Vital Signs Issue: December 2015

New CDC estimates underscore the need to increase awareness of a daily pill
that can prevent HIV infection

Approximately 1 in 4 gay, bisexual men; 1 in 5 people who inject drugs;
and 1 in 200 heterosexuals should be counseled about pre-exposure prophylaxis (PrEP)

A new Vital Signs report published today estimates that 25 percent of sexually active gay and bisexual adult men, nearly 20 percent of adults who inject drugs, and less than 1 percent of heterosexually active adults are at substantial risk for HIV infection and should be counseled about PrEP, a daily pill for HIV prevention.

PrEP for HIV prevention was approved by the Food and Drug Administration in 2012. When taken daily, it can reduce the risk of sexually acquired HIV by more than 90 percent. Daily PrEP can also reduce the risk of HIV infection among people who inject drugs by more than 70 percent. However, according to recent studies, some primary health care providers have never heard of PrEP. Increasing awareness of PrEP and counseling for those at substantial risk for HIV infection is critical to realizing the full prevention potential of PrEP.

“PrEP isn’t reaching many people who could benefit from it, and many providers remain unaware of its promise,” said CDC Director Tom Frieden, M.D., M.P.H. “With about 40,000 HIV infections newly diagnosed each year in the U.S., we need to use all available prevention strategies.”

PrEP is one essential component in the nation’s high-impact prevention strategy

While PrEP can fill a critical gap in America’s prevention efforts, all available HIV prevention strategies must be used to have the greatest impact on the epidemic. These include treatment to suppress the virus among people living with HIV; correct and consistent use of condoms; reducing risk behaviors; and ensuring people who inject drugs have access to sterile injection equipment from a reliable source.

PrEP is one of four focus areas in the July 2015 Update to the National HIV/AIDS Prevention Strategy. Other key elements of the Strategy and CDC’s high-impact prevention approach are:

• Widespread HIV testing and linkage to care that enables early treatment;
• Broad support for people living with HIV to remain engaged in comprehensive care, including support for treatment adherence;
• And universal viral suppression.

Overview

Preexposure prophylaxis (PrEP) is a medicine taken daily that can be used to prevent getting HIV. PrEP is for people without HIV who are at very high risk for getting it from sex or injection drug use. People at high risk who should be offered PrEP include about 1 in 4 sexually active gay and bisexual men*, 1 in 5 people who inject drugs, and 1 in 200 sexually active heterosexual adults. When taken every day, PrEP is safe and highly effective in preventing HIV infection. PrEP is even more effective if it is combined with other ways to prevent new HIV infections like condom use, drug abuse treatment, and treatment for people living with HIV to reduce the chance of passing the virus to others. Many people who can benefit from PrEP aren't taking it. If more health care providers know about and prescribe PrEP, more HIV infections could be prevented.

Health care providers can:

Test patients for HIV as a regular part of medical care. Discuss HIV risks and continued use of prevention methods, including condom use, with all patients.
Follow the 2014 PrEP Clinical Practice Guidelines to perform recommended tests and prescribe PrEP to patients without HIV who could benefit.
Counsel patients who can benefit from PrEP on how to take it every day and help them apply for insurance or other programs to pay for PrEP.
Schedule appointments for patients using PrEP every 3 months for follow-up, including HIV testing and prescription refills.

*This fact sheet refers to all men who have sex with men (MSM) as gay or bisexual. Sexually active refers to people who have had sex in the past year.

PrEP is for some people at very high risk for getting HIV

Daily PrEP can reduce the risk of getting HIV from sex by more than90%.

Daily PrEP can reduce the risk of getting HIV among people who inject drugs by more than 70%.

1 in 3 primary care doctors and nurses haven't heard about PrEP.

Problem

Many people at very high risk for HIV infection are not getting PrEP.

PrEP is for some people at very high risk for getting HIV:

1 in 4 sexually active gay and bisexual adult men without HIV who:
- Have an HIV-positive partner, or
- Have multiple partners, a partner with multiple partners, or a partner whose HIV status is unknown and
  - Have anal sex without a condom, or
  - Recently had a sexually transmitted infection (e.g. syphilis).
1 in 5 adults without HIV who inject drugs who:
- Share needles or equipment to inject drugs, or
- Recently went to a drug treatment program (specifically, a methadone, buprenorphine, or suboxone treatment program), or
- Are at risk for getting HIV from sex.
1 in 200 sexually active heterosexual adults without HIV who:
- Have an HIV-positive partner, or
- Have multiple partners, a partner with multiple partners, or a partner whose HIV status is unknown and
  - Do not always use a condom for sex with people who inject drugs, or
  - Are women who do not always use a condom for sex with bisexual men.

Not enough health care providers know about PrEP.

40,000

About 40,000 HIV infections are diagnosed each year in the US.

In 2015, 34% of primary care doctors and nurses had never heard of PrEP (2015 survey).
All prescribing health care providers can deliver PrEP care, including test for HIV, ask about sex and drug use behaviors to determine their patient's risk of getting HIV, and prescribe PrEP when indicated.

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Infographics

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What Can Be Done

The Federal government is

Increasing access to PrEP and other HIV prevention and health care services as recommended in the National HIV/AIDS Strategy for the United States .
Ensuring coverage of recommended preventive services, such as HIV testing, without cost sharing in most health insurance plans.
Educating health care providers and people at high risk about PrEP through health department programs, social marketing campaigns, and other training and technical assistance efforts.
Helping to monitor PrEP use and its effects.

Health care providers can

Test patients for HIV as a regular part of medical care. Discuss HIV risks and continued use of prevention methods, including condom use, with all patients.
Follow the 2014 PrEP Clinical Practice Guidelines to perform recommended tests and prescribe PrEP to patients without HIV who could benefit.
Counsel patients who can benefit from PrEP on how to take it every day and help them apply for insurance or other programs to pay for PrEP.
Schedule appointments for patients using PrEP every 3 months for follow-up, including HIV testing and prescription refills.

State and local health departments and community-based organizations can

Raise awareness about PrEP use, train health care providers, and develop policies and procedures that will increase access to PrEP.
Monitor PrEP use among those at highest risk for HIV.
Educate people about risky sexual and drug use behaviors and ways to reduce their risk, including PrEP and how to get it.

Everyone can

Get tested for HIV and know their status.
Learn how HIV is transmitted and how it can be prevented.
Talk to their health care providers about HIV risk and ways to prevent it, including PrEP, condom use, abstinence, drug treatment, and HIV treatment for people with HIV.

Everyone taking PrEP can

Take PrEP every day to give it the best chance to work.
See their health care provider every 3 months for follow-up, including HIV testing and PrEP refills.
Take other actions to further reduce HIV and STD risk.