As outlined in the National HIV/AIDS Strategy, one of the key steps to successfully reducing the number of new HIV infections in the U.S. is expanding targeted HIV prevention efforts using a combination of effective, evidence-based approaches. Recently, we had the opportunity to speak with Mario Pérez, Director of the Division of HIV and STD Programs at the Los Angeles County Department of Public Health, and a member of the President’s Advisory Council on HIV/AIDS, about how Los Angeles County is implementing one of those evidence-based HIV prevention strategies on the local level.
We asked Mr. Pérez to describe Los Angeles County’s implementation of Pre-Exposure Prophylaxis (PrEP) among targeted populations. PrEP is an HIV prevention method in which high-risk HIV-negative individuals take daily antiretroviral drugs to reduce their risk of becoming infected. When used consistently, PrEP has been shown to be effective in men who have sex with men (MSM), heterosexually-active men and women, and most recently, injection drug users. PrEP is not intended to be used in isolation, but rather in combination with other prevention methods to reduce the risk of HIV infection. If it is delivered effectively and targeted to those at highest risk, PrEP may play a role in helping to reduce the incidence of new HIV infections in the United States. In July 2012, the U.S. Food and Drug Administration (FDA) approved the use of Truvada® (emtricitabine/tenofovir disoproxil fumarate) as PrEP in combination with safe sex practices, risk reduction counseling, and regular HIV testing to reduce the risk of sexually-acquired HIV infection in uninfected adults who are at highest risk for HIV infection, and studies are planned and underway on how to maximize the benefits of PrEP. (Read more about PrEP on this page from CDC.)
Mr. Pérez explained that Los Angeles County is currently testing the acceptability, feasibility, and cost of PrEP implementation among high-risk communities in the LosAngeles area. “There are a number of local populations and risk groups that have extremely high rates of HIV infection,” he explained. “For example, we have unacceptably high rates of HIV infection among our transgender population, as well as among black gay men in Los Angeles County. The proportion of individuals in these populations who seroconvert every year is very high, so we’re always looking for tools like PrEP that can help avert their seroconversion.
“PrEP is not necessarily an intervention that is used over indefinite periods of time,” he continued. “It’s more of a short- to medium-term intervention that should be used during the most at-risk period of a person’s life. We’ve been testing what it means to add PrEP to our HIV prevention toolbox in these select communities.”
Mr. Pérez went on to explain that an ongoing study of the use of PrEP in targeted communities in Los Angeles County has been funded by the California HIV/AIDS Research Program . “We’re very excited to see what the results of the study show in terms of accessibility, acceptability, and cost-effectiveness and are eager to share our findings with partners throughout the country, so that they can see if PrEP is something they should consider implementing. We’re excited that there has been political will in our state and county to test this biomedical intervention because it really has the potential to help avert some of the many new infections we see in the United States.”
To learn more about what’s happening in Los Angeles County, view our recent interview with Mr. Pérez on how Los Angeles County is using the HIV treatment cascade as a tool to inform their HIV prevention, treatment, and care efforts.
To learn more about PrEP, please see the following blog posts:
- Conversations from CROI 2013: CDC’s Dr. Jonathan Mermin
- Daily Use HIV Prevention Approaches Didn’t Work for African American Women in VOICE Study
- Conversations from CROI 2012: Dr. Jonathan Mermin on PrEP and an AIDS-Free Generation
- Using PrEP as a Prevention Tool for MSM: The Promise Comes with Challenges
Editor’s Note: This blog was developed from a conversation with Mr. Perez while he recorded Conversations on AIDS.gov – HIV Treatment Cascade on the Local Level: Mario Perez, LA County video.