-hand support to meet a range of needs.

The researchers also found that the treatment partners of people with suppressed HIV tended to provide more in-depth adherence support, such as dropping off medications, as well as broader, non-medical support that encouraged someone to stay healthy in ways not directly tied to medication.

For example, treatment partners of people with suppressed HIV were more likely to prepare food or baths, and proactively attend to other emotional and physical needs. They were also more likely to remind the person to eat healthily, to exercise, to avoid alcohol and drugs, and provide general support and acceptance. Overall, 69% of patients who reported receiving these kinds of nonmedical support from their treatment partner were virally suppressed.

Treatment partners of people with unsuppressed HIV tended to focus more narrowly on reminding people to take medication or attend appointments. Even when providing nonmedical support, treatment partners in this category tended to focus on medication, for example, by reminding someone to eat before taking antiretrovirals.

Citing similar findings from Uganda, researchers suggest the reason why treatment partners who took a more holistic approach were more successful was because they may have been perceived to be more caring, whereas treatment partners with a more narrow or ‘badgering’ focus on adherence were more likely to be viewed as failing to understand the wider context and challenges experienced by someone living with HIV.

At the moment, people living with HIV are rarely given guidance on who they should select, and likewise treatment partners are often not advised on how to provide effective support.

These findings suggest treatment partners not only need basic, biomedical training about HIV medication, adherence and side effects, but they could also benefit from training about what kinds of support are most effective, how to provide this support through the use of non-confrontational counselling skills, and which approaches to avoid.


Richmond City Council Adopts Human Rights Commission, Includes LGBTQ Protections

By protecting on basis of sexual orientation and gender identity, City Council went farther than current Virginia state law — a decision which has uncertain legal implications.

The Richmond City Council adopted a Human Rights Commission on Monday, June 11. This commission would create greater representation when human rights violations are committed in the city. In addition to the classes protected under the Virginia Human Rights Act, the newly certified commission will specifically investigate discrimination claims on the basis of “sexual orientation, transgender status, [and] gender identity.” Richmond will join several other Virginia cities with LGBTQ protection, including Newport NewsVirginia BeachCharlottesville, and Alexandria.

The 13-member board would include 11 adult members, six appointed by the council and five appointed by the Mayor; along with two non-voting youth members, one appointed by the council and one appointed by the Mayor. Some of the responsibilities of this commission will include advising city council and the mayor on cases, providing assistance to victims by pointing them to proper agencies with which to file a complaint, and providing public forums to address their concerns. In a way, the commission will act as a liaison between city council and the mayor, and all of those marginalized within our community.

Despite City Council’s establishment of this commission, there’s some question as to whether the LGBTQ protections will be legally enforceable. Virginia is a Dillon Rule state, which means it operates under a rule originally stated by former US Circuit Court Justice John Forrest Dillon. The Dillon Rule states that local governance must yield to statewide authority, unless the General Assembly grants jurisdiction to the local governance. Since, under current statewide classifications, sexuality and gender identity are not protected classes, the LGBTQ protections ensured by the city’s Human Rights Commission may not be legally enforceable.

Speaking to Style Weekly, Councilman Parker Agelasto explained that it was important to Council to include these protections regardless. “What we’re trying to do is establish an environment in which people feel comfortable in the city of Richmond,” Agelasto told Style. “If [LGBTQ people] are not comfortable, we as a governing body can give them an outlet to express that to us and give us a chance to do better.”

Mayor Stoney also gave his support to these protections, telling Style, ”We need to ensure that no matter who you are, where you come from, where you live, how you worship or who you love, that you have the opportunity to live, work and play in a welcoming, diverse and inclusive city where you can be protected from discrimination.”

The commission cannot fully form, however, until the city attorney signs off on it, which has yet to occur — instead, City Council chose to approve changes to the protected classes covered by the commission before receiving approval from the city attorney. It’s uncertain how this will play out now that Council has approved the commission; however, the fact that both City Council and Mayor Stoney have approved of the measure certainly sends a strong positive message to Richmond’s LGBTQ community.

By Jo Rozycki and Marilyn Drew Necci


Sexually transmitted infections up, HIV down in B.C.

BC Centre for Disease Control points to less frequent condom use

Rates of sexually transmitted infections are on the rise in B.C., with public health experts pointing to fewer people using condoms as the cause.


Dr. Jason Wong, a physician epidemiologist at the BC Centre for Disease Control, said rates of bacterial STIs, such as chlamydia, gonorrhea and syphilis, have been climbing for two decades both within the province and across the country.

B.C. recorded 15,700 cases of chlamydia, 3,300 cases of gonorrhea and 683 cases of syphilis last year.

Canada recorded 116,500 cases of chlamydia – the most commonly reported STI in the country – in 2015, the latest year in which data were available, along with 19,845 cases of gonorrhea and about 3,300 cases of syphilis, which has seen the biggest jump since 2010 at 86 per cent.

Rates of HIV, meanwhile, have been been in decline. “In B.C., there were 190 HIV cases in 2017,” Wong said. That’s compared to 254 reported cases in 2016.


Why sexually transmitted infections are still plaguing so many Canadians is “definitely the million-dollar question.”

The most probable reason, Wong said, is because of improvements in treatment and care for people with HIV.

“People have become less and less concerned with contracting HIV, and so what this potentially may lead to is reductions in condom use.”

Some researchers have suggested dating apps such as Tinder or Grindr could play a role in the uptick in STIs, because of more sexual interactions altogether.

Wong shot down that theory: “The technology has just changed the way people have tried to find partners, but I think if we compare this to going to the bar or the club, or meeting through friends, I don’t think it’s fundamentally any different – just a different interface.”

Other factors contributing to the increase can actually be positive, such as advancements in detection methods – often a partial cause in long-term trends for diseases and infections.

STI screenings have become less invasive and more sensitive, Wong said, allowing for an earlier confirmation for infections that have otherwise no symptoms.

“For women now, urine tests are equivalent to a cervical swab,” he said, adding detection has gotten better specifically for gonorrhea and chlamydia.

While bacterial STIs can be cured with antibiotics, infections can turn serious when untreated, including damage to the brain and cardiovascular system, as well as impact on fertility in woman. In some cases, it can be fatal.

Wong said condoms are one of the simplest and most widely encouraged measures to protect yourself, as well as undergoing regular screenings to ensure quick treatment.

“Ensuring your health is at its best and you’re not likely to transmit to other people is also an important strategy.”



HIV/AIDS patients fail to access drugs as clinics demand $1per visit

GOROMONZI: A number of people in need of HIV antiretroviral treatment (ART), supplied for free by the government, are failing to access the drugs on time as some health centres here are demanding that each patient should pay $1 on each visit, putting the lives of the many at risk.

Villagers in Mwanza area said because of the economic challenges in the country, some people in the area were failing to get their treatment on time as they were unable to fork out the required $1 to access the pills.

“You might think $1 is a very little sum but people here are facing serious economic hardships that they cannot access the dollar required at the health centres to access the drugs and as a result they go for days without taking their medication,” a villager in Mwanza who asked not to be named said.

People on ART need to take the drugs every day.  Another female HIV patient in the area questioned why they were required to pay the one dollar when ART drugs are supplied for free at other health centres in the country.

“I used to get my drugs for free in Chitungwiza before I relocated to Goromonzi last year.  I was shocked when I went to Mwanza Clinic and I was told that I needed to pay a dollar every time I came to collect new treatment.  That is unfair to us as besides walking long distances as we have no money public transport to get to the clinic, we are also being forced to pay money for something that is supplied for free by the government,” she said.

“As a result, some people we know are on ART are failing to collect their drugs on time as they are turned away if they don’t have the required dollar and this poses a serious risk to their lives,” she added.

A health worker at Mwanza Clinic confirmed this week that every HIV patient in need of drugs was required to pay $1 per every visit for administrative purposes.

“Patients should access their drugs for free but we have administrative issues and money is required for that as the government does not fully support all our operations here. We need money to pay allowances for volunteers who assist with cleaning the clinic and washing laundry used by the patients and the government is not paying them,’ the nurse said.

The government, through the National AIDS Council (NAC), is now providing ART to 1 million people living with HIV. According to the United Nations Development Programme (UNDP), due to access to antiretroviral treatment, 49 000 deaths were averted in 2016 while 393 000 deaths have been averted since 2006 in Zimbabwe.


Successful Management of HIV is Outpacing That of Diabetes in Women

Among HIV-positive women with diabetes, HIV control has improved over time, but diabetes control has not, according to new study results.

Through the widespread adoption of antiretroviral therapy, HIV has become a manageable chronic disease with a similar life expectancy to those without the disease. However, with longer life expectancies comes the comorbidities for this patient population. It is predicted that up to 84% of people with HIV will have at least 1 non-communicable, chronic disease by 2030, according to the study published in Open Forum Infectious Diseases. Notably, people living with HIV have are 1.6 times more likely to develop type 2 diabetes.

“Although older age and obesity are associated with the development of diabetes, data show that people living with HIV are more likely to develop diabetes at younger ages and without obesity compared to the general population,” wrote the authors of the study. “The dual diagnosis of HIV and diabetes is troubling given their independent association with higher risk of cardiovascular disease, the leading cause of mortality in people living with HIV.”

Noting a lack of research on achievement of diabetes treatment goals among people living with HIV, researchers collected data from the Women’s Interagency HIV Study, the largest multicenter, prospective cohort study of comparable HIV-positive and HIV-negative women. Data from 2001, 2006, and 2015 were analyzed. A total of 486 HIV-positive and 258 HIV-negative women with diabetes were included.

Participants completed semiannual study visits consisting of a physical exam, collection of serum and plasma for laboratory analyses, and an interview-administered survey on demographics, social characteristics, disease characteristics, and medication-related information.

Results showed that most women visited a healthcare provider since their last study visit across all 3 time points (91.8% in 2001, 91.4% in 2006, and 92.2% in 2015. The proportion of women achieving the A1c goal of less than 7% was 60.7% in 2001, 73.2% in 2006, and 58% in 2015.

Meanwhile, the blood pressure goal—systolic blood pressure of less than 140 mmHg and diastolic blood pressure of less than 90 mmHg—was similar across all 3 time points (70.5%, 74.5%, and 72.8%, respectively). There was a small but steady increase in the proportion of women achieving the cholesterol goal of low-density lipoprotein less than 100 mg/dL (38.5%, 47.5%, and 53.2%, respectively).

The proportion of women who achieved all 3 targets was low across all time points (23.3%, 26.4%, and 22.3%, respectively).

The researchers observed no differences in achieving any of the diabetes care goals between HIV-positive and HIV-negative women. In 2006, more HIV-positive women saw a healthcare provider (96% vs 80.4%) and achieved blood pressure control (79.3% vs 63%).

Notably, the proportion of HIV-positive women who achieved viral suppression nearly doubled over the period, increasing from 40.7% in 2001 to 86.9% in 2015.

“Among HIV-positive women, we found HIV control has improved over time, but diabetes control has not,” wrote the authors. “HIV-negative women, however, did have significant improvement in glycemic control from 2001 to 2015.”

They concluded that these findings reinforce the importance of considering HIV as a chronic infectious disease where management of comorbidities, such as diabetes, is important.

Author: Jaime Rosenberg

Healthcare providers missing opportunities to prescribe PrEP to patients at high risk of HIV

Healthcare providers are missing opportunities to prescribe pre-exposure prophylaxis (PrEP) to patients at high risk of HIV, according to US research published in Clinical Infectious Diseases.

The research found that two-thirds of patients sought health care, a quarter because of a sexually transmitted infection (STI), in the period before their infection with HIV. Women, African Americans and younger patients were especially likely to have missed opportunities for PrEP prescribing.

“The finding that ¼ had an STD [sexually transmitted disease] diagnosis at a prior health care visit suggests that clinicians may not be responding to the fact that gonorrhea and syphilis are strongly suggestive for HIV acquisition in both MSM [men who have sex with men] and heterosexually active women,” comment the authors. “The finding that Hispanic/Latino persons were significantly less likely to have a prior health care visit is concerning, given that rates of new infection are rising among young Hispanic/Latino MSM.”

Daily PrEP can reduce the risk of infection with HIV by over 99%. However, it’s been estimated that only 10% of individuals in the US who would potentially benefit from PrEP are currently receiving this highly effective method of HIV prevention. Research has also revealed disparities in PrEP provision according to race/ethnicity, HIV risk group, gender and age.

Investigators in South Carolina wanted to see if healthcare providers were missing opportunities to prescribe PrEP to patients at high risk of HIV. They designed a retrospective study involving 885 patients aged 13 years and older who were newly diagnosed with HIV between 2013 and 2016 and who had evidence of recent infection with the virus. Data were gathered regarding attendance at healthcare facilities in the period before HIV diagnosis. The investigators also examined the reasons why the patients sough health care.

Two-thirds of patients visited a healthcare facility in the period before their HIV diagnosis. These patients had a mean of seven healthcare visits. Most of the visits (84%) were to hospital emergency departments. A plurality of visits (42%) involved patients without health insurance or who paid for health care themselves, with 36% having public insurance and 18% private insurance. Few Hispanic/Latino patients made healthcare visits.

Patients with missed opportunities for PrEP prescribing were more likely to be female than male (p < 0.0001), African American than white (p < 0.0001) and younger than 30 years of age (p < 0.0003).

A quarter of patients attended a healthcare facility because of gonorrohea or syphilis, increasing to 29% when chlamydia was added as a reason for seeking health care.

“Although PrEP uptake has been increasing nationwide, its delivery in the southern states where the majority of new HIV diagnoses are now occurring, to African American men and women, and to young Hispanic/Latino men, has been disturbingly low,” conclude the authors. “To urgently address these geographic and demographic inequalities, it is necessary to increase health care utilization among black men and women and Hispanic/Latin men, reduce the number of missed opportunities for HIV testing at all health care visits, and identify indications for PrEP use in HIV-negative persons – especially those with diagnosed bacterial STDs, so that PrEP for HIV prevention can be provided.”

Author: Michael Carter