On Oct. 17 in Miami, the Florida Department of Health (FLDOH) hosted a statewide meeting for providers and the community, about the health of gay, bi, and other men who have sex with men (MSM). FLDOH wanted to obtain suggestions about the implementation of PrEP and troubling trends.
Troubling Trends among gay, bi and other MSM in Florida
New syphilis infections increased in 2014, by 29 percent from the yearly average of the previous three years. Gonorrhea cases rose by 80 percent and chlamydia cases by about 75 percent from 2010 to 2014. These increases occurred most often among gay, bi, and other MSM in their 20s.
From 2005 to 2014, new HIV infections in Florida increased about 26 percent among gay, bi, and other MSM. At the same time, new HIV infections in Florida decreased among all other adult males. Gay, bi, and other MSM are the key to controlling the HIV epidemic in Florida.
The Continuum of Care for the HIV Diagnosed identifies points of successful HIV care:
- Diagnosis of the HIV infected (HIV testing)
- First visit to an HIV care provider (Linkage).
- Regular visits to an HIV care provider (Maintenance), and 4) Minimal amounts of active virus in the body (A Suppressed Viral Load). When someone has a suppressed viral load, they will maintain their own health and have minimal risk of infecting others. Among gay, bi, and other MSM, all racial groups show about a 20 percent drop from Linkage to Maintenance in Care. This 20-point drop exceeds all other differences between two adjacent points in the Continuum. Maintaining people in HIV care has become the point of HIV care most in need of improvement to control the epidemic.
As in most areas of life, racial differences occur in the Continuum of Care among HIV infected gay, bi, and other MSM in Florida. Among Black gay, bi, and other MSM, only 52 percent had achieved viral suppression. Among Latino and White gay, bi, and other MSM, these rates run from 63 percent (Latinos) to 68 percent (Whites). All three racial groups need improvement, but the greatest need for improvement occurs among Black gay, bi, and other MSM.
FLDOH set up the meeting for maximum idea generation. The meeting had no space for discussing the suggestions and no decision making power. Individuals made the suggestions below as individuals.
HIV TESTING: The mobile vans should test for syphilis, gonorrhea, and chlamydia as well as HIV.
PrEP: Post-Exposure Prophylaxis (PEP) should be linked with PrEP, as people who need PEP would be good candidates for PrEP. A 24/7 PrEP/PEP hotline could increase uptake of PrEP and PEP. More providers need training in administering PrEP. In order to identify possible gaps in PEP and PrEP care, people have to create and maintain local PEP and PrEP resource inventories of providers, pharmacies, labs etc.
CONDOMS: People need to develop a consistent dialogue about “bareback” sex and “bareback” porn for the PrEP era. Any condom campaign should be sex-positive and avoid “slut-shaming.”
INCREASING LINKAGE TO CARE. It would be useful to co-locate testing and care more often. Phone aps used in Africa to increase adherence might be useful here.
A full report of the feedback will be available by the end of the year.
To read the full report on “The Epidemiology of HIV among MSM in Florida”, please visit http://bit.ly/1S9KkUh
For information on financial assistance with co-pays for PrEP or for those without insurance, please visit http://bit.ly/1Yl9Zx4.