PrEP to Prevent HIV in American Youth—How Can It Be Expanded?
In advance of National Youth HIV & AIDS Awareness Day on April 10, we discuss increasing pre-exposure prophylaxis for young people at risk.
In the United States, more than 1 in 5 new HIV diagnoses are in youth aged 13 to 24, and gay and bisexual adolescents and young men account for 81% of the diagnoses in this age group. Young African Americans and Latinos continue to be disproportionately affected; among gay and bisexual youth, African Americans accounted for 54% of new infections in 2016, and Latinos accounted for 25%.1
Pre-exposure prophylaxis, or PrEP, is a powerful tool for preventing HIV. Sold as the once-daily oral medication Truvada, until last year it had FDA approval only for use in adults aged 18 and older. In May 2018, PrEP was approved by the FDA for prevention of HIV in adolescents, but young people still face obstacles to obtaining the drug.
“Now that one barrier to PrEP has been eliminated, it is important to systematically assess and address other barriers to PrEP for adolescents and young adults,” said Sean E. Bland in an issue brief he recently authored for amfAR on expanding access to PrEP for adolescents and young adults. Mr. Bland is a Senior Associate at the O’Neill Institute for National and Global Health Law at the Georgetown University Law Center, where he studies and advises on policy options for improving HIV prevention and treatment.
Sean E. Bland“One challenge is that in most states adolescents under age 18 cannot access PrEP on their own without parental consent. This can be a significant obstacle for adolescents most at risk for HIV because they may not have disclosed their sexual orientation or risk behaviors to their parents and may fear the repercussions of disclosure,” said Mr. Bland.
Confidentiality can also be breached when explanation of benefits documents are sent. Many state laws require that these notices of coverage decisions be provided to the primary insured policyholder—who is often the patient’s parent. Many young people don’t want their parents to be notified that they’re taking a drug related to sexual activity, even if they don’t have to obtain parental consent before obtaining it. The cost of the medications can also be an impediment.
Jurisdictions seeking to expand access to PrEP for young people must address these issues of consent, confidentiality, and payment, says the issue brief. It examines how three states—Colorado, New York, and California—have dealt with these concerns. Although different states vary as to their laws, policies, and health service programs, the experience of these states are presented as potential models.
“As policymakers and HIV community stakeholders consider options for improving access to PrEP and supporting effective HIV prevention for adolescents and young adults, it is important for them to understand the policy and program approaches undertaken in other jurisdictions so they can identify best practices and learn from the challenges faced by others,” said Mr. Bland.
1HIV Among Youth. Centers for Disease Control and Prevention. April 2018