Changes in HIV Preexposure Prophylaxis Awareness and Use Among Men Who Have Sex with Men — 20 Urban Areas, 2014 and 2017
Authors: Teresa Finlayson, Susan Cha, Ming Xia, Lindsay Trujillo, Damian Denson, Joseph Prejean, Dafna Kanny, Cyprian Wejnert, Meaghan Abrego, Alia Al-Tayyib, Bridget Anderson, Narquis Barak, Lissa Bayang, Jeremy M. Beckford, Nanette Benbow, Barbara Bolden, Kathleen A. Brady, Mary-Grace Brandt, Sarah Braunstein, Richard Burt, Rosalinda Cano, Sidney Carrillo, Jie Deng, Rose Doherty, Anna Flynn, Colin Flynn, David Forrest, Dawn Fukuda, Danielle German, Sara Glick, Henry Godette, Vivian Griffin, Emily Higgins, Theresa Ick, Tom Jaenicke, Antonio D. Jimenez, Salma Khuwaja, Monina Klevens, Irene Kuo, Marlene LaLota, Zaida Lopez, Yingbo Ma, Kathryn Macomber, Stephanie Masiello Schuette, Melanie Mattson, David Melton, Sandra Miranda De León, Alan Neaigus, Willie Nixon, Chrysanthus Nnumolu, Alicia Novoa, Conall O’Cleirigh, Jenevieve Opoku, Paige Padgett, Jonathon Poe, Nikhil Prachand, H. Fisher Raymond, Hafeez Rehman, Kathleen H. Reilly, Alexis Rivera, William T. Robinson, Yadira Rolón-Colón, Kimi Sato, John-Mark Schacht, Ekow Kwa Sey, Shane Sheu, Jennifer Shinefeld, Mark Shpaner, Amber Sinclair, Lou Smith, Emma Spencer, Ashley Tate, Hanne Thiede, Jeff Todd, Veronica Tovar-Moore, Margaret Vaaler, Chris Wittke, Afework Wogayehu, Pascale Wortley, Meagan C. Zarwell
Journal: MMWR Morbidity and Mortality Weekly Report (2019)

In February 2019, the U.S. Department of Health and Human Services proposed a strategic initiative to end the human immunodeficiency (HIV) epidemic in the United States by reducing new HIV infections by 90% during 2020-2030* (1). Phase 1 of the Ending the HIV Epidemic initiative focuses on Washington, DC; San Juan, Puerto Rico; and 48 counties where the majority of new diagnoses of HIV infection in 2016 and 2017 were concentrated and on seven states with a disproportionate occurrence of HIV in rural areas relative to other states.† One of the four pillars in the initiative is protecting persons at risk for HIV infection using proven, comprehensive prevention approaches and treatments, such as HIV preexposure prophylaxis (PrEP), which is the use of antiretroviral medications that have proven effective at preventing infection among persons at risk for acquiring HIV. In 2014, CDC released clinical PrEP guidelines to health care providers (2) and intensified efforts to raise awareness and increase the use of PrEP among persons at risk for infection, including gay, bisexual, and other men who have sex with men (MSM), a group that accounted for an estimated 68% of new HIV infections in 2016 (3). Data from CDC's National HIV Behavioral Surveillance (NHBS) were collected in 20 U.S. urban areas in 2014 and 2017, covering 26 of the geographic areas included in Phase I of the Ending the HIV Epidemic initiative, and were compared to assess changes in PrEP awareness and use among MSM. From 2014 to 2017, PrEP awareness increased by 50% overall, with >80% of MSM in 17 of the 20 urban areas reporting PrEP awareness in 2017. Among MSM with likely indications for PrEP (e.g., sexual risk behaviors or recent bacterial sexually transmitted infection [STI]), use of PrEP increased by approximately 500% from 6% to 35%, with significant increases observed in all urban areas and in almost all demographic subgroups. Despite this progress, PrEP use among MSM, especially among black and Hispanic MSM, remains low. Continued efforts to improve coverage are needed to reach the goal of 90% reduction in HIV incidence by 2030. In addition to developing new ways of connecting black and Hispanic MSM to health care providers through demonstration projects, CDC has developed resources and tools such as the Prescribe HIV Prevention program to enable health care providers to integrate PrEP into their clinical care.§ By routinely testing their patients for HIV, assessing HIV-negative patients for risk behaviors, and prescribing PrEP as needed, health care providers can play a critical role in this effort.