Ten years into the era of the HIV prevention drug known as PrEP, attempts to utilize its lauded ability to reduce new infections have stalled in the United States.

This deficiency is a major reason why the United States lags behind so many other nations in the fight against HIV, with a national pandemic that has been plagued by racial disparities for decades and a new infection rate that is only slowly falling.

LaRon Nelson, an assistant professor of nursing and public health at Yale University, stated last month at the Conference on Retroviruses and Opportunistic Infections in Seattle, “We have reached a scientific crisis in HIV prevention.” Nelson noted the disparity between PrEP’s remarkable performance in large-scale trials and its little impact in the real world.

PrEP, which is an acronym for pre-exposure prophylaxis and involves taking oral or injectable prescription antiretroviral medications in advance of potential HIV exposure, has gained significant popularity, but only among white gay and bisexual men, whose HIV rate has been steadily declining for years.

Infections with HIV among homosexual and bisexual males in the U.S.

Estimates of HIV infection among white homosexual and bisexual men have decreased, whereas estimates among Black and Latino gay and bisexual men have remained steady or fallen just little.

Despite the efforts of a national public-health army and the countless millions of dollars invested to promote and facilitate PrEP use among Black and Hispanic gay and bi men, this disparity continues. These groups have the greatest prevalence of HIV infection of the major intersecting categories, and transmissions among them have remained stable or scarcely decreased in recent years.

So, even in the midst of a national reckoning with racial inequality, PrEP has only contributed to exacerbate racial inequalities in HIV transmission among males who have sex with other men.

According to the Centers for Disease Control and Prevention, 70% of new infections of the virus are among homosexual and bisexual males. In 2019, Whites accounted for 15% of the 34,800 HIV transmissions, whereas the far smaller numbers of their Black and Hispanic peers accounted for 26% and 23% of new infections, respectively.

In addition, despite more than a year after the approval of a long-acting injectable version of PrEP, ViiV Healthcare’s Apretude, just a small number of people are receiving it. The majority of insurers have declined to fund the costly medication. Hence, Apretude’s promise will likely remain unrealized for the foreseeable future, despite the fact that clinical studies demonstrated injectable PrEP to be much superior to oral PrEP in preventing HIV on a public health level, particularly among Black homosexual men.

Distressing statistics

Truvada, a two-drug combination tablet developed by Gilead Sciences and authorized as PrEP in 2012, was followed in 2019 by a similar medicine, Descovy. Several studies indicate that when either medicine is taken daily, the risk of HIV infection among homosexual, bisexual, and transgender men and women is reduced by at least 99 percent.

Between 2015 and 2019, the CDC forecasts that yearly HIV transmissions decreased by only 8%. Even in areas where HIV prevention investment is inadequate, such as Tennessee, where Republican Governor Bill Lee recently exacerbated the causes exacerbating his state’s pandemic by withholding $8.3 million in yearly CDC preventive funds, the number of new cases is increasing.

The CDC estimates that around 814 000 homosexual and bisexual men in the United States are suitable candidates for PrEP. Between 2017 and 2022, the number of individuals utilizing PrEP, who have historically been predominantly homosexual and bisexual males, grew from 155,000 to 382,000. Yet, a Seattle-presented CDC research revealed that in September 2022, only 187,000 individuals were using PrEP inside the 30-day timeframe, indicating that many people do not take medication for the whole 30 days.

Apretude’s approval promised progress

Approved in December 2021, Apretude requires a bimonthly injection administered by a medical professional. In a large clinical research, treating trans women and men who have sex with males Apretude as PrEP was related with a 66% reduction in the overall HIV diagnosis rate.

The increased efficacy of Apretude was due to the fact that individuals adhered to the injection schedule better than the daily tablet plan.

Dr. Hyman Scott, an expert in HIV prevention from the San Francisco Department of Public Health, reported at a conference in Seattle that among the 844 Black Americans who participated in the trial, those who were randomly assigned to receive the injectable drug had a 72% lower HIV rate than those who received Truvada.

His data predicts that if 10,000 comparable Black homosexual, bisexual, and transgender men and women were observed for one year, 50 would get HIV if administered Apretude and 200 would test positive if given Truvada.

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