Post-exposure prophylaxis (PEP) for HIV, which consists of immediate treatment for possible exposure to HIV to prevent infection, has been the standard of care for quite a few years.
People who contract HIV once can contract it again, often through the same risk behaviors that led to the initial infection. A long-standing question has been whether getting infected with a second strain of HIV leads to more rapid HIV disease progression than infection with a single strain.
So ended Joep's last email to me.
Last year, like many others in the HIV community, I was thrilled to learn that a little girl born in Mississippi with HIV may have been cured of HIV infection by the early initiation of antiretroviral treatment. I thought that we were on the cusp of a monumental public policy and humanitarian advance -- not one that required experimental space-age treatments, but one achievable today with the very antiretroviral tools we already have. The enthusiasm that Ms. Mississippi's story generated demonstrates just how urgently we all desire a HIV cure, even if not for all adults, at least for the babies born to HIV-infected mothers. The community cared about her story, and the media cared about her story. Her story was on the front page of the New York Times and the Wall Street Journal alike.
I am a doctor who specializes in LGBT health and HIV medicine. I have spent the last 30 years working to help my patients who have HIV live with the illness and trying to help those who are HIV negative stay that way. I am also a 60-year-old gay man who has spent those same three decades trying to keep myself from becoming infected with HIV. I am tired of being scared, so I am starting on PrEP (pre-exposure prophylaxis). I hope that by sharing my story I may help others make decisions about protecting their own health.
Male-to-female transgender women (TGW) are the most affected by the HIV/AIDS epidemic. However, little data have been generated on the efficacy of new HIV prevention technologies in this community, and concerns have been raised regarding the participation of TGW in HIV prevention research. I want to share some reflections, based on my experience planning and organizing community education, recruitment and retention of men who have sex with men (MSM) and TGW in HIV/AIDS research in Peru, Ecuador and the U.S. for the past 14 years. I will also try to provide an explanation of why TGW do not participate in HIV prevention research, and recommendations to improve participation.
We are failing our young, black and Hispanic men who have sex with men (MSM) and transgender women. Each year in the U.S., we see nearly 50,000 new HIV infections. New York City remains the epicenter of the country's epidemic. Black MSM and black women, including transgender people, remain deeply impacted.
No one raised their hand. Their faces conveyed bewilderment, as if the idea had never occurred to them. I was sitting in a circle of men living with HIV, a weekly group I lead where we delve into both the complications and skills inherent with living with the virus. I had just asked them to share what gives them purpose and passion and everyone seemed at a loss.
I saw Steve in clinic a few weeks before his marriage to Marty. They were knee deep in wedding planning. Had they ordered enough irises? Could they squeeze in one more belated RSVP? Would the best man be funny without being too embarrassing? As we chatted, about weddings and then about Steve's medications, I remembered our last several years of clinic visits. Knowing Steve for years now, I've been honored to see him change and grow. And I've grown to like him.
In 2011, when the U.S. Centers for Disease Control and Prevention (CDC) released interim guidance on pre-exposure prophylaxis (PrEP), I was immediately skeptical about the feasibility and pessimistic about the practicality of this intervention. If health care providers won't routinely screen for HIV, how would we convince them to prescribe a prevention pill to healthy people? Furthermore, by embracing this biomedical intervention, I believed the CDC was signaling the eventual abandonment of behavior change interventions. I was deeply disappointed -- until World AIDS Day 2013, when a young, gay man was diagnosed with acute HIV infection at our hospital. His story has forced me to face the reality of PrEP's role as a viable and necessary prevention strategy for people like him.
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