Following years of apparent stagnation in the U.S. fight against HIV, recent reports suggest that things are looking up. What’s the full story?
This summer will mark 35 years since the first reports of AIDS. Additionally, two decades have now passed since combination antiretroviral treatment began to transform a health crisis into a more manageable public health concern.
Anniversaries are time to take stock: to reflect on the lessons of the past, assess the status quo and make projections for the future. For many years now, the American HIV epidemic has appeared trapped in a protracted stagnation, paralyzed by the systemic flaws of the U.S. health care system, fueled by increases in sexual risk-taking among men who have sex with men (MSM) while new infections drop among other risk groups, and stymied by increased public apathy.
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Good news for gays
The prevention advances to which McCray refers are grounded in the increasing scientific understanding of the power of antiretrovirals to prevent transmission. First there is so-called treatment as prevention (TasP) among people living with HIV. In addition, Truvada (tenofovir/emtricitabine) as pre-exposure prophylaxis (PrEP) is available for HIV-negative people. Approved in 2012, PrEP is estimated to reduce the risk of acquiring the virus by more than 99 percent when taken daily.
The CDC recently estimated that 1.2 million Americans could benefit from PrEP, including 492,000 MSM, 115,000 injection drug users, and 624,000 heterosexuals.
A precise picture of how widespread PrEP use has become is hard to come by. But the combination of anecdotal evidence as well as data from Gilead Sciences, Truvada’s manufacturer, suggests that the pill is becoming an increasingly popular form of HIV prevention. After prescriptions apparently tripled between 2014 and 2015, a very rough estimate of 22,000 Americans, primarily MSM, were on PrEP as of about a year ago.