November 19, 2018 - On World AIDS Day, a Look at US Youth and HIV Prevention
By Isa Fernandez, PhD, ATN Executive Committee Chair and Professor of Public Health at Nova Southeastern University
World AIDS Day, held annually on December 1, is an awareness day that helps broaden the general population’s awareness of HIV and AIDS. In the spotlight for World AIDS Day are the many advances in scientific research. While these scientific advances have given the world more resources for HIV prevention and care than we have ever had before, the epidemic remains one of the biggest health challenges of our time.
Among those who bear the impact of the epidemic are youth in the US. Adolescents ages 13-24 represented 21% of new HIV diagnoses in the US in 2016, according to the Centers for Disease Control and Prevention (CDC). By the end of 2015, 60,300 young people were living with HIV in the US.
The Adolescent Medicine Trials Network for HIV/AIDS Interventions (ATN) is focused on researching innovative strategies and programs to help youth reduce their chances of becoming infected with HIV and helping youth living with HIV to lead healthier lives by promoting engagement in care and testing novel bio-behavioral treatment options.
PrEP: A New Tool in the Adolescent HIV Prevention Toolkit
It has been a little over six months since the Food and Drug Administration (FDA) approved Pre-Exposure Prophylaxis, or PrEP, for adolescents at-risk for acquiring HIV. PrEP is a drug regimen approved by the FDA in 2012 for adults that helps prevent HIV-negative people from acquiring HIV. The FDA approval of PrEP for adolescents was partially based on the results of ATN 113, Project PrEPare. The CDC reports that using PrEP reduces the sexual risk of acquiring HIV by 90%.
ATN 113 was a 48-week study of HIV-negative young men ages 15-17 who took a daily PrEP regimen. It was the first study to measure PrEP safety among adolescent men who have sex with men (MSM). Research results indicated that the participants tolerated PrEP medication well. Study participants also engaged in regular office visits and behavioral counseling.
The study’s lead investigator was Dr. Sybil Hosek of the Cook County Health and Hospital System in Chicago. “The FDA's decision is a milestone for HIV prevention among youth,” Dr. Hosek said. “It paves the way for easier adolescent access to a highly efficacious biomedical HIV prevention product that has been approved for adults for the past 6 years.”
While we don’t yet have figures to date on how many young people have been prescribed PrEP in the US, we can examine the state of HIV prevention in youth with the knowledge that we have a new tool in the HIV prevention and care toolkit: PrEP. The FDA approval of PrEP for adolescents who are at-risk for acquiring HIV is a promising step towards reducing the numbers of people living with HIV every year. This World AIDS Day, we do have some progress towards HIV prevention in youth. The CDC reports that annually, HIV infections declined 24% among youth between 2010-2015.
Also encouraging are the reported results of a study on the willingness of health care providers to prescribe PrEP to youth at risk for HIV in the US, published in the Journal of Adolescent Health in August 2018. The study’s authors found that the majority of health care providers were willing to prescribe PrEP to adolescents.
Barriers to HIV Prevention in Adolescents
HIV prevention in youth will likely require ongoing attention from caregivers to ensure that youth regularly take the medication. ATN 113 found that adherence to PrEP declined significantly when office visits and counseling were reduced from monthly to quarterly. The study suggests that adolescents need more frequent clinic visits to make sure they are taking their medication as directed to fully gain the benefits of PrEP. Youth who adhered poorly to PrEP in the ATN 113 study (determined by measuring the level of the PrEP drug in blood samples) saw high rates of sexually transmitted infections (STIs) and the acquisition of HIV.
The ATN and PrEP Research
The ATN is currently conducting numerous research studies involving adolescent participants and the measurement of PrEP linkage, uptake and/or adherence for HIV prevention at sites around the country. Among them are:
- ATN 140: LYNX
- ATN 141: MyChoices
- ATN 142: P3 (Prepared, Protected, Empowered)
- ATN 149: Engaging Seronegative Youth to Optimize the HIV Prevention Continuum
- ATN 155: Planning4PrEP
- ATN 158: Life Steps
- ATN 159: ePrEP
- ATN 160: TechStep
In this, the 30th World AIDS Day observance, we acknowledge three decades of effort by researchers towards preventing HIV among at-risk populations, including adolescents. The ATN will continue to investigate new ways to prevent HIV in adolescents, and I look forward to the progress we will make in 2019 and over many years to come.
If you are a young person who is interested in finding out how to get involved this World AIDS Day, read more in this article. For more information on PrEP and how to protect yourself against HIV, visit your local health clinic or visit the CDC information on PrEP here. Find a local HIV care provider on the HIV.gov website with this interactive map locator.