If PrEP Decreases HIV Transmission, What Is Impeding Its Uptake?

"...Despite the demonstrated efficacy of PrEP, and the approval by regulatory bodies in the US, uptake has not been rapid. In recent years, the concept of a continuum of HIV care has been a helpful heuristic for the assessment of the effectiveness of virological suppression at a population level [14]. In the current issue of Clinical Infectious Diseases, Kelley et al have reviewed some of the sources of attenuation in the Atlanta HIV prevention continuum (i.e. barriers to PrEP provision for high-risk MSM) [15]. Their data suggest that only about 15% of MSM who would be appropriate candidates for PrEP would likely access the medication. Part of the problem is that PrEP awareness remains low, albeit having increased somewhat over the past few years [16, 17]. Social disenfranchisement plays a role, i.e. MSM who are poorer or less educated appear to be less informed about PrEP [18]. Medical mistrust remains entrenched for some Black persons because of earlier adverse experiences with clinical research (e.g. the Tuskegee experiment) leading to tuning out new information [19]. Media campaigns by some “PrEP denialists” may have created confusion for some who might benefit from PrEP [20]..."

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By:  Kenneth H. Mayer1,2,3, and Douglas S. Krakower1,2,3 
1  The Fenway Institute - Fenway Health, Boston, MA, USA 
2  Beth Israel Deaconess Medical Center, Boston, MA, USA 
3  Harvard Medical School, Boston, MA, USA