Columbia University School of Social Work, Room 312
How would you like your PrEP? The fit of new HIV prevention tools to lived sexual lives.
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Chris Beyrer MD, MPH, is the inaugural Desmond M. Tutu Professor in Public Health and Human Rights at the Johns Hopkins Bloomberg School of Public Health. He is a Professor of Epidemiology, International Health, Nursing and Medicine at Johns Hopkins. He serves as Director of the Johns Hopkins Training Program in HIV Epidemiology and Prevention Science and as Founding Director of the Center for Public Health and Human Rights. He is the Associate Director of the Johns Hopkins Center for AIDS Research (CFAR) and of the University’s Center for Global Health. Dr. Beyrer has extensive experience in conducting international collaborative research and he has spent much of his career focusing on health and human rights. He was President of the International AIDS Society from 2014-16, and was elected to membership in the National Academy of Medicine in 2014.
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The science of primary and secondary prevention of HIV has made profound advances in the last decade. The results of several large treatment as prevention (TasP) trials have confirmed that persons living with HIV who are sustainably virally suppressed do not transmit to sexual partners, and these studies have included both heterosexual and male same sex status different partnerships. This has led to a social advocacy movement: Undetectable=Untransmissible, or U=U. Oral pre-exposure prophylaxis with Tenofovir-Emtricitabine (Truvada and its generic formulations) has shown remarkable effectiveness in primary prevention of HIV for men who have sex men (MSM), since this oral formulation has high penetration and efficacy in the gut, protecting receptive anal sex partners—the highest risk exposure for unprotected sex. Data support the use of PrEP in MSM for both daily and on demand regimens. Effective use of TasP and PrEP can reduce HIV transmission and acquisition probabilities between men who have sex with men to virtually nil.
How have these dramatic changes affected sexually active gay and bisexual men? Findings from a number of qualitative studies suggest that there is a sea change underway in many communities where TasP and PrEP are available, MSM have access, and community uptake and use has been widespread. Men are reporting declines in anxiety, in fear of infection, and in self and enacted stigmas associated with HIV status. Many are reporting increased communication, and enhanced intimacy, as concerns over HIV status differences decline. A “status neutral” future may be emerging, with profound consequences for individuals, couples, and communities. Yet there remain concerns over access, over adherence, particularly among younger and more marginalized MSM, and there are concerns around other sexually transmitted infections (STI) as condom use changes. Gay and bisexual men have been both heavily burdened by the HIV pandemic, and in the vanguard of uptake of advances in science. The prevention revolution underway is again, being used, adapted, and experienced by MSM.