Expert insights:
Topics in HIV
prevention

HIV in the US has evolved over time and so has our approach to helping prevent it. Join the conversation as PrEP (pre-exposure prophylaxis) experts discuss the latest in HIV prevention strategies and how they help keep sexual health conversations going in their clinics. Register for an upcoming HIV prevention webinar or select a video to learn more.

DESCOVY FOR PrEP® Webinars

Register for a Live Virtual Event
HIV Prevention as Primary Care

TAVELL KINDALL, AACRN, PhD, AAHIVS, DNP Wednesday, December 4, 2024 1:00 PM ET

Understand PrEP as a primary preventive care service and learn strategies for normalizing conversations about PrEP medication as part of a sexual health discussion. We will also discuss DESCOVY FOR PrEP® as an HIV prevention option.

Register
Register for a Live Virtual Event
Identifying People Who May Benefit From PrEP Medication

MARIA SZABELA, MD Wednesday, December 11, 2024 3:00 PM ET

It is important to know what communities may have a higher likelihood of HIV acquisition, and identify people who want or need PrEP medication as one part of an overall HIV prevention strategy. See practical strategies to effectively initiate discussions about HIV prevention options and also get information on the critical role of PrEP medication for people who want or need it. We will also discuss DESCOVY FOR PrEP® as an HIV prevention option.

Register

These non-CME educational programs and speakers are sponsored by Gilead Sciences, Inc.

Digital Library

Contents

Transcript

(0:02)

Introduction

(0:17)

PrEP: An effective HIV prevention strategy

(1:10)

Regional disparities in PrEP uptake and HIV diagnoses

(1:50)

Normalizing PrEP use

(2:38)

PrEP: A potential gateway to routine care

(3:08)

Helping end the HIV epidemic

Introduction [0:02]

My name is Jonathon Anderson, and I am the US Medical Affairs HIV prevention lead at Gilead.

I live in Atlanta with my family. I'm originally from St. Louis, and I've been a pharmacist for about 12 and a half years now.

PrEP: An effective HIV prevention strategy [0:17]

The data has shown that PrEP has made an impact on HIV diagnoses in the United States. When you look at areas where PrEP uptake is the highest, we see the greatest decreases in HIV diagnoses—compared to areas where PrEP uptake was the lowest.

So, it's clear that PrEP is an effective HIV prevention strategy, and the CDC recommends using PrEP to help reduce HIV diagnoses.

For years, people who may benefit from PrEP—even before PrEP existed—had to rely on themselves to protect themselves. And it's time that we as a community—come together to make sure that everyone knows what PrEP is, that everyone knows that it's a socially accepted HIV prevention intervention.

It's one tool in a larger toolbox that we need to do a better job of normalizing.

Regional disparities in PrEP uptake and HIV diagnoses [1:10]

We continue to have the lowest PrEP uptake and the highest number of new HIV diagnoses in the South.

These disparities are driven in large part by social and structural inequalities like racism, stigma, homophobia, poverty—and those all impact access to healthcare.

So if we can identify the solutions that we need to implement—whether it be destigmatization programs, whether it's HIV testing programs—if we can find out what it takes to make an impact for the people of the South, we can identify what it's gonna take to make an impact on the epidemic across the nation.

Normalizing PrEP use [1:50]

The CDC has been very clear about the role that providers can play in normalizing sexual health conversations, specifically as a part of that conversations around HIV prevention and PrEP.

They say that all sexually active individuals should have a conversation with their providers about HIV prevention and PrEP.

If providers take the words of the CDC guidelines and really engage all sexually active adults and adolescents, it's gonna go a really long way to normalize this conversation. It could be as normalized as having a conversation about hypertension or diabetes.

Primary care providers have a real role when it comes to healthcare screenings and HIV prevention, and sexual health should absolutely be a part of that.

PrEP: A potential gateway to routine care [2:38]

I think PrEP can be extremely empowering. People who use PrEP are taking an active part in their sexual health.

And in getting people who may benefit from PrEP into care, you're able to address the other needs that they have, whether it be primary care screenings or understanding what their other healthcare needs are.

This may be the first time that these folks are really engaging in their health, and that's something that we can't lose sight of.

Helping end the HIV epidemic [3:08]

It's time for everybody to get involved in HIV prevention. This epidemic has been going on for far too long, given the tools that we have today.

We need to normalize PrEP as a society. We need to accept the communities that are most impacted by HIV, and we need to acknowledge that those communities deserve the special care and attention that they've lacked for so long. That's the only way we're gonna end the epidemic, and we're at that moment in time.

Watch to learn more about engaging and educating young men on HIV prevention.

PrEP Use in Young MSM

Learn more about engaging and educating young men on HIV prevention.

(0:02)

Introduction

(0:25)

HIV diagnoses and PrEP use in young MSM

(1:39)

Approaching sexual health conversations with young MSM

(2:32)

Engaging young MSM in HIV prevention conversations

(3:50)

An opportunity to connect with young individuals

Introduction [0:02]

My name is David Malebranche. I am a board-certified internal medicine physician with specialties in HIV prevention and treatment as well as LGBTQ health racial inequities in medicine.

I live in Atlanta, Georgia, and I'm currently the Senior Director of Global Medical Affairs at Gilead Sciences.

HIV diagnoses and PrEP use in young MSM [0:25]

According to the 2020 CDC estimates, about 3 out of every 5, or 60%, of new HIV diagnoses in this country are among young MSM, or men who have sex with men, between the ages of 13 and 34.

Now, if you shift gears and look to who is actually getting PrEP, it's not that same population. So only 23% of young men who have sex with men ages 16 to 34 are receiving PrEP.

Some of the barriers that I see commonly among young men who have sex with men when it comes to PrEP uptake have partly to do with what's going on in their individual lives and then what happens once they get into the clinical setting.

So with regards to their individual lives, you're dealing with stigma, especially with young people. They're still figuring out what they like sexually.

And then when they get into the office setting, you basically have some providers that will still ask them questions when they say, “Hey, I want to explore PrEP for HIV prevention.” And people will say, “Well, why don't you just use a condom?”

So, when you hear that immediately, that's a huge barrier because you know, at that point, that the person that you trust to get you HIV prevention is not gonna be receptive to what you're saying.

Approaching sexual health conversations with young MSM [1:39]

HIV prevention is a part of our overall sexual health approach and, for me, it's just a matter of really starting as a clinician with a sexual history and having a conversation with patients or individuals that really makes them feel comfortable.

Particularly when we focus on young men who have sex with men, I'm thinking about some of the experiences that they may have had, with society, with discrimination on different levels.

So, I want to be very sensitive to the stigma part of it.

The 3 tenets I use with a sexual health conversation is 1, to normalize it—let them know that these are questions that we talk about with everybody.

2, explain the rationale so they understand that this helps me take better care of you as a provider. And then 3, you want to reassure them. So let them know that this conversation that's happening between you and them is gonna be private.

Engaging young MSM in HIV prevention conversations [2:32]

The new CDC guidelines upgraded from previous versions…instead of using specific labels of people and groups that would benefit from PrEP, they actually expanded the language to include anyone who is sexually active—adults or adolescents.

It completely changes the game. And so, as clinicians, instead of just looking at people to see if they fit in those boxes about who would benefit from PrEP, it opens it up and encourages us to just have a general sexual health conversation.

MSM may not be a sexual identity that patients actually jive with. And then as far as risk is concerned, when people are having sex, whether it's condomless or not, no one likes to hear that they're necessarily engaging in risky sex.

Our role as healthcare providers is not to be the condom police. We're supposed to listen to what our patients tell us and use our best knowledge and experience to give them the best options for them and their sexual partners.

You want to encourage PrEP for HIV prevention, but you also want to encourage that they adopt or explore other safer sex practices at the same time. Education on condom use is important in helping to protect individuals from STIs.

An opportunity to connect with young individuals [3:50]

Providers may only get one chance to build trust and rapport with patients.

What you say to them can be life-changing and life-affirming instead of the negative messaging they receive every day.

This is that one person, this is that one moment that they have, and you have an opportunity to either turn them away or help them become more engaged.

Watch to learn more about the impact of PrEP on new HIV diagnoses.

Impact of PrEP on New HIV Diagnoses

Learn more about the impact of PrEP on new HIV diagnoses.

(0:02)

Introduction

(0:17)

PrEP: An effective HIV prevention strategy

(1:10)

Regional disparities in PrEP uptake and HIV diagnoses

(1:50)

Normalizing PrEP use

(2:38)

PrEP: A potential gateway to routine care

(3:08)

Helping end the HIV epidemic

Introduction [0:02]

My name is Jonathon Anderson, and I am the US Medical Affairs HIV prevention lead at Gilead.

I live in Atlanta with my family. I'm originally from St. Louis, and I've been a pharmacist for about 12 and a half years now.

PrEP: An effective HIV prevention strategy [0:17]

The data has shown that PrEP has made an impact on HIV diagnoses in the United States. When you look at areas where PrEP uptake is the highest, we see the greatest decreases in HIV diagnoses—compared to areas where PrEP uptake was the lowest.

So, it's clear that PrEP is an effective HIV prevention strategy, and the CDC recommends using PrEP to help reduce HIV diagnoses.

For years, people who may benefit from PrEP—even before PrEP existed—had to rely on themselves to protect themselves. And it's time that we as a community—come together to make sure that everyone knows what PrEP is, that everyone knows that it's a socially accepted HIV prevention intervention.

It's one tool in a larger toolbox that we need to do a better job of normalizing.

Regional disparities in PrEP uptake and HIV diagnoses [1:10]

We continue to have the lowest PrEP uptake and the highest number of new HIV diagnoses in the South.

These disparities are driven in large part by social and structural inequalities like racism, stigma, homophobia, poverty—and those all impact access to healthcare.

So if we can identify the solutions that we need to implement—whether it be destigmatization programs, whether it's HIV testing programs—if we can find out what it takes to make an impact for the people of the South, we can identify what it's gonna take to make an impact on the epidemic across the nation.

Normalizing PrEP use [1:50]

The CDC has been very clear about the role that providers can play in normalizing sexual health conversations, specifically as a part of that conversations around HIV prevention and PrEP.

They say that all sexually active individuals should have a conversation with their providers about HIV prevention and PrEP.

If providers take the words of the CDC guidelines and really engage all sexually active adults and adolescents, it's gonna go a really long way to normalize this conversation. It could be as normalized as having a conversation about hypertension or diabetes.

Primary care providers have a real role when it comes to healthcare screenings and HIV prevention, and sexual health should absolutely be a part of that.

PrEP: A potential gateway to routine care [2:38]

I think PrEP can be extremely empowering. People who use PrEP are taking an active part in their sexual health.

And in getting people who may benefit from PrEP into care, you're able to address the other needs that they have, whether it be primary care screenings or understanding what their other healthcare needs are.

This may be the first time that these folks are really engaging in their health, and that's something that we can't lose sight of.

Helping end the HIV epidemic [3:08]

It's time for everybody to get involved in HIV prevention. This epidemic has been going on for far too long, given the tools that we have today.

We need to normalize PrEP as a society. We need to accept the communities that are most impacted by HIV, and we need to acknowledge that those communities deserve the special care and attention that they've lacked for so long. That's the only way we're gonna end the epidemic, and we're at that moment in time.

Watch to learn more about reframing HIV prevention and emphasizing its importance to sexual health in the Black Community.

PrEP Use in the Black Community

Learn more about reframing HIV prevention and emphasizing its importance to sexual health in the Black community.

(0:02)

Introduction

(0:24)

PrEP use is lowest amongst Black MSM and transgender women

(1:19)

Helping to support PrEP uptake in the Black community

(2:20)

Raising awareness of programs that increase access to HIV prevention

(3:07)

Reframing HIV prevention and emphasizing its importance to sexual health

Introduction [0:02]

My name is David Malebranche. I am a board-certified internal medicine physician with specialties in HIV prevention and treatment as well as LGBTQ health racial inequities in medicine.

I live in Atlanta, Georgia, and I'm currently the Senior Director of Global Medical Affairs at Gilead Sciences.

PrEP use is lowest amongst Black MSM and transgender women [0:24]

Black men, particularly Black MSM, are at the top of the populations most affected by HIV in the United States and demonstrate some of the lowest rates of receiving PrEP. In 2019, Black men accounted for three-quarters of new HIV diagnoses among all Black people in the United States.

A CDC analysis found that Black transgender women accounted for 62% of HIV diagnoses among all trans women with HIV living in seven major US cities.

When it comes to PrEP uptake, you're really thinking about who it's marketed for.

When it initially came out in 2012, the focus a lot was on LGBTQ communities, particularly White LGBTQ communities.

Black communities didn't really feel that PrEP was for them. I heard a lot of people saying, ‘Isn't that that gay drug?’ And by ‘gay’ they meant ‘White gay,’ so they didn't feel it was necessarily for Black communities.

Helping to support PrEP uptake in the Black community [1:19]

We're faced a lot of the societal issues that prevent equitable PrEP uptake in Black communities, and particularly among Black men who have sex with men and transgender women.

Institutionally, some of the ways I've addressed these barriers in my previous practice included flyers and educational information showing Black people. If you don't have brochures or images that reflect the diversity of the community that you're serving or utilize language that encourages sexual health conversations, people may not feel represented or comfortable there.

You could also add prompts on the clinic website or app that mention PrEP use and encourage conversations with your provider, including reminders in the electronic medical record for clinicians to ask about sexual health and discuss HIV testing.

And then finally, actually hiring a lot of people from the community in various roles, whoever it may be that represents the community that you're serving; make people feel like there's a safer space there and that it's for them.

Raising awareness of programs that increase access to HIV prevention [2:20]

Limited access to affordable healthcare coverage is one of the most important factors affecting PrEP use.

Continued assistance programs and policies that allow PrEP to be accessed even when uninsured, as well as financial assistance with lab draws and clinic fees for follow-up, are crucial to reach Black MSM and transgender women.

Providers need to be made aware of and educated on certain PrEP medications and what resources are available to reach Black and transgender communities. For example, in 2019, the United States Preventive Services Task Force issued its highest recommendation Grade A for PrEP medication and ancillary services.

Reframing HIV prevention and emphasizing its importance to sexual health [3:07]

A lot of providers may not be well versed in sexual health or HIV prevention. We need a lot more education to bring them up to speed on where we are right now. There's always room for improvement with the way we approach HIV prevention as part of sexual health; as clinicians, we should work harder at helping people achieve the sexual lives they want instead of being judgmental of the kind of sex they're having.

The goal as a medical provider is not to compound the oppressive forces that people may feel in their day-to-day existence. When they come in to see you, they are looking at you to be the oasis in a desert of stigma and bias.

Providers could help normalize and reframe PrEP by emphasizing sexual health and HIV prevention as part of primary care. When a provider is having a conversation about sexual health, we should be asking what it means to have a healthy sex life. What does that look like for you? What's your priority regarding your sexual health? What would make this visit be successful for you? If you actually approach from that standpoint, where it's not, ‘As the clinician, what I feel is the top priority for your visit today,’ but as the patient, ‘What's your top priority today?’

Then you can have a successful encounter.

MSM=men who have sex with men.