A 48-week study of 78 sexually active gay and bi teenage males from six U.S. cities found that pre-exposure prophylaxis (PrEP) — a medication which is highly effective at preventing HIV — can safely reduce the risk of contracting HIV for people under the age of 18. This is an important finding, especially for reducing HIV transmission among young gay and bi men of color who remain among the most at-risk for HIV, but it also raises larger issues of how accessible PrEP medications will be to young people.
The study and its findings
All of the teens were HIV-negative at the start of the study and given a supply of Truvada (a common PrEP medication) for daily use. According to the study’s authors:
All of the teens were considered at-risk for HIV because of factors such as having unprotected sex with a male partner who had HIV or whose HIV status was unknown, having at least three male partners, or having a sexually transmitted infection other than HIV.
By the end of 48 weeks, only three participants tested positive for HIV, meaning that PrEP helped 96% of the participants stay HIV-negative. Blood tests revealed that the three who contracted HIV took PrEP less than twice a week, a frequency that greatly reduces the medication’s ability to prevent HIV.
Interestingly, the study also found that most of its young participants had a hard time sticking to the daily regimen of taking one pill a day. By the final week (week 48), only 22% had high enough levels of Truvada in their blood to actually prevent HIV. When asked why, participants said they feared that others would think they were HIV-positive for taking the medication.
This means that if Truvada does become widely available to younger gay and bi people, it will have to come with an education campaign on its proper use and facts to dispel misconceptions and stigma associated with the drug.
The two obstacles potentially preventing access to the teen PrEP use
The National Institute of Health funded the study (it’s a part of the U.S. Department of Health and Human Services) and hopes that it will encourage the Food and Drug Administration to make PrEP more available to young people, but it raises several potential issues.
For one, we may end up with young gay and bi boys taking PrEP when they aren’t even out to their parents yet. Also, the other is the issue parental consent.
Similar to young women who have to get parental consent for birth-control pills or other reproductive health options, stigma and misunderstanding around gay sex, HIV and preventative sexual health could make parents and doctors reluctant to allow young people to access PrEP, especially if these adults aren’t educated about the drug and its benefits.
Ultimately the data seems to indicate that young people need particular community support when taking PrEP, from the healthcare provider, community, friends and ideally family.
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