Pride, prejudice and... PrEP

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Appraising the impact of new prevention technologies. This presentation was given by Dean Murphy (AFAO) at the AFAO HIV Educators Conference 2010.

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  • By the end of 2010 several studies on HIV pre-exposure prophylaxis (PrEP)—including two phase III trials—are scheduled to have concluded and/or have released results. In this presentation I will just cover three things: 1) The when of PrEP. What is on the horizon. Also really briefly the what, who and where of current PrEP clinical. [which ARVs are being tested as potential prophylaxis against HIV infection, in which combination, and the particular dosing strategies; who is enrolled the current trials, meaning the primary HIV risk behaviours of the trial populations; and 4) where the trials are taking place.] 2) A reminder of some of the associations with HIV-related stigma among gay and other MSM in Australia from John de Wit’s presentation yesterday. 3) Some speculation on the impact of PrEP. That’s is, how might PrEP increase, or even decrease, stigma and discrimination. This speculation is based on some of the experience of PrEP clinical trials and the introduction of other prevention technologies, conversations with other working in the field, and the approach that PrEP is not a stable object that will do the same thing in all the environments in which it is introduced. Its effects might rather be quite different. So, key questions are: how might the way PrEP interact with existing technologies to add to or reduce stigma? How might existing stigma affect what PrEP will look like in Australia?
  • This slide from a site formerly called PrEP watch which is jointly produced by the AIDS Vaccine Advocacy Coalition (AVAC) and UCLA shows the ongoing PrEP trials.
  • The second last column in the table shows the intervention arms of the current trials. The first candidate for PrEP is tenofovir on its own which you can see is being used in the first two trials at the top. However as you move down the column you can see (in the boxes with underlining) a number of trials are assessing Truvada (that is tenofovir in combination with FTC) as PrEP. The iPrEX trial of tenofovir and FTC which is due to release results in 2011 is the first phase III study to use a tenofovir/FTC combination rather than tenofovir alone, and is also the first phase III trial among MSM . Two studies are also looking at tenofovir as a topical microbicide.
  • Pride, prejudice and... PrEP

    1. 1. Pride, prejudice and... PrEP : appraising the impact of new prevention technologies Dean Murphy AFAO HIV Educators’ Conference 2010 Australian Federation of AIDS Organisations
    2. 2. Background <ul><li>By the end of 2010, results of some clinical trials of HIV pre-exposure prophylaxis (PrEP) will be released. </li></ul><ul><li>This presentation: </li></ul><ul><ul><li>PrEP trials </li></ul></ul><ul><ul><li>HIV-related stigma and discrimination </li></ul></ul><ul><ul><li>Possible impacts of PrEP </li></ul></ul>
    3. 3. Current PrEP trials: when
    4. 4. Current PrEP trials: what; who
    5. 5. Current PrEP trials: where
    6. 6. Expectations <ul><li>We don’t know much about expectations of PrEP among gay men & MSM </li></ul><ul><li>PrEP study by MSM Global Forum is starting now </li></ul><ul><li>In US, low levels of awareness of PrEP among gay and bisexual men, and very low levels of non-prescribed use </li></ul><ul><li>However, high acceptability if efficacious </li></ul>
    7. 7. HIV-related stigma and discrimination <ul><li>Experience of stigma associated with: </li></ul><ul><ul><li>More social engagement with other PLHIV </li></ul></ul><ul><ul><li>Greater importance of own serostatus identity </li></ul></ul><ul><ul><li>[Not associated with having HIV-negative or status unknown regular or casual partners] </li></ul></ul><ul><li>Expression of stigma associated with: </li></ul><ul><ul><li>Less social engagement with PLHIV and gay men </li></ul></ul><ul><ul><li>More perceived HIV transmission risk </li></ul></ul><ul><ul><li>Greater importance of own serostatus identity </li></ul></ul><ul><ul><li>[Not associated with having HIV-positive regular or casual partners] </li></ul></ul>
    8. 8. PrEP and increased HIV-related stigma? <ul><li>Attitudes towards people who seroconvert in the post-PrEP era </li></ul><ul><li>PrEP ‘failures’ (i.e. viral breakthrough) </li></ul><ul><li>Disclosure (e.g. for seroodiscordant couples) </li></ul><ul><li>Responsibility/criminalisation </li></ul><ul><li>Access </li></ul><ul><li>Designation of new risk groups (who are recommended for PrEP) </li></ul><ul><li>Resources </li></ul>
    9. 9. PrEP and decreased HIV-related stigma? <ul><li>Reduced HIV transmission risk </li></ul><ul><li>More serodiscordant relationships </li></ul><ul><li>Less stigmatising attitude towards HIV in general </li></ul><ul><li>Serostatus identity? </li></ul><ul><li>Re-engagement with HIV prevention </li></ul><ul><li>New risk reduction strategies? </li></ul>
    10. 10. Keeping up to date… <ul><li>AIDS Vaccine Advocacy Coalition (AVAC) </li></ul><ul><ul><li>http://www.avac.org (This site has replaced prepwatch.org) </li></ul></ul><ul><li>Community HIV/AIDS Mobilization Project (CHAMP) </li></ul><ul><ul><li>http://www.champnetwork.org/iprep-research-agenda </li></ul></ul><ul><li>AFAO </li></ul><ul><ul><li>http://www.afao.org.au/ </li></ul></ul><ul><li>National Institutes of Health </li></ul><ul><ul><li>http:// clinicaltrials.gov / </li></ul></ul>

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