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Earlier this week, the WHO released its latest guidelines on HIV prevention, diagnosis, treatment, and care. The guidelines focus on five key groups who both are at the highest risk for getting HIV and receive the least care. The groups include:

  • Men who have sex with men (MSM).
  • Sex workers
  • Prisoners
  • IV drug users
  • Trans* individuals

The guidelines are meant to be adapted for each country’s unique setting. However, the groups, regardless of where you are in the world, remain the same. In other words, in both the developed and developing world, these five groups are the ones most likely to get HIV and not receive treatment for it.

Reasons for this exist at almost every level. Individuals in these groups tend to mistrust healthcare providers and establishments based on past negative experiences. Additionally, they experience higher rates of violence, poverty, and mental illness. As a result, the WHO recommends an overall HIV strategy that is comprehensive and intersectional. Health sector interventions are one part of said strategy and PrEP is just one of such intervention.

More specifically, the WHO views PrEP as an additional HIV prevention choice for MSM. The recommendation moved from provisional due to persistently high rates of HIV among MSM as well as evidence that is “strong” and “high quality.” Given that the WHO estimates PrEP could produce a 20-25% global reduction in HIV incidence in this population, it is no surprise they moved forward with recommending it.

Given the major concern that this recommendation will reduce condom use, it is also worth noting that the study on which the WHO made the recommendation actually showed an increase in condom use among PrEP users. This, of course, can be a false result given that we know many people prefer to answer surveys with the most socially acceptable answer.

Ultimately, I feel that much of the fear expressed by US public health and healthcare providers comes from a deeper fear and shame of talking about sex. “Use a condom. Every time.” has become almost standard. At this point it is easy and routine. The new recommendation, however, shifts how a conversation about safe sex will need to happen. In other words, it requires actually having a conversation about sex that goes beyond “Are you sexually active?” Determining whether PrEP is the best HIV prevention choice calls for an inquiry into patients’ sexual history, repertoire, preferences, etc. Since comparisons between PrEP and contraception abound, it is worth noting that such a conversation rarely happens for something as established and relatively well-accepted as birth control options. Healthcare providers receive little to no training on how to broach these topics. Additionally, as the report mentions, “PrEP does not fit well in current (US) models of care, which do not include frequent, regular clinic visits.” Taken together a cycle forms:

  1. Healthcare providers receive minimal training about sexual health.
  2. Healthcare providers are at risk of offending, traumatizing, or generally just having a poor response to MSM.
  3. MSMs develop a mistrust of healthcare providers and share minimal information. Or their mistrust is confirmed upon hearing about another negative experience. They may avoid treatment completely.
  4. There is an apparent lack of need for more comprehensive sexual health training.
  5. No training is created and sex continues to be ignored and mishandled by healthcare.

It is exciting to see the WHO take a strong harm-reduction stance around this issue. While the recommendation is not without potential negative consequences and difficulties, it provides one way to meet people where they’re at and offer a different kind and level of prevention. Ultimately, the more tools we have to prevent HIV, the better we will be able to target campaigns, outreach, and programs to groups that will be a best fit. Like with most things in life, a one size approach will not fit all. The clearer HIV prevention efforts get on their target audience the more effective they can be in reaching their goal.

Other Sexual Health News This Week

Institutional Summit Calls for Action Against Sexual Assault on College Campuses (Madame Noire)

Training For a Triathlon Commonly Leads To Urinary Incontinence and Other Pelvic Floor Disorders (Prevention)

President Obama to Sign Order Barring Federal Discrimination Against Sexual Orientation, Gender Identity Monday (NY Daily News)

Rochester, NY Extends Protections for Gender Identity and Expression (Human Rights Campaign)

10 States Join Indiana’s Appeal of Federal Judge’s Same-Sex Marriage Ruling (IndyStar)

Transgender Inmates Pushing Policy Changes (WLBZ2)

State Agencies Launch LGBT Data-Collection Effort (Capital New York)

Important Dates

Proposals for the following conferences are due in July. Click on each title for more information and to apply.

Playground: A Sex-Positive Inclusive Event for All Communities. Proposals due by 31 July 2014.

The following conferences take place in August. Click on each title for more information and to register.

National Reproductive Health Conference, Aug 2-6, Orlando, FL.

Woodhull Sexual Freedom Summit, August 14-17, Alexandria, VA. Look for SHR writer Kait Scalisi who is volunteering at the conference.

National Sexual Assault Conference, August 20-22, Pittsburgh, PA Be sure to check out “Sexual Violence in ‘The Scene’:Lessons from and Challenges Within BDSM/Kink Circles” presented by Aida Manduley from SHR’s partner organization, The CSPH.