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  HIV Research for Prevention
October 17-19, 2016
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In San Francisco 12,500 on PrEP--But Lower Use in Young, Blacks, Women
  HIV Research for Prevention (HIVR4P), October 17-19, 2016, Chicago
Mark Mascolini
About 12,500 San Franciscans use preexposure prophylaxis (PrEP) today, according to an analysis by the San Francisco Department of Public Health (SFDPH) and collaborators in HIV clinics and community-based organizations [1]. But data collected so far show relatively lower use by people younger than 19, blacks, and women.
San Francisco has been a center of PrEP interest, research, and use since this antiretroviral-based strategy for blocking HIV acquisition first emerged. But understanding knowledge and uptake of PrEP in the community remains a challenge, SFDPH investigators noted, because there is no national or regional PrEP surveillance system. To gather and analyze PrEP knowledge and use data in San Francisco, these researchers turned to two sources: community-based self-reported measures and clinic-based measures.*
Five data sources indicated that PrEP knowledge among San Franciscans jumped from 19% in 2011 (the year after publication of the landmark iPrEx PrEP trial [2]), to 61% in 2012, and to 80-87% in 2014. Large majorities at study sites continued to report knowing about PrEP in 2015 (83-90%) and 2016 (71-91%). Analysis of four data sources showed that high proportions of people 19 or older (66-93%) reported knowing about PrEP in 2016, but PrEP knowledge was lower across three sites in people younger than 19 (50-70%).
Three data sources showed that 33%, 36%, and 80% of San Franciscan women knew about PrEP in 2016, compared with 76%, 90%, and 91% of men. At four sites, 50%, 84%, 84%, and 88% of blacks had heard of PrEP, proportions somewhat lower than in whites (88-94%), Hispanics (66-90%), and Asians (76-91%).
Analysis of self-reports indicated that PrEP use rose from 10-16% in 2014 (3 sites), to 20-23% in 2015 (2 sites), and to 11-44% in 2016 (4 sites). PrEP use proved lower in people under 19 (9%) than in people 19 to 29 (10-27%), 30-39 (11-48%), 40 to 49 (12-47%), and 50 or older (10-40%). Across three sites, lower proportions of blacks reported using PrEP than did whites, Hispanics, or Asians. At those three sites, 0%, 3%, and 4% of women used PrEP, compared with 44%, 11%, and 30% of men.
Using data from five sources, the researchers compared 2016 PrEP use in five age groups with newly diagnosed HIV cases in those age groups in 2015. By that measure, only 1% in the under-19 group used PrEP, compared with 36% of people 19 to 29, 30% of those 30 to 39, 22% of those 40 to 49, and 11% of those 50 or older.
Data from five sources comparing 2016 PrEP use in four racial/ethnic groups with 2015 HIV diagnoses in those four groups found the lowest proportion of users among Asians and Pacific Islanders (12%), followed by blacks (17%), Hispanics (26%), and whites (42%). The same type of analysis indicated that 2% of transfemales and 9% of females used PrEP in 2016, compared with 88% of males.
The researchers calculated that 12,500 San Franciscans now use PrEP. The city aims to add 2500 people to the PrEP rolls in 2017. Despite high overall PrEP uptake, they stressed, three target populations are not being reached well--people under 19 years old, blacks, and women.
1. Scheer S, Scott H, Marcus J, et al. PrEP uptake and demographic characteristics of PrEP users in two large medical systems in San Francisco. HIV Research for Prevention (HIVR4P 2016), October 17-19, 2016, Chicago. Abstract OA24.03.
2. Grant RM, Lama JR, Anderson PL, et al. Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. N Engl J Med. 2010;363:2587-2599.
*Community-based self-reported measures came from the National HIV Behavioral Surveillance (NHBS) system, the SFDPH STD Clinic, STOP AIDS, and HIV testing at community-based organization HIV testing sites. Clinic-based measures included the SFDPH STD Clinic, SFDPH primary care clinics, and the San Francisco arm of the Kaiser-Permanente healthcare system.