Getting PrEP to Key Populations Is Critical to Global Fight Against HIV

March 12, 2021

“Key populations and their partners account for 50% or more of global HIV infections—80% of new HIV infections outside of sub-Saharan Africa,” said Greg Millett, amfAR Vice President and Director of Public Policy. Millett was addressing the 2021 Conference on Retroviruses and Opportunistic Infections (CROI), held virtually March 6-10. CROI is an annual international forum for leading scientists in the field of HIV/AIDS and related conditions.

In his presentation, “Challenges in Reaching Key Populations with PrEP,” Millett reported on global scale-up of pre-exposure prophylaxis (PrEP) including initiation and persistent use of the prevention medication as well as barriers to access. Among key populations, sex workers have 30 times the risk of acquiring HIV compared to the general population globally; people who inject drugs, 29 times; men who have sex with men (MSM), 26 times; and transgender people, 13 times the risk.

“We cannot end the global HIV pandemic without addressing key populations and making sure that we scale up not only ART [antiretroviral treatment] but PrEP and other prevention methods for key populations,” said Millett.

Citing findings from recent studies, Millett noted that awareness of PrEP among key populations remains low, whereas willingness to use such prevention drugs if they were available is relatively high. Barriers to PrEP access include cost, criminalization, location of services, marketing, and the COVID-19 pandemic.

“We cannot end the global HIV pandemic without addressing key populations and making sure that we scale up not only ART [antiretroviral treatment] but PrEP and other prevention methods for key populations,” said Millett.

Dr. Annette Sohn, amfAR Vice President and Director of amfAR’S TREAT Asia program, co-moderated the CROI symposium, “Improving Adolescent PrEP Use: Understanding Developmental Processes and Context.” Efforts to advance global prevention for adolescents, who made up one quarter of all new HIV infections in 2019, continue to face challenges. The goal of the talk was to understand the unique developmental processes that drive those challenges. This in turn could help care providers work more effectively with adolescents and inform interventions to improve PrEP uptake and adherence.

Treat Asia at CROI — Dr. Annette Sohn (left) co-moderated the talk, “Improving Adolescent PrEP Use: Understanding Developmental Processes and Context.”

Adolescence is a time of profound developmental changes in physical, social, cognitive, and emotional function that affect health behaviors, and is marked by the emergence of gender and sexual identities. It is also a period in which young people begin adjusting to developmental tasks important to transition into adulthood including independence, decision-making autonomy, and initiating relationships.

Dr. Sohn and colleagues explored these issues relevant to adolescent risk behaviors and in the context of developing lifelong healthy behaviors. Their recommendations—meant to optimize uptake of PrEP among adolescents—included considering the neuro-cognitive, emotional, and social strengths of this developmental stage and the multiple factors that foster or protect against behavioral health risks relating to PrEP use.