2. PrEP as an HIV Prevention Tool in Queer Communities of Color: Barriers and Opportunities BACKGROUND Joanne Stekler, MD MPH

3. Lifetime risk of HIV in U.S.
Source: Centers for Disease Control and Prevention

4. What is PrEP? Pre-exposure prophylaxis =
HIV-negative people
taking HIV medications
before getting exposed
to prevent them from getting HIV infection.
Daily oral tenofovir-emtricitabine is currently the only medication FDA-approved for PrEP.

5. Does PrEP work?

6. PrEP side effects and safety
Nausea, headache, or fatigue may occur in first 2-4 weeks
“Startup Syndrome”
Monitoring at least every 6 months recommended
Renal Safety
TDF-FTC associated with small change (~1%) in bone density
No increase in fractures seen
Bone Effects
Source: US Public Health Service. Clinical practice guidelines for PrEP. May 2014.

7. Paying for PrEP
Project Inform:

8. Who is PrEP for?
Anyone with an HIV-positive sex partner or injecting partner
Recent bacterial STI (chlamydia, gonorrhea, or syphilis)
“High” number of sex partners
Inconsistent or no condom use
Commercial sex work
Anyone in an area with a high prevalence of HIV infection

9. PrEP uptake by race/ethnicity
Bush et al (Gilead), ICAAC 2016, session 371

10. Barriers to PrEP uptake
Knowledge about PrEP
Perception of risk
Cost and access to healthcare insurance and providers
Mistrust of medical community
Need for daily adherence
Stigma (e.g. “Truvada whore”)