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April is STD Awareness Month (#STDMonth), and specifically April 10 is National Youth HIV & AIDS Awareness Day (NYHAAD). This is important since 21% of new HIV diagnoses occur in people between the ages of 13-24 years. However, this number is likely low since only 10% of high school students have ever been tested for HIV.
Human Immunodeficiency virus (HIV) and Acquired Immunodeficiency Syndrome (AIDS) have been the topic of several of our previous blogs (including brief look at the science, specific look at HIV and drug use, and the importance of getting tested for HIV). Since HIV is transmitted from contact with infected body fluids, like through unprotected sex and sharing infected needles for drug use, preventing transmission through use of condoms and clean needles is important. However, there is another way to prevent the spread of HIV: taking a daily medication that prevents HIV from taking hold and spreading throughout your body. Pre-exposure prophylaxis (PrEP) was approved for adults in 2012. PrEP is delivered as a single pill, Truvada (made of 2 medications: tenofovir and emtricitabine), once daily. When taken consistently, it can reduce risk of HIV by over 90%. The use of Truvada for PrEP was approved for minors under 18 years of age in 2018. PrEP is for people without HIV who are at very high risk for getting it from sex or injection drug use. The federal guidelines recommend that PrEP be considered for people who are HIV-negative and in an ongoing sexual relationship with an HIV-positive partner.
This recommendation also includes anyone who:
isn't in a mutually monogamous relationship with a partner who recently tested HIV-negative, and
is a . . .
gay or bisexual man who has had anal sex without using a condom or been diagnosed with an STD in the past 6 months, or
heterosexual man or woman who does not regularly use condoms during sex with partners of unknown HIV status who are at substantial risk of HIV infection (for example, people who inject drugs or women who have bisexual male partners).
PrEP is also recommended for people who have injected drugs in the past 6 months and have shared needles.
PrEP is different from post-exposure prophylaxis (PEP), although the abbreviations are similar (thus easily confused). PEP should be used only in emergency situations and must be started within 72 hours after a recent possible exposure to HIV, for example after a sexual assault.
If adolescents have one of the highest rates of new HIV infections, why isn't PrEP being prescribed more often to at-risk teens? In a recent survey of adolescent health care providers, 93.2% of the providers had heard of PrEP; however, only 35.2% of these providers indicated that they had previously ever prescribed PrEP. In other words, providers need to be educated. There is an online PrEP educational curriculum for health care providers, and a team at UW Health will be tackling this as well.
What can youth and their loved ones do? First of all, make sure that HIV/AIDS, safer sex, and dangers of drug use are topics of conversation. Sure, these topics may be discussed in school (although, it may not be, only 13 states require medically accurate sex and HIV education), but teens need to hear this stuff often! If you need help having these conversations, check out these guides from Advocates for Youth. Also, make sure that you and your loved ones get tested for HIV! The Center for Disease Control and Management recommends that everyone gets tested for HIV at least once in their lives. Knowing your own HIV status is an important piece of health information.
UW Health HIV/AIDS Comprehensive Care Program also has information about HIV prevention on their website. If you have other questions about HIV/AIDS and PrEP, make sure to discuss with your health care provider.