New England Journal of Medicine
October 4, 2018 Vol. 379 No. 14
Being PrEPared — Preexposure Prophylaxis and HIV Disparities
Robert H. Goldstein, M.D., Ph.D., Carl G. Streed, Jr., M.D., and Sean R. Cahill, Ph.D.
If current trends persist, one in six U.S. men who have sex with men will be infected with human immunodeficiency virus (HIV) in their lifetime, according to the Centers for Disease Control and Prevention (CDC).1 This prediction highlights the long road ahead if we are to end the spread of HIV in the United States, but it does not tell the full story, which is complicated and nuanced. Of the 39,782 new HIV infections that occurred in the United States in 2016, nearly half were in black or Latino men who have sex with men, and 52% occurred in the South (a region defined by the CDC as Alabama, Arkansas, Delaware, the District of Columbia, Florida, Georgia, Kentucky, Louisiana, Maryland, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia).1 Preexposure prophylaxis (PrEP) with tenofovir disoproxil fumarate and emtricitabine (TDF–FTC), which the CDC has recommended since 2014 as a safe and very effective method of preventing HIV infection in high-risk populations, is an underused tool for reducing this alarming imbalance…