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Unequal HIV prevention pill use puts minority men at higher risk

Black and Latino gay men are less likely to take Truvada as HIV pre-exposure prophylaxis, or PrEP, largely because doctors don't recommend it to them.

Fewer minority men who are at risk for HIV take a prevention pill or discuss it with their doctors, U.S. researchers say.

Awareness of a pill for “preexposure prophylaxis,” or PrEP, is high for all groups of men who have sex with men. But lower proportions of black and Hispanic men, compared with white men, have actually gotten prescriptions for the drug, which is 99 percent effective at preventing HIV transmission, the study team found.

Based on interviews, researchers found the disparities emerge at the point of having a discussion about PrEP with a healthcare provider. This suggests doctors can do more to help close this gap, they write in the Centers for Disease Control and Prevention’s (CDC) Morbidity and Mortality Weekly Report.

“This type of research is critical to finding - and correcting - missed opportunities to offer PrEP to people at risk for HIV, particularly among African American and Latino gay and bisexual men,” said study leader Dafna Kanny of the CDC’s Division of HIV/AIDS Prevention.

National Gay Men’s HIV/AIDS Awareness Day is September 27. The “Ending the HIV Epidemic” national initiative aims to reduce new infections by 75 percent in five years and by 90 percent in 10 years.

“It’s important for providers to take sexual histories of gay and bisexual men and to discuss PrEP as an option for HIV prevention with those who could potentially benefit from it,” Kanny told Reuters Health by email. “These discussions also help to destigmatize PrEP use, which is particularly important for increasing PrEP use among African American and bisexual men.”

Kanny’s team analyzed interviews with more than 4,000 men who participated in the 2017 National HIV Behavioral Surveillance survey to understand who is using PrEP and why some are not using it.

Candidates for PrEP use include men with multiple male sex partners in the past year, a male sex partner with an HIV infection during the past year, condomless anal sex or a bacterial sexually-transmitted infection within the past year.

Overall, 95 percent of the white men in the study said they were aware of PrEP, along with 87 percent of Hispanic men and 86 percent of black men. Yet only 58 percent of whites, 44 percent of Hispanics and 43 percent of blacks said they discussed PrEP with a clinician in the past year.

About 42 percent of white men, 30 percent of Hispanic men and 26 percent of black men reported taking PrEP in the past year.

Among the steps from awareness to getting onto PrEP, discussing it with a healthcare provider seemed pivotal. Men who got that far were more likely to be using PrEP. Still, disparities remained. Among the 2,000 men who discussed PrEP with a clinician, 68 percent of white men reported PrEP use, compared with 62 percent of Hispanic men and 55 percent of black men.

These differences were not explained by a lack of insurance or a usual source of health care - typical barriers to accessing prescription medications.

Geographically, disparities in PrEP use were seen between white and black men in the South and West, and between white and Hispanic men in the South.

The CDC estimates that less than 25 percent of the more than 1 million Americans who could benefit from PrEP are using it, Kanny said. She added, “There is a critical need to address racial and ethnic disparities.”

Future studies will need to investigate other barriers to PrEP use, such as high deductibles and high co-pays, which affect racial and ethnic minorities in particular, said Brandon Marshall of the Brown University School of Public Health in Providence, Rhode Island, who wasn’t involved in the CDC study.

“If we continue to see these disparities, HIV infections will likely continue to grow,” he told Reuters Health by phone. “Our goals to end the epidemic will be out of our grasp.”

Recent research indicates that some doctors don’t prescribe PrEP because they believe it will lead to risky sexual behavior, Marshall noted, which may disproportionately affect racial and ethnic minority men.

“These race-based stereotypes held by some providers also continue to perpetuate mistrust of the medical community in racial/ethnic minority communities,” he said. “If you feel your healthcare provider isn’t listening to you or not addressing your needs, it’s time to find a different provider who has more experience with PrEP and can answer your questions.”

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