PRE-EXPOSURE PROPHYLAXIS (PrEP) AS HIV PREVENTION STRATEGY AND PUBLIC HEALTH IMPLICATIONS

Abstract

As the rate of AIDS-related mortality continues to decrease due to advanced combination antiretroviral therapies available, many recent efforts have been made to stop new infections. While there are still ongoing research efforts on HIV vaccine development, Truvada® for pre-exposure prophylaxis (PrEP) is available to general public as an HIV prevention strategy. PrEP specifically targets populations at-risk including gay men, men-who-have-sex-with- men(MSM), and heterosexual serodiscordant couples. A recent study of PrEP utilization reported an extraordinary slow uptake of PrEP; it suggests a need to evaluate current PrEP roll-out. This review explores potential causes of the current slow uptake phenomena. These include common concerns among PrEP providers and populations at-risk; long-term side effects, PrEP adherence, fear of drug-resistance, and potential rise of risky sexual behaviors. Previous PrEP randomized clinical trials (RCTs) showed its effectiveness but did not recognize its potential barriers outside clinical settings. Implementation of PrEP in a population-level should therefore include comprehensive counseling programs to support medication-adherence, and future research must carefully monitor current PrEP users and address potential pitfalls to maximize its protective benefits.