PrEP and STIs

The mainstay of PrEP therapy, pre exposure prophylaxis therapy, is Truvada. Composed of two medications used to treat HIV, tenofovir and emtricitabine, Truvada is approved for daily use to help prevent an HIV negative person from getting HIV through sexual contact or injection drug use. When used daily, it has been shown to reduce transmission of HIV up to 99% (Anderson). PrEP therapy has been shown to reduce the risk of HIV through sex for gay and bisexual men, transgender women, and heterosexual men and women, as well as injection drug users (Kagan).

Undoubtedly this is a great advancement for the HIV Epidemic that the world is facing to date. However, it does not come without consequence. Some authors have voiced concern regarding the behavioral disinhibition of PrEP therapy. Simply put, do PrEP users’ perception on decreased risk of HIV infection lead to riskier sexual practices and increased transmission of sexually transmitted infections (Barreiro)?

Traeger et al recently set out to describe STI incidence and behavioral risk factors among gay and bisexual men receiving PrEP therapy. STIs being screened for consisted of chlamydia, gonorrhea, and syphilis. Among the 2981 mostly gay and bisexual men receiving PrEP, STI incidence was 91.9 per 100 person-years, with 736 participants (25%) accounting for 2237 (76%) of all STI’s (Traeger).

Others disagree with the risk compensation fear associated with PrEP therapy (Rojas), stating that STIs and HIV can’t be looked at in a box; they need more interdisciplinary perspectives and long-term evidence cohorts. Either way, no one can argue that scheduling routine STI testing on PrEP therapy would be a poor choice in management.

Tara Rakiewicz  DUCOM 2020

 

Anderson, Peter L., et al. “Emtricitabine-Tenofovir Concentrations and Pre-Exposure Prophylaxis Efficacy in Men Who Have Sex with Men.” Science Translational Medicine, American Association for the Advancement of Science, 12 Sept. 2012, stm.sciencemag.org/content/4/151/151ra125.full.

Barreiro, Pablo. “Hot News: Sexually Transmitted Infections on the Rise in PrEP Users.” AIDS Reviews, U.S. National Library of Medicine, 2018, www.ncbi.nlm.nih.gov/pubmed/29628512.

Kagan, Rachael, and David Evans. “Love May Have Another Protector.” PrEP, San Francisco Department of Public Health, prepfacts.org/prep/the-basics/.

Rojas Castro D, Delabre RM, Molina JM. Give PrEP a chance: moving on from the "risk

compensation" concept. J Int AIDS Soc. 2019;22 Suppl 6(Suppl Suppl 6):e25351. doi:10.1002/jia2.25351


Traeger MW, Cornelisse VJ, Asselin J, et al. Association of HIV Preexposure Prophylaxis With
Incidence of Sexually Transmitted Infections Among Individuals at High Risk of HIV Infection. JAMA. 2019;321(14):1380–1390. doi:10.1001/jama.2019.2947

 

 

Recognizing race and gender biases in healthcare

One of my favorite shows on television is comedian John Oliver’s ‘Last Week Tonight’. I enjoy his political satire show for many reasons. Thanks to its platform on HBO John Oliver is able to discuss his true feelings about the news over the past week, and specific opinions about politicians in the news. His show is informative and hilarious, but what I enjoy the most is the second half of the show when he reports on a specific story or issue. On his August 18th episode of this year, he devoted the second part of his show to investigating gender and racial bias in medicine. This subject is especially important to me and was both upsetting and informative to watch. The segment begins with interview clips from white women and women of color who experienced biases when they sought medical treatment. The biases they were faced with inhibited their care, and for some resulted in adverse outcomes. These women are not alone in their experience.

A study published in 2014 in the Journal of the American Board of Family Medicine presented internal and family medicine physicians with vignettes of patients with osteoarthritis. The vignettes were identical except for patient race, one Caucasian and one African American. Participants reported that they believed the white patients were being more medically cooperative than the African American ones¹. Another study published in 2016 in the Proceedings of the National Academy of Sciences in the United States, found that a substantial number of the participants surveyed, which included white lay-people, medical students, and residents, held false beliefs about biological differences between blacks and whites. Furthermore, the study found that these false beliefs predict racial bias in pain perception and treatment recommendations². These studies demonstrate the real implications bias has on patients and the healthcare they receive.

Race and gender biases in healthcare are not relics of the past - they are very much present and perpetuated in our current healthcare system. I believe that it is the provider’s obligation to themselves and their patients to take the time to assess their own inherent biases. From this, one can learn how to recognize bias in themselves and others, and work to provide specialized and bias-free care for patients. In theory, this will lead to providing the best care possible for the patient, and hopefully a positive experience in the healthcare setting. This in turn promotes follow-up and access to preventive healthcare measures. Additionally, I believe it is important to teach medical students early in their medical careers about implicit biases and the effects of gender and racial biases in medicine. If these concepts are broken down early on, it will decrease perpetuation, but it will also leave ample time for students to further investigate and discuss this important aspect of healthcare.

Camille Campion   DUCOM 2020

 

Articles Cited:

1. Oliver M.N.., K.M. Wells, J.A. Joy-Gaba, et al. Do physicians’ implicit views of African Americans affect clinical decision making?. JABFM.2014, 27(2)177-188.
2. Hoffman K.M., S. Trawalter, J. R. Axt, and M. N. Oliver. Racial bias in pain assessment and treatment recommendations, and false beliefs about biological differences between blacks and whites. PNAS. 2016. 113(16)4296-4301.

I highly recommend viewing the segment, please find the link below:

https://www.hbo.com/last-week-tonight-with-john-oliver/2019/111-episode-170

 

Inherent bias survey by Project Implicit developed by Harvard University:

            https://implicit.harvard.edu/implicit/takeatest.html