Trends in Informal Antiretroviral Use for HIV Prevention

Data suggest that some gay and other men who have sex with men are using antiretroviral medications without a prescription.

Mance Buttram, PhD

Pre-exposure prophylaxis, or PrEP, is a daily regimen of antiretroviral therapy (ART) intended to prevent HIV infection in patients who are at a high risk of contracting the disease. PrEP is most beneficial for patients who have direct contact, either through sex or intravenous drug use, with someone who is HIV-positive.

According to the CDC, “PrEP is highly effective for preventing HIV if it is used as prescribed” but “much less effective when it is not taken consistently.”

For patients with known potential exposure to HIV, another alternative for prevention is post-exposure prophylaxis, or PEP, which must be started within 72 hours of exposure and continued for 28 days.

In response to recent reports of “non-prescribed and non-medically supervised use” of PrEP and PEP, Mance Buttram, PhD, the Associate Director of the Center for Applied Research on Substance Use and Health Disparities at Nova Southeastern University, decided to undertake an investigation into these practices, which he refers to as “informal” use of ART, among men who have sex with men in South Florida.

One Buttram’s primary motivations for this study was the fact that patients engaging in informal use of PrEP or PEP may be putting themselves at greater risk of infection if they do not adhere to recommended regimens and monitoring. In addition, informal use of PrEP and PEP may also contribute to antiretroviral resistance.

The study was qualitative in nature, consisting of in-depth interviews (60—90 minutes) with men who have sex with men in South Florida. Study participants were adult males (over age 18) who reported at least 1 male anal sex partner during the previous 90 days, who had at least 1 sexual encounter without a condom, and who reported obtaining and using HIV medication without a prescription.

Study participants reported a range of reasons for informal use of HIV medications. Some men used the medication in conjunction with other forms of protection, including condoms. Other men used informal HIV medications in place of condoms, as their only method of HIV prevention, because they felt the medications provided adequate protection.

There were a number of HIV medications used by study participants, including emtricitabine/tenofovir (Truvada) and elvitegravir/cobicistat/emtricitabine/tenofovir (Stribild). Truvada is the current FDA-approved option for PrEP. While study participants took the medication in a manner similar to the approved regimen, others used the medications only sporadically.

Despite the fact that study participants were obtaining and using HIV medications in a manner intended to prevent HIV infection, some never heard of PrEP or PEP and even doubted their existence. Those participants who heard of PrEP or PEP often did not know the specifics of the correct way to use the medication for HIV prevention or how the medication actually worked.

“Gay and other men who have sex with men, including those who are HIV-positive and those with and without a PrEP prescription, need to know the proper use of and benefits associated with PrEP and potential risks related to diversion and informal use,” Buttram concluded.

Since many participants reported peers to be a primary source of information about HIV medications, Buttram suggested that social networking applications may be of particular benefit, in addition to traditional information sources such as HIV testing sites.

The use of antiretroviral medications for HIV prevention in South Florida: initiation, use practices, medications and motivations” was published last month in Culture, Health, and Sexuality.

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