If you take Truvada every day, you have a tiny chance of getting HIV even if you have unprotected sex. But some gay men, the natural candidates for the drug, are ambivalent or critical of the HIV prevention pill, also known as PrEP (for Pre-Exposure Prophylaxis), and others don’t know it exists. This is especially true among Latinos, who have been slow to get prescriptions, even though they are more than three times as likely as whites to become infected with HIV.
One reason is that Latinos are more likely to come from traditional Catholic families and may be uncomfortable talking openly about sex and homosexuality, even to their doctors, says Richard Zaldivar, who runs The Wall Las Memorias, a Los Angeles nonprofit that hosts a support group for gay and bisexual Latino men.
The stigma may lift as more gay men hear stories about friends who are taking Truvada and realize that the drug is saving the lives of people they know.
Cost and availability come into play. Insurers and Medicaid in many states cover the drug, but Latinos often lack insurance and may not know about other funding from local governments and the manufacturer, Gilead Sciences, Inc., which offers assistance to the uninsured or people with large copays.
Latino men also tend to avoid medical care unless they’re really sick; going to a doctor is an admission of vulnerability and a request for help. Fewer medical visits means they are less likely to hear about Truvada from a physician or nurse, and, if they do get HIV, will hear the news later, which increases their chance of spreading the virus.
Preliminary data from a study with gay and bisexual Latino men in Texas found that only 58 percent of this group thought of themselves as candidates for Truvada, a lower percentage than among other groups. Many hadn’t heard of it in New York City, according to research there.
The stigma goes beyond Latinos. In a July 2014 survey in the magazine POZ, read by people who are HIV-positive, 82 percent of the respondents said that they supported the use of PreP as a prevention tool, but 72 percent answered “Yes” to the question, “Do you think there’s a stigma attached to taking PreP?”
POZ readers reported their perception that most gay men don’t know the drug exists and that doctors are ignorant as well. This is part of a general lack of knowledge about HIV issues in the population at risk: As many as 20 percent of people who are HIV-positive don’t know it, and only 33 percent are taking anti-viral drugs.
Gilead is funding projects to get the word out, including a $80,000 grant targeted at bringing in high-risk gay Latino men in Los Angeles.
The Latino Commission on AIDS has also launched a campaign, “#PrEPCAVIDOS,” based on the adjective “precavidos” or “cautious” in English.
You can take a quiz to answer the question “Is PreP for me?” here. Condoms are still the best way to go, assuming you’ll use them every time you run the risk of infection. Truvada doesn’t protect against other sexually-transmitted diseases (there are more cases than ever before, especially among men), and some users can develop kidney problems. Critics say it’s a bad idea to give anyone a way to feel safer having sex without a condom. However, there’s evidence that people who go to the trouble of getting a prescription and taking the drug actually become more cautious because they’ve put the risk of HIV at the forefront of their minds, rather than ignoring it.
It’s sadly common for gay and bisexual men to skip the condom: 47 percent say they don't wear a condom every time they have sex, the nonprofit Stigma Project reports in an effective poster of two men in a bedroom parodying a marriage proposal. A man on bended knee offers a condom to his standing partner, under the heading “Your Knight in Shining Armor.”
Beyond Latinos, another high-risk group that may need outreach are bisexual male teenagers of all ethnicities, some research shows.
February 10, 2016
Christopher Nystuen, MD, MBA