Why can’t gay men stick to PrEP regimen better?

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An encouraging decline in HIV rates was skewered by an exception for gay men. Now PrEP possibilities get dampened with news that gay and bisexual men aren’t adhering to the regimen as consistently as everyone else.

A new study on PrEP – or Pre-Exposure Prophylactic, a daily dose of the AIDS drug Truvada that helps prevent HIV infection – showed promise for adherance to the plan in subjects at high risk of contracting the disease. Unless you’re gay.

Federally funded researchers looked at gay and bisexual men plus transgender women in Thailand and New York City, as well as cisgendered straight women in South Africa.

Adherence rates were measured by techniques that included self-reporting, blood and hair analyses, and data from devices that record opening of pill cases. The initial pitch of the results to the International AIDS Society Conference on HIV Pathogenesis, Treatment and Prevention in Vancouver sounded promising.

A recent study reports that those with a high risk of contracting HIV will adhere to a daily PrEP regimen to prevent HIV, shutting down critics who've said pre-exposure prophylaxis won't work because of adherance issues.

Funded by the National Institutes of Health, the study indicates that populations at substantial risk of HIV will adhere to the effective HIV prevention medication Truvada, which is a combination of  two antiretrovirals (tenofovir and emtricitabine) in a single pill. 

But then you see the numbers, and more than a third of the gay and bisexual male subjects could have done better. Much better.

In this HIV Prevention Trials Network study, 76 percent of women prescribed PrEP adhered to the daily regimen. Trans women from Harlem and Bangkok had even higher rates of adherence (86 percent) while gay and bi men in those two cities showed a 65 percent adherence.

Only 65 percent? Afraid so. Perhaps the good news is that a majority are able to adhere to the PrEP regimen.

Maybe the better news is that more work is being done by the National Institutes of Health, which funded the first study. A study is in play now to identify “Factors Affecting PrEP Adherence,” and yet another is seeking volunteers to study prevention via PrEP for MSM, or men who have sex with men. The study’s called “Optimizing Antiretroviral-Based Prevention by Enhancing PrEP Adherence in MSM.” That’s you, gay and bisexual men. Click and see if you qualify to be part of it.

Here’s hoping things go even better in the upcoming programs. We could use the good news, after what we already knew about dropping HIV rates, unless you're gay, and uncontrolled cases of the disease among gay men, especially if you're also young.

In the meantime if you're on PrEP, take it regularly as prescribed. Because one thing is clear: Naysayers are losing the long game in the battle over PrEP's place in the war against HIV. We're happy to fight for adherence rather than just hold out hope for a pill that significantly turns back HIV. The CDC agrees. Heck, even Grindr wants you to enjoy your butt sex with the little blue pill. It's all a matter of deciding whether PrEP is right for you.

[HIV Plus | NIH Clinical Trials]


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