Rates of HIV screening are alarmingly low in some populations of gay and bisexual men in the United States and only a small minority of eligible patients are taking Truvada as pre-exposure prophylaxis (PrEP) for HIV prevention, according to a recent study by the Williams Institute of the University of California, Los Angeles School of Law.
The Centers for Disease Control and Prevention (CDC) recommends all sexually active men who have sex with men (MSM) test annually for HIV and include PrEP in their HIV prevention methods. With a probability sample, the first that offers nationwide estimates, researchers found only 4% of MSMs are using PrEP and as many as 25% of young gay and bisexual men have never been tested for HIV—while fewer than half are screened at least once per year.
“Our findings suggest that health education efforts are not adequately reaching sizable groups of men at risk for HIV infection,” the study’s principal investigator, Ilan H. Meyer, Distinguished Senior Public Policy Scholar at the Williams Institute, said in a press release. “It is alarming that high- risk populations of men who are sexually active with same-sex partners are not being tested or taking advantage of treatment advances to prevent the spread of HIV.”
Nationwide, the number of new HIV infections has decreased year-over-year since 2010, a public health achievement that still does not mitigate the potential risks associated with low rates of HIV screening and PrEP use. Meanwhile, the spike in sexually transmitted infections (STI) like gonorrhea, chlamydia, and syphilis among MSM has been partially attributed to riskier behaviors among men who use PrEP. That conclusion, which is fueled in part by peer- reviewed research—and also, perhaps, by some sexual shaming or stigma—is challenged by the findings reported in the Williams Institute paper.
Lead study author Phillip Hammack, Ph.D., professor of psychology at the University of California, Santa Cruz, told the Los Angeles Blade: “Our data don’t support the idea that we can attribute the rise in STIs to PrEP use, at least not in a direct manner. I personally don’t think that’s what’s happening.” More responsible are a constellation of different cultural factors, from the availability of easy sex via hook-up apps to decreased anxiety about HIV/AIDS, Hammack explained. “I would speculate it has more to do with a culture shift about sex. More people are having sex today. We’re in sort of a quiet sexual revolution when it comes to new identities, new labels, and sexual behavior.”