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Another study reports PrEP effectiveness

3 of 275 seroconverted on Truvada: researchers

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PrEP, gay news, Washington Blade
PrEP, gay news, Washington Blade

A new study offers more evidence that pre-exposure prophylaxis (PrEP) can be an effective HIV prevention strategy.

NEW YORK — A study published last week offers more evidence that pre-exposure prophylaxis (PrEP) is an effective prevention strategy for keeping sexually active gay men HIV-negative.

Previous studies have shown that Truvada can reduce the risk of HIV infection but it was unclear if the benefits would be offset by an increase in risky behavior. But as British researchers report in the Sept. 9 edition of the Lancet, Truvada is highly effective, U.S. News & World Report and several other outlets report.

A team of researchers led by Sheena McCormack, of the Medical Research Council clinical trials unit at University College London, sought to investigate this issue.

The randomized trial, which was conducted at 13 sexual health clinics in England, involved HIV-negative gay men who had had anal sex at least once without a condom within 90 days.

The researchers randomly assigned 275 of the men to receive Truvada right away. Another 269 men received the treatment after a delay of one year. The researchers conducted a follow-up with the men every three months. The participants and the researchers were aware of their assigned treatment group, U.S. News & World Report reports.

Based on early findings suggesting that PrEP is highly effective, the trial steering committee recommended in October 2014 that all participants in the delayed-treatment group be offered the preventive treatment.

Among the men who received treatment right away, three HIV infections occurred, compared to 20 in the delayed-treatment group, the study found. The researchers calculated those in the immediate-treatment group had an 86 percent relative reduction in their risk for infection with the virus compared to the group that received delayed treatment, U.S. News & World Report reports.

Meanwhile, the prevalence of sexually transmitted infections, such as syphilis, gonorrhea or chlamydia, was similar in both treatment groups.

“This finding is highly encouraging for PrEP implementation, although quantifying the likely demand in the U.K. remains challenging.The impressive reduction in HIV incidence in people taking PrEP, without a measurable increase in other sexually transmitted infections, is reassuring for clinical, community and public health stakeholders,” McCormack and colleagues concluded, according to U.S. News & World Report.

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Health

White House urged to expand PrEP coverage for injectable form

HIV/AIDS service organizations made call on Wednesday

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Apretude is a long-lasting PrEP injection that has proven to be significantly more effective at reducing the risk of sexually-acquired HIV. (Photo courtesy of ViiV Healthcare)

A coalition of 63 organizations dedicated to ending HIV called on the Biden-Harris administration on Wednesday to require insurers to cover long-acting pre-exposure prophylaxis (PrEP) without cost-sharing.

In a letter to Chiquita Brooks-LaSure, administrator of the Centers for Medicare and Medicaid Services, the groups emphasized the need for broad and equitable access to PrEP free of insurance barriers.

Long-acting PrEP is an injectable form of PrEP that’s effective over a long period of time. The FDA approved Apretude (cabotegravir extended-release injectable suspension) as the first and only long-acting injectable PrEP in late 2021. It’s intended for adults and adolescents weighing at least 77 lbs. who are at risk for HIV through sex.

The U.S. Preventive Services Task Force updated its recommendation for PrEP on Aug. 22, 2023, to include new medications such as the first long-acting PrEP drug. The coalition wants CMS to issue guidance requiring insurers to cover all forms of PrEP, including current and future FDA-approved drugs.

“Long-acting PrEP can be the answer to low PrEP uptake, particularly in communities not using PrEP today,” said Carl Schmid, executive director of the HIV+Hepatitis Policy Institute. “The Biden administration has an opportunity to ensure that people with private insurance can access PrEP now and into the future, free of any cost-sharing, with properly worded guidance to insurers.”

Currently, only 36 percent of those who could benefit from PrEP are using it. Significant disparities exist among racial and ethnic groups. Black people constitute 39 percent of new HIV diagnoses but only 14 percent of PrEP users, while Latinos represent 31 percent of new diagnoses but only 18 percent of PrEP users. In contrast, white people represent 24 percent of HIV diagnoses but 64 percent of PrEP users.

The groups also want CMS to prohibit insurers from employing prior authorization for PrEP, citing it as a significant barrier to access. Several states, including New York and California, already prohibit prior authorization for PrEP.

Modeling conducted for HIV+Hep, based on clinical trials of a once every 2-month injection, suggests that 87 percent more HIV cases would be averted compared to daily oral PrEP, with $4.25 billion in averted healthcare costs over 10 years.

Despite guidance issued to insurers in July 2021, PrEP users continue to report being charged cost-sharing for both the drug and ancillary services. A recent review of claims data found that 36 percent of PrEP users were charged for their drugs, and even 31 percent of those using generic PrEP faced cost-sharing.

The coalition’s letter follows a more detailed communication sent by HIV+Hepatitis Policy Institute to the Biden administration on July 2.

Signatories to the community letter include Advocates for Youth, AIDS United, Equality California, Fenway Health, Human Rights Campaign, and the National Coalition of STD Directors, among others.

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Health

Young gay Latinos see rising share of new HIV cases, leading to call for targeted funding

Fernando Hermida diagnosed four months after asking for asylum

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Fernando Hermida drives to Orlando, Fla., to attend a medical appointment for HIV care on May 27, 2024. (Associated Press photo by Laura Bargfeld)

Four months after seeking asylum in the U.S., Fernando Hermida began coughing and feeling tired. He thought it was a cold. Then sores appeared in his groin and he would soak his bed with sweat. He took a test.

On New Year’s Day 2022, at age 31, Hermida learned he had HIV.

“I thought I was going to die,” he said, recalling how a chill washed over him as he reviewed his results. He struggled to navigate a new, convoluted health care system. Through an HIV organization he found online, he received a list of medical providers to call in D.C., where he was at the time, but they didn’t return his calls for weeks. Hermida, who speaks only Spanish, didn’t know where to turn.

By the time of Hermida’s diagnosis, the U.S. Department of Health and Human Services was about three years into a federal initiative to end the nation’s HIV epidemic by pumping hundreds of millions of dollars annually into certain states, counties, and U.S. territories with the highest infection rates. The goal was to reach the estimated 1.2 million people living with HIV, including some who don’t know they have the disease.

Overall, estimated new HIV infection rates declined 23 percent from 2012 to 2022. But a KFF Health News-Associated Press analysis found the rate has not fallen for Latinos as much as it has for other racial and ethnic groups.

While African Americans continue to have the highest HIV rates in the U.S. overall, Latinos made up the largest share of new HIV diagnoses and infections among gay and bisexual men in 2022, per the most recent data available, compared with other racial and ethnic groups. Latinos, who make up about 19 percent of the U.S. population, accounted for about 33 percent of new HIV infections, according to the Centers for Disease Control and Prevention.

The analysis found Latinos are experiencing a disproportionate number of new infections and diagnoses across the U.S., with diagnosis rates highest in the Southeast. Public health officials in Mecklenburg County, North Carolina, and Shelby County, Tennessee, where data shows diagnosis rates have gone up among Latinos, told KFF Health News and the AP that they either don’t have specific plans to address HIV in this population or that plans are still in the works. Even in well-resourced places like San Francisco, HIV diagnosis rates grew among Latinos in the last few years while falling among other racial and ethnic groups despite the county’s goals to reduce infections among Latinos.

“HIV disparities are not inevitable,” Robyn Neblett Fanfair, director of the CDC’s Division of HIV Prevention, said in a statement. She noted the systemic, cultural, and economic inequities — such as racism, language differences, and medical mistrust.

And though the CDC provides some funds for minority groups, Latino health policy advocates want HHS to declare a public health emergency in hopes of directing more money to Latino communities, saying current efforts aren’t enough.

“Our invisibility is no longer tolerable,” said Vincent Guilamo-Ramos, co-chair of the Presidential Advisory Council on HIV/AIDS

Lost without an interpreter

Hermida suspects he contracted the virus while he was in an open relationship with a male partner before he came to the U.S. In late January 2022, months after his symptoms started, he went to a clinic in New York City that a friend had helped him find to finally get treatment for HIV.

Too sick to care for himself alone, Hermida eventually moved to Charlotte to be closer to family and in hopes of receiving more consistent health care. He enrolled in an Amity Medical Group clinic that receives funding from the Ryan White HIV/AIDS Program, a federal safety-net plan that serves over half of those in the nation diagnosed with HIV, regardless of their citizenship status.

His HIV became undetectable after he was connected with case managers. But over time, communication with the clinic grew less frequent, he said, and he didn’t get regular interpretation help during visits with his English-speaking doctor. An Amity Medical Group representative confirmed Hermida was a client but didn’t answer questions about his experience at the clinic.

Hermida said he had a hard time filling out paperwork to stay enrolled in the Ryan White program, and when his eligibility expired in September 2023, he couldn’t get his medication.

He left the clinic and enrolled in a health plan through the Affordable Care Act marketplace. But Hermida didn’t realize the insurer required him to pay for a share of his HIV treatment.

In January, the Lyft driver received a $1,275 bill for his antiretroviral — the equivalent of 120 rides, he said. He paid the bill with a coupon he found online. In April, he got a second bill he couldn’t afford.

For two weeks, he stopped taking the medication that keeps the virus undetectable and intransmissible.

“Estoy que colapso,” he said. I’m falling apart. “Tengo que vivir para pagar la medicación.” I have to live to pay for my medication.

One way to prevent HIV is preexposure prophylaxis, or PrEP, which is regularly taken to reduce the risk of getting HIV through sex or intravenous drug use. It was approved by the federal government in 2012 but the uptake has not been even across racial and ethnic groups: CDC data show much lower rates of PrEP coverage among Latinos than among white Americans.

Epidemiologists say high PrEP use and consistent access to treatment are necessary to build community-level resistance.

Carlos Saldana, an infectious disease specialist and former medical adviser for Georgia’s health department, helped identify five clusters of rapid HIV transmission involving about 40 gay Latinos and men who have sex with men from February 2021 to June 2022. Many people in the cluster told researchers they had not taken PrEP and struggled to understand the health care system.

They experienced other barriers, too, Saldana said, including lack of transportation and fear of deportation if they sought treatment.

Latino health policy advocates want the federal government to redistribute funding for HIV prevention, including testing and access to PrEP. Of the nearly $30 billion in federal money that went toward things like HIV health care services, treatment, and prevention in 2022, only 4% went to prevention, according to a KFF analysis.

They suggest more money could help reach Latino communities through efforts like faith-based outreach at churches, testing at clubs on Latin nights, and training bilingual HIV testers.

Latino Rates Going Up

Congress has appropriated $2.3 billion over five years to the Ending the HIV Epidemic initiative, and jurisdictions that get the money are to invest 25 percent of it in community-based organizations. But the initiative lacks requirements to target any particular groups, including Latinos, leaving it up to the cities, counties, and states to come up with specific strategies.

In 34 of the 57 areas getting the money, cases are going the wrong way: Diagnosis rates among Latinos increased from 2019 to 2022 while declining for other racial and ethnic groups, the KFF Health News-AP analysis found.

Starting Aug. 1, state and local health departments will have to provide annual spending reports on funding in places that account for 30 percent or more of HIV diagnoses, the CDC said. Previously, it had been required for only a small number of states.

In some states and counties, initiative funding has not been enough to cover the needs of Latinos.

South Carolina, which saw rates nearly double for Latinos from 2012-2022, hasn’t expanded HIV mobile testing in rural areas, where the need is high among Latinos, said Tony Price, HIV program manager in the state health department. South Carolina can pay for only four community health workers focused on HIV outreach — and not all of them are bilingual.

In Shelby County, Tennessee, home to Memphis, the Latino HIV diagnosis rate rose 86 percent from 2012 to 2022. The health department said it got $2 million in initiative funding in 2023 and while the county plan acknowledges that Latinos are a target group, department director Michelle Taylor said: “There are no specific campaigns just among Latino people.”

Up to now, Mecklenburg County, North Carolina, didn’t include specific targets to address HIV in the Latino population — where rates of new diagnoses more than doubled in a decade but fell slightly among other racial and ethnic groups. The health department has used funding for bilingual marketing campaigns and awareness about PrEP.

Moving for medicine

When it was time to pack up and move to Hermida’s third city in two years, his fiancé, who is taking PrEP, suggested seeking care in Orlando, Fla.

The couple, who were friends in high school in Venezuela, had some family and friends in Florida, and they had heard about Pineapple Healthcare, a nonprofit primary care clinic dedicated to supporting Latinos living with HIV.

The clinic is housed in a medical office south of downtown Orlando. Inside, the mostly Latino staff is dressed in pineapple-print turquoise shirts, and Spanish, not English, is most commonly heard in appointment rooms and hallways.

“At the core of it, if the organization is not led by and for people of color, then we’re just an afterthought,” said Andres Acosta Ardila, the community outreach director at Pineapple Healthcare, who was diagnosed with HIV in 2013.

“¿Te mudaste reciente, ya por fin?” asked nurse practitioner Eliza Otero. Did you finally move? She started treating Hermida while he still lived in Charlotte. “Hace un mes que no nos vemos.” It’s been a month since we last saw each other.

They still need to work on lowering his cholesterol and blood pressure, she told him. Though his viral load remains high, Otero said it should improve with regular, consistent care.

Pineapple Healthcare, which doesn’t receive initiative money, offers full-scope primary care to mostly Latino males. Hermida gets his HIV medication at no cost there because the clinic is part of a federal drug discount program.

The clinic is in many ways an oasis. The new diagnosis rate for Latinos in Orange County, Florida, which includes Orlando, rose by about a third from 2012 through 2022, while dropping by a third for others. Florida has the third-largest Latino population in the U.S., and had the seventh-highest rate of new HIV diagnoses among Latinos in the nation in 2022.

Hermida, whose asylum case is pending, never imagined getting medication would be so difficult, he said during the 500-mile drive from North Carolina to Florida. After hotel rooms, jobs lost, and family goodbyes, he is hopeful his search for consistent HIV treatment — which has come to define his life the past two years — can finally come to an end.

“Soy un nómada a la fuerza, pero bueno, como me comenta mi prometido y mis familiares, yo tengo que estar donde me den buenos servicios médicos,” he said. I’m forced to be a nomad, but like my family and my fiancé say, I have to be where I can get good medical services.

That’s the priority, he said. “Esa es la prioridad ahora.”

KFF Health News and The Associated Press analyzed data from the U.S. Centers for Disease Control and Prevention on the number of new HIV diagnoses and infections among Americans ages 13 and older at the local, state, and national levels. This story primarily uses incidence rate data — estimates of new infections — at the national level and diagnosis rate data at the state and county level.

Bose reported from Orlando, Fla.. Reese reported from Sacramento, Calif. AP video journalist Laura Bargfeld contributed to this report.

The Associated Press Health and Science Department receives support from the Robert Wood Johnson Foundation. The AP is responsible for all content.

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation.

A Project of KFF Health News and the Associated Press co-published by Univision Noticias

CREDITS:

Reporters: Vanessa G. Sánchez, Devna Bose, Phillip Reese

Cinematography: Laura Bargfeld

Photography: Laura Bargfeld, Phelan M. Ebenhack

Video Editing: Federica Narancio, Kathy Young, Esther Poveda

Additional Video: Federica Narancio, Esther Poveda

Web Production: Eric Harkleroad, Lydia Zuraw

Special thanks to Lindsey Dawson

Editors: Judy Lin, Erica Hunzinger

Data Editor: Holly Hacker

Social Media: Patricia Vélez, Federica Narancio, Esther Poveda, Carolina Astuya, Natalia Bravo, Juan Pablo Vargas, Kyle Viterbo, Sophia Eppolito, Hannah Norman, Chaseedaw Giles, Tarena Lofton

Translation: Paula Andalo

Copy Editing: Gabe Brison-Trezise

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — an independent source of health policy research, polling, and journalism. Learn more about KFF.

Subscribe to KFF Health News’ free Morning Briefing.

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Commentary

Asian American and LGBTQ: A Heritage of Pride

May is Asian American, Native Hawaiian and Pacific Islander Heritage Month

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Glenn D. Magpantay (Photo courtesy of Glenn D. Magpantay)

Asian Americans and Pacific Islanders (APIs) are the nation’s fastest growing racial minority group by 2040, one in 10 Americans will be of Asian ancestry. And, while many Americans think that anti-Asian hate and racism towards Asian Americans has disappeared, the community disagrees.

The Asian American Foundation which found that Asian Americans are continually subjected to hate, violence, and discrimination, baldly reveals that disparity. 

  • 33 percent of Americans think hate towards Asian Americans has increased in the past year, compared to 61 percent of Asian Americans themselves.
  • In the past year, 32 percent of Asian Americans across the country reported being called a racial slur; 29 percent said they were verbally harassed or verbally abused.
  • Southeast Asian Americans report even higher incidences of being subject to racial slurs (40 percent), verbal harassment or abuse (38 percent), and threats of physical assault (22 percent).
  • Many Asian Americans live in a state of fear and anxiety with 41 percent of Asian American/ Native Hawaiian/Pacific Islander (AANHPI) believing they will likely be the victims of a physical attack due to their race, ethnicity, or religion. These numbers are disturbing.  

I serve as the only Asian American Pacific Islander member on the U.S. Commission on Civil Rights. And, I am the first and only queer AAPI on the U.S. commission. I am deeply honored to both serve my country and represent my Asian Americans and Pacific Islander community.    

Last year, the commission investigated the Federal Response to Anti-Asian Racism in the United States. With congressional authorization, the report documented the experiences of AANHPIs in the U.S. since the dubbing of COVID-19 as the “China Virus” infecting people with the “Kung Flu” by government leadership. Words matter, as this report shows.

This report has a deep personal connection for me. I am the survivor of a hate crime of 25 years ago for being gay, and the victim of a hate crime for being Asian 25 months ago 

The Stop AAPI Hate Coalition reported that bias incidents against individuals who are Asian and lesbian, gay, bisexual, transgender or queer (LGBTQ) were most prominent between 2019 and 2022, highlighting the intersectional nature of these incidents. For example, two transgender Asian women stated: 

“I was with my new boyfriend at a restaurant. When we walked in the server started calling me names … a b—h, ch—k, tra—i.e. … He said I have a big fat p—s, and told me to go back to China. Then my boyfriend proceeded to walk in the restaurant and when I took a step forward, the server hit me, so I left.” 

“Left a restaurant with friends in the Asian district of town. A man began to follow me calling out ‘Hey you f—got c—k!’ and ‘Come here you virus!’ I began to walk fast towards a crowd until he stopped following me.”

To address these and other equally appalling experiences, I helped shepherd the bipartisan Commission on Civil Rights recommendations to the president, Congress, and the nation that: 

  • Prosecutors and law enforcement should vigorously investigate and prosecute hate crimes and harassment against Asian Americans, as well as Asian Americans who are LGBTQ.
  • First responders should be trained to understand what exactly constitutes a hate crime in their jurisdiction, including the protections of LGBTQ people.
  • Federal, state, and local law enforcement and victim services should identify deficiencies in their programs for individuals with limited English proficiency

Greater language access will make an enormous impact for the Asian American community as one in five Asian individuals speak a language other than English at home. A third (34 percent) is limited English proficient. The most frequently spoken languages are Chinese, Korean, Vietnamese, Tagalog, Thai, Khmer, Bengali, Gujarati, Hindi, and Punjabi.   

For me, this report comes full circle. Since 1988, I’ve lobbied for passage of LGBTQ-inclusive federal and state laws to prevent hate crimes. Since 2001, I’ve supported South Asian and Muslim victims of post 9/11 violence. In response to the shootings at the Pulse nightclub in Orlando, Fla, in 2016; Atlanta Spa in Georgia in 2021; and Club Q in Colorado Springs, Colo., in 2022, I‘ve trained over 3,000 lawyers, law students, and community leaders on hate crimes law.  

And yet, our work is not yet done. 

May is Asian Pacific American Heritage Month. June is LGBTQ Pride Month. Despite these challenges, we are resilient. Let us join together in celebrating our Heritage of Pride 

Glenn D. Magpantay, Esq., is a long-time civil rights attorney, professor of law and Asian American Studies, and LGBTQ rights activist. Glenn is a founder and former Executive Director of the National Queer Asian Pacific Islander Alliance (NQAPIA). He is principal at Magpantay & Associates: A nonprofit consulting and legal services firm. In 2023, the U.S. Senate (majority) appointed Glenn to the U.S. Commission on Civil Rights to advise Congress and the White House on the enforcement of civil rights laws and development of national civil rights policy. 

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