Australia
The new MTV generation: Using methamphetamine, Truvada and Viagra (MTV) to enhance sex and stay safe.
Gay and bisexual men (GBM) often use recreational drugs to enhance sexual pleasure, commonly referred to as “chemsex”. The use of methamphetamine and Viagra (or other erectile dysfunction drugs) both together or separately are strongly predictive of incident HIV infection. However, Truvada as PrEP, virtually eliminates HIV risk during condomless anal intercourse (CLAI). Hence, when HIV-negative GBM add PrEP to their party drug regimen during intensive sex partying networks, they actively reduce the possibility of HIV transmission during chemsex.
The study found that MTV was independently associated with CLAI with casual partners and “fuckbuddies”, being older GBM, and engaging in group sex compared to “MV only” or “T only” group. It also found that there was greater social engagement with other gay men and having multiple sexual partners in the MTV group compared to “MV only” or “T only” group.
Apart from PrEP mitigating the increased HIV risk association with party drugs regimens, it also demonstrated that this harm reduction strategy is being utilised by GBM. Thus the use of PrEP during chemsex could help reduce HIV transmissions within this at-risk population.
Netherlands
High incidence of hepatitis C virus (HCV) (re-) infections among PrEP users in the Netherlands: Implications for prevention, monitoring and treatment.
HCV prevalence was 4.8% among HIV-negative MSM starting PrEP in the Netherlands. This study explored HCV incidence rate (IR), characteristics of newly infected individuals, using HCV genotype distribution and phylogenetic clustering among MSM and transgender person (TGP) who were using PrEP in the Netherlands. The study found that the incidence of initial and re-HCV infection among HIV-negative MSM on PrEP was high and was comparable to what was observed in HIV-positive MSM. The high degree of phylogenetic clustering between HCV strains acquired by MSM with and without HIV suggested a shared transmission network. Implications for prevention, monitoring and treatment should therefore focus with regular HCV testing to provide prompt treatment as well interventions to lower HCV-related behaviour in MSM on PrEP.
United Kingdom
The responsibility of PrEP: A qualitative exploration of MSM’s use of informal PrEP in London.
There were concerns that PrEP will lead to “risk compensation” (i.e. MSM will use condoms less frequently and increase their sexual risk because of PrEP). In the UK it has been contented that the drop in HIV incidence is partially credited to PrEP-related activism and the initiative taken by MSM as early adopters of informal generic PrEP through online purchase. On the contrary, PrEP provided an opportunity for MSM to take individual responsibility for their own sexual health. However, to date there is little research has examined the issue of “responsibility” in PrEP users.
The study participants expressed that responsibility was not a single idea but rather an overarching theme for framing different concerns: control over their own health, relationships with other MSM, and the gay community, and citizenship. The responsibility they felt toward themselves created uncertainties about their sexual risk with or without PrEP. Their responsibility towards their community was put into practice through information sharing and peer support of other potential PrEP users. Few clinics supported their PrEP use, and were seen as taking on the State’s responsibility for their health as citizens.
This qualitative study found that the policy conditions in UK, and the lack of access to PrEP have given rise to a widespread practice of informal PrEP sourcing and use. This self-directed form of prevention extended the notion of responsibility beyond an individual user to a collective responsibility of PrEP shared by MSM communities, and by PrEP providers to adequately support early adopters and informal users.
Thailand
Drug-drug interaction (DDI) between the use of feminizing hormone therapy (FHT) and Pre-exposure prophylaxis (PrEP) among transgender women (TGW): The iFACT study.
Concern about potential DDI between FHT and PrEP have hampered uptake and adherence of PrEP among TGW. To determine DDI between FHT and PrEP, the study measured pharmacokinetic parameters of blood plasma tenofovir (TFV), estradiol (E2) and testosterone. The study demonstrated lower plasma TFV exposure in the presence of FHT, suggesting that FHT may potentially affect efficacy among TGW; but E2 exposure was not affected by PrEP. The study acknowledged that further research is warranted to determine whether these reductions in TFV are clinically significant.
United States of America
Expansion of HIV pre-exposure prophylaxis (PrEP) among key population in PEPFAR’s global program date, fiscal year 2016-2017.
Key populations (KP), such as men who have sex with men (MSM), female sex workers (FSW) and transgender persons (TG), experience a disproportionate risk of HIV infection compared to the general population (GP). PrEP represents a preventive strategy to reduce new HIV infection among HIV-negative individuals with significant risk behaviour. PEPFAR, the largest global HIV program funder, issued guidance on the implementation of PrEP programs to reduce HIV incidence among KP, developed KP-specific monitoring indicators and began collecting KP disaggregated data in 2016-2017.
Over the half-yearly reporting period in 2016-2017, PrEP enrolment increased substantially among both KP and GP, albeit with more attenuated success in scaling this effective HIV prevention intervention among KP compared to the GP. To address slower growth enrolment among all KPs, particularly for FSW and TG compared to GP, specific efforts are needed to streamline PrEP scale-up through advocacy with host country government to address restrictive national policies and potential gender inequalities.
