HIV prevention revolution: Can a single shot change America’s epidemic trajectory?

Can a single shot change America's epidemic trajectory?
Can a single shot change America's epidemic trajectory?

United States: The US Preventive Service Task Force has endorsed an injectable medication to prevent the transmission of HIV in the United States – it has been regarded as an important effort to end the HIV epidemic in the nation.

In regards to preventing the transmission of the virus, the Task Force backed Cabotegravir – sold under the brand name Apretude, in August as a method of PrEP, formally known as preexposure prophylaxis.

How effective is the medication?

According to the US News, a report has suggested that after taking the injection every two months, following the two initial doses one month apart, the risk of the infection in men – who had sex with men and transgender women – decreased by 66 percent (66%) as compared to daily oral medication Truvada.

Has the US FDA shown trust in Apretude?

Reportedly, the United States Food and Drug Administration (US FDA) approved Apretude back in the year 2021.

The task force suggested that Apretude should be covered by health insurers without any extra costs if it falls under the Affordable Care Act. The initiative could be a game-changer for at-risk patients.

In this regard, a senior manager of policy and advocacy for the non-profit AIDS Foundation Chicago – Omar Martinez Gonzalez, stated, “There’s a stigma associated with taking PrEP, so for people who don’t feel safe taking a medication every day or are not able to remember to take an oral medication every day, oral PrEP is not feasible for them,” as per US News.

Gonzalez further continued, “By having another option that’s long-acting that they have to take every other month, it greatly increases their ability to get on PrEP and not have to worry about taking a pill every day.”

A sigh of relief: HIV cases witness a decline in the US!

However, the different rates of HIV infection and preventive care, along with varying levels of insurance coverage and an upcoming legal decision, might slow down progress and hinder efforts toward a bigger goal.

However, according to the statistics unveiled by the Centers for Disease Control and Prevention, the infection rate in Americans (aged 13 and above) has witnessed a decline of 12 percent (12%) between 2017 and 2021.

Further, the government has anticipated that the rate would fall by 90 percent (90%) by the year 2030, meaning that the United States will have only 4,000 infections by the end of the decade. Concerning this, the CDC outlined that the decline rate must be increased at a faster pace.

Visual Representation

The issue was further elaborated by an assistant professor at the Santa Clara University School of Law and a scholar in health law and policy at Georgetown University’s O’Neill Institute for National and Global Health Law – Sean Bland, who mentioned, “There’s modeling that suggests we could potentially end the HIV epidemic on the track that we are (on) in many white communities across the country, but we would not be successful in ending the epidemic in Black communities,” the reports by the US News revealed.

He further stated, “Unless we have a strategy that not only ensures access to free or low-cost PrEP but really focuses on the geographic regions and the populations that are most vulnerable in addressing their barriers to preventable services, including PrEP, we’re not going to achieve those goals.”

Uneven impact: Black population experiences a disproportionate burden

The initial data by the CDC underlined that the highest number of infections has been registered among the Black population of America, accounting for around 40 percent (40%) of the total 36,704 cases in the US among people aged 13 or above.

The second most affected community was Hispanics, who accounted for around 31 percent (31%), while just 24 percent (24%) of Whites were registered to be infected.  

It is to be noted that, according to US News, just 13 percent (13%) of more than 468,000 Blacks aged 16 and above using PrEP in the year 2022 received a prescription, according to the CDC. In addition to this, 24 percent (24%) of the more than 312,000 Hispanics using PrEP received medical prescriptions.

However, the numbers among Whites are quite impressive – as 94 percent (94%) of more than 300,000 Whites have received prescriptions with the benefit of PrEP.

A surge in PrEP use

The use of PrEP in the United States has witnessed a steady increase since Truvada became the first-ever medication against Cancer. The medicine was approved in 2012. As per the data revealed by the CDC, in the year 2021, around 30 percent (30%) of people using PrEP were prescribed. The number witnessed an increase as compared to only 13 percent (13%) in 2017.

Although, the government aims to take the percentage up to 50 percent (50%) by the year 2025.

The concerns of the health authorities have increased after experiencing racial and ethnic disparities, as higher uptake was taken by the Whites. According to the figures revealed by AIDSVu, the HIV surveillance website affiliated with Emory University and Gilead Sciences, the medications – Truvada and Descovy were taken by just five (5) Black beneficiaries of PrEP, nine (9) Hispanic and 36 White PrEP users in 2022.

Martinez Gonzalez stated, “Among communities of color, our sexual networks are smaller and more intertwined. So, if there is an outbreak of HIV within that community, then it will obviously increase the chances of coming into contact with HIV. If you also add on the layers of racial inequities in terms of access to testing, access to treatment, access to insurance, and access to health care, all of that compounds together to create a crisis,” as per US News.

The data by AIDSVu further revealed the disproportionate data between HIV infections and PrEP utilization. In the South, about half of the new HIV cases in 2021 were among Black individuals, but only 21 percent (21%) of them used PrEP in 2022. In the West, Hispanics made up 46 percent (46%) of new HIV cases in 2021, but only 23 percent (23%) used PrEP in the following year.

According to the US News, the relation between PrEP and the infection was addressed by an assistant professor of medicine at the Case Western Reserve University School of Medicine and an internal medicine and pediatric specialist in the LGBTQI+ Pride Network of the Cleveland-based MetroHealth System – Dr Laura Mintz. Mintz underlined that providing a boost to the usage of PrEP will lead to the availability of medications in locations other than LGBTQ-specialty clinics.

Future considerations

The director of HIV and health equity for LGBTQ+ advocacy organization the Human Rights Campaign – Torrian Baskerville, expressed that it is important to initiate a robust national strategy for distributing PrEP so that medication is received by the most impacted communities.

According to the reports by US News, “We need to make sure we are maintaining a focus on the populations in the geographic regions where we’re seeing the infections and ensuring that we’re funding community-based organizations and clinics that serve those populations in the ways that they need,” Bland said.

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