“HIV estimates released by the CDC two weeks ago—showing that new HIV infections have risen nearly 50 percent in young black gay men since 2006—make it clear that the status quo is failing to keep the epidemic in check,” said David Evans, director of research advocacy at Project Inform. “PrEP could be one of the more promising new options we have to offer young HIV-negative gay men at the highest risk of infection in the U.S., but until we expand PrEP programs in real-world settings we won’t be able to translate the trial results into public health impact.”
PrEP involves HIV-negative people taking antiretroviral medication before exposure to the virus to prevent infection. Three clinical trials have demonstrated that when used consistently, PrEP is both safe and effective at preventing HIV infection, but it’s unknown if and how results apply outside of clinical trials. Activists are urging the U.S. government to move quickly to fund and coordinate demonstration projects to evaluate PrEP in the real word and determine the best ways to use it.
“We are at a pivotal moment in HIV prevention, and what happens next hinges on a swift, coordinated effort to understand how PrEP can be used effectively by people at highest risk for infection,” said Dr. Judy Auerbach, vice president of research and evaluation at San Francisco AIDS Foundation. “If we do too little, or the demonstration projects aren’t properly designed, there’s a real danger that we could lose the promise of one of the most important scientific breakthroughs in HIV prevention.”
Two PrEP demonstration projects are near launch, and others are under discussion, but funding remains uncertain and participating medical providers and institutions are not being coordinated. The groups issuing the call to action request that HHS respond rapidly to ensure that coordination takes place and that the projects with the highest likelihood of answering key research questions are fully funded. These questions include the feasibility, desirability, uptake, and effectiveness of PrEP in different settings, among others.
“We cannot be content with budget constraints and calls to do more with less,” said Mitchell Warren, AVAC executive director. “Science has given us new ways to potentially significantly blunt the epidemic in the U.S. and around the world. We have an obligation to push to find the best ways to use antiretroviral drugs as prevention – both for HIV-positive people to reduce their risk of passing on HIV to others and for HIV-negative people to protect themselves. The U.S. government and other funders must move quickly to ensure the availability of resources for the essential next steps for PrEP, including demonstration projects and continued research.”
The call to action was issued by Project Inform, along with the AIDS Foundation of Chicago, AIDS United, amfAR: the Foundation for AIDS Research, AVAC: Global Advocacy for HIV Prevention, the Black AIDS Institute, the International Rectal Microbicide Advocates, National Alliance of State & Territorial AIDS Directors, the National Minority AIDS Council and the San Francisco AIDS Foundation. It’s accompanied by a report called “PrEP: Roadmap to the Real World,” in which advocates detail key questions to be answered in demonstration projects.[If an item is not written by an IRMA member, it should not be construed that IRMA has taken a position on the article’s content, whether in support or in opposition.]