Very few sexually active gay and bisexual men use prophylactic drug to prevent HIV transmission, study finds

Only 4 percent of sexually active gay and bisexual men in the United States use Truvada, a highly effective medication used to prevent the transmission of HIV, according to the results of a first-of-its-kind study.

Led by Psychology Professor Phillip Hammack, the study, "HIV Testing and Pre-Exposure Prophylaxis (PrEP) Use, Familiarity, and Attitudes among Gay and Bisexual Men in the United States: A National Probability Sample of Three Birth Cohorts," was published Sept. 7 in the journal PLOS ONE.

Truvada is a once-a-day prescription medication used to reduce the risk of HIV infection; it is the only FDA-approved form of pre-exposure prophylaxis, or PrEP, which is recommended by the Centers for Disease Control and Prevention (CDC) for those at high risk of HIV/AIDS.

"The extremely low rate of PrEP use, while not surprising given barriers to access in various parts of the country, is disappointing," said Hammack.

Researchers also found that most sexually active gay and bisexual men aged 18-25 are not tested for HIV annually, as recommended by the CDC, and 25 percent of young men have never been tested.

"I worry especially about younger men who didn't grow up with the concerns of HIV that men of older generations did," said Hammack. "The low rate of HIV testing probably reflects a degree of complacency and cultural amnesia about AIDS."

Conducted by the Williams Institute at UCLA School of Law, the study is the first to report on estimates of HIV testing and use of PrEP among gay and bisexual men using a national probability sample in the United States. In the study, researchers examined gay and bisexual men in three age groups: young (18-25), middle (34-41) and older (52-59).

"Our findings suggest that health education efforts are not adequately reaching sizable groups of men at risk for HIV infection," said principal investigator Ilan H. Meyer, Distinguished Senior Public Policy Scholar at the Williams Institute. "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."

Other key findings regarding PrEP use include:

• Visiting an LGBT health clinic and searching online for LGBT resources were associated with greater likelihood of PrEP use.
• 52 percent of young sexually active gay and bisexual men were familiar with PrEP as HIV prevention, compared with 79 percent of men aged 34-41.
• Bisexual and non-urban men were less familiar with PrEP compared with gay-identified and urban men.
• 68 percent of men who were familiar with PrEP as HIV prevention had a positive attitude toward PrEP use—despite the low level of usage.

Significant findings regarding HIV testing include:

• Only 45 percent of young sexually active gay and bisexual men had been tested for HIV at least annually, compared with 59 percent of men aged 34-41 and 36 percent of those aged 52-59.
• Approximately 8 percent of the middle and older groups of men had never been tested for HIV.
• Black gay/bisexual men were more likely than white men to meet recommendations for HIV testing, which may be due to recent efforts to target black men for HIV testing.
• Visiting an LGBT health clinic and being out as gay or bisexual to health care providers were associated with greater likelihood of HIV testing.

"In the early days of the AIDS epidemic, gay and bisexual men had to rely on LGBT community sources to receive information about HIV prevention," said Meyer. "Our findings suggest that contact with LGBT community resources—health clinics and online information—still serves an important role in HIV prevention."