PrEP, Now for Adolescents

It’s been an important month for Truvada, the once-daily pill for HIV prevention, more commonly known as PrEP.

On May 15th, the Food and Drug Administration (FDA) approved Truvada for PrEP for HIV prevention in adolescents. Prior to this label change, PrEP was only indicated for at-risk individuals 18 years of age or older. Citing the FDA press release, “The addition of the adolescent indication is based on a study in HIV-negative individuals 15 to 17 years of age. In the United States, adolescents and young adults 13 to 24 years of age comprised 21 percent of all new infections in 2016, according to the U.S. Centers for Disease Control and Prevention, and 81 percent of those infections were among young men who have sex with men.”

Truvada for PrEP is now indicated in combination with safer sex practices to reduce the risk of sexually acquired HIV-1 in at-risk adults and adolescents weighing at least 35 kg. -FDA, 2018

In addition to the news about PrEP for adolescents, new research published last week in the journal AIDS and Behavior from one of the earliest champions of PrEP for HIV prevention, Dr. Robert Grant, demonstrates the power of social relationships, coming out and LGBTQ identity in PrEP uptake and adherence.

In working with over a thousand transgender women and cisgender men who have sex with men, Grant’s research shows a strong positive correlation between the disclosure of LGBTQ identity across numerous types of relationships (parents, partners, etc.) and PrEP uptake and adherence. His work also shows a strong positive association between PrEP uptake and use and an individual’s engagement with LGBTQ organizations, dating/sex apps, websites, clubs and businesses.

In the discussion of his team’s work, Grant states, “it’s possible that the role of LGBT organizations in encouraging PrEP uptake may diminish. Similarly, as PrEP use becomes more common, we anticipate that many of the concerns surrounding disclosure of PrEP use may diminish in certain populations.”

In light of the new FDA label indication for adolescents, I think LGBT organizations, particularly ones that work primarily with LGBT youth, will be critical in promoting PrEP and supporting LGBT youth in taking the once-daily pill. Part of how these programs do so successfully with 18–24 year olds, as Grant’s findings agree, is by providing:

• holistic support of LGBT individuals in the coming out and/or transition process,
• housing-first and integrated social services,
• identity affirmation and a safe place for expression and exploration, and
• encouraging and supporting social connectedness.

As Grant later states, “PrEP implementation programs should collaborate with these organizations to ensure that they have the necessary information and resources available to promote the spread of accurate and useful information about PrEP use.” PrEP advocates and programs, rooted deeply in the LGBT community, will be valuable resources to newer programs as knowledge and acceptability of PrEP in the United States continues to grow.

Read more about the FDA’s approval for Truvada for PrEP for adolescents here: https://www.businesswire.com/news/home/20180515006187/en/U.S.-Food-Drug-Administration-Approves-Expanded-Indication

Read more from Dr. Robert Grant and his colleagues in the journal AIDS and Behavior here: https://link.springer.com/article/10.1007%2Fs10461-018-2151-0