HIV Prevention By Theo Hodge, Jr. MD for

HIV Prevalence in Certain Populations in the United States Is Higher Than in Some Nations With High Prevalence of HIV 1,2 3 3 3 4 4 5 5 6 6 6 6 6 6 6 1. Centers for Disease Control and Prevention. HIV Surveillance Report, 2014; vol. 26. http://www.cdc.gov/hiv/library/reports/surveillance/. Published November 2015. Accessed April 2017; 2. U.S. Census Bureau. Population estimates. http://www.census.gov/programs-surveys/popest/data/data-sets.2013.html. Accessed April 2017; 3. Annual Epidemiology and Surveillance Reports for the District of Columbia. HIV/AIDS, Hepatitis, STD and TB Administration (HAHSTA) Annual Report 2014; 4. AIDSVu. https://aidsvu.org/state/louisiana/new-orleans/. Accessed April 2017; 5. AIDSVu. https://aidsvu.org/state/new-york/new-york-city/. Accessed April 2017; 6. Prevalence of HIV, World Bank Group. http://data.worldbank.org/indicator/SH.DYN.AIDS.ZS. Accessed April 2017.

Major Disparities Exist in the Estimated Lifetime Risk of HIV Diagnosis in the US One in n: >282 159–282 98–158 <98 84 69 115 121 139 143 Lowest Risk Highest Risk 150 101 155 West Midwest 13 49 96 51 54 81 85 86 93 97 56 103 159 115 Northeast 102 98 138 South Hess K, et al. CROI 2016. Boston, MA. #52. Adapted from CDC at https://www.cdc.gov/nchhstp/newsroom/2016/croi-2016.html#Graphics2. Accessed April 2017.

Lifetime Risk of HIV Diagnosis Lifetime Risk of HIV Diagnosis by Race/Ethnicity Lifetime Risk of HIV Diagnosis Among MSM by Race/Ethnicity African-American Men 1 in 20 Total MSM 1 in 6 African-American Women 1 in 48 African- American MSM 1 in 2 Hispanic Men 1 in 48 Hispanic Women 1 in 227 Hispanic MSM 1 in 4 White Men 1 in 132 In addition to risk by race/ethnicity, relative sexual risk of HIV infection per 10,000 exposures (assuming no condom use) according to exposure type is as follows: Receptive anal intercourse: 138 Insertive anal intercourse: 11 Receptive vaginal intercourse: 8 Insertive vaginal intercourse: 4 Receptive fellatio/oral sex: Low Insertive fellatio/oral sex: Low Patel P, et al., AIDS 2014, 28:1509–1519. White Women 1 in 880 White MSM 1 in 11 The overall lifetime risk of HIV in the United States is 1 in 99 African-American men have highest lifetime risk of HIV of all races and ethnicities (1 in 20) African-American MSM (1 in 2) and Hispanic MSM (1 in 4) have even higher lifetime risk of HIV Hess K, et al. CROI 2016. Boston, MA. #52. Adapted from CDC at https://www.cdc.gov/nchhstp/newsroom/2016/croi-2016.html#Graphics2. Accessed April 2017.

Identification of Adult Candidates for TRUVADA for PrEP Uninfected individuals at high risk for sexually acquired HIV-1 may include: Individuals who engage in sexual activity in a high-prevalence area or social network AND have one or more of the following risk factors: Individuals with HIV-1-infected partner(s) – OR + ? Inconsistent or no condom use Sexual partners of unknown HIV-1 status with any of these risk factors Exchange of sex for commodities (money, food, shelter, drugs) Diagnosis of STIs Use of illicit drugs or alcohol dependence Incarceration STI, sexually transmitted infection. TRUVADA Prescribing Information. Gilead Sciences, Inc. 2016.

PrEP Utilization by Gender and Race in the US (2013 to Q1 2016) Females (n=3485) Males (n=24,594) Black White Hispanic Asian Slide: National Electronic Prescription Database: New PrEP Starts in the US (2013-Q1 2016) Despite having the some of the highest life-time risks of acquiring HIV, PrEP starts have been disproportionately low for black men and women and Hispanic men. These data underscore the need for focused HIV prevention and PrEP services to decrease new HIV infections for populations at greatest risk.1 Reference Bush S, Rawlings K, Magnuson, et al. Utilization of emtricitabine/tenofovir (FTC/TDF) for HIV pre-exposure prophylaxis in the United States by gender (2013-1Q2016). J Int AIDS Soc. 2016;19(suppl 7):14-15. Abstract O314. White Females 3.8 and 4.4 times more likely to be started than their Black or Hispanic counterparts White Males 8.3 and 6.7 times more likely to be started than their Black or Hispanic counterparts In 2014, 44% and 23% of new HIV infections were black and Hispanic persons compared with 27% for whites. Bush S, et al. J Int AIDS Soc. 2016;19(suppl 7):14-15. Abstract O314.

National Electronic Prescription Database: New PrEP Starts in the US (2012-2015) Highest rates of FTC/TDF for PrEP Men: 76% >25 years of age: 85% States with the highest rate of PrEP use Massachusetts, New York, Illinois Barriers to PrEP use should be addressed in those at high risk of HIV acquisition Women <25 years of age States with historically high infection rates Starting PrEP (2012-2015) State Number Rate (% population) Massachusetts 4950 0.073 New York 12,588 0.064 Illinois 4302 0.033 Florida 5675 0.028 California 10,437 0.027 New Jersey 2301 0.026 Pennsylvania 2878 0.022 Georgia 2230 Texas 5120 0.019 Ohio 2156 Slide: National Electronic Prescription Database: New PrEP Starts in the US (2012-2015) Highest rates of FTC/TDF for PrEP were in men (76%) and those >25 years of age: 85%. States with the highest rate of PrEP use include Massachusetts, New York, and Illinois.1 Barriers to PrEP use should be addressed in those at high risk of HIV acquisition, including women, <25 years of age, and states with historically high infection rates.1 Reference Mera R, McCallister S, Palmer B, et al. Truvada (TVD) for HIV pre-exposure prophylaxis (PrEP) utilization in the United States (2013-2015). JAIDS. 2016;19(suppl 5):30. Abstract TUAX0105LB. Mera R, et al. JAIDS. 2016;19(suppl 5):30. Abstract TUAX0105LB.