1. HIV Prevention By Theo Hodge, Jr. MD for

2. 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 Published November Accessed April 2017; 2. U.S. Census Bureau. Population estimates. 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. Accessed April 2017; 5. AIDSVu. Accessed April 2017; 6. Prevalence of HIV, World Bank Group. Accessed April 2017.

3. 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 Boston, MA. #52.
Adapted from CDC at Accessed April 2017.

4. 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 Boston, MA. #52. Adapted from CDC at Accessed April 2017.

5. 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

6. 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): 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): Abstract O314.

7. 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 ( )
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 ( )
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 ( ). JAIDS. 2016;19(suppl 5):30. Abstract TUAX0105LB.
Mera R, et al. JAIDS. 2016;19(suppl 5):30. Abstract TUAX0105LB.