PrEP decreases HIV incidence by nearly 80% in west African men, despite suboptimal adherence


HIV incidence among west African men taking PrEP fell by 79%, when compared to an earlier cohort of men who did not have access to PrEP. This is despite adherence not being optimal for most men, especially among those taking event-driven PrEP. This PrEP demonstration study was conducted in four west African cities by Dr. Christian Laurent from the University of Montpellier and colleagues and published in The Lancet HIV. While overall HIV incidence in west African countries is around 1% in the general population, it is much higher among men who have sex with men (MSM), at approximately 13%. A great deal of stigma and discrimination is directed towards gay and bisexual men, affecting outcomes along the HIV care continuum in West Africa. Côte d’Ivoire, Mali, and Burkina Faso lack legal LGBT equality and protections, while Togo outlaws all same-sex sexual activity. Additionally, many African MSM also have sex with women, thereby contributing to more widespread epidemics. In these contexts, access to PrEP in accessible and safe community-based settings is a crucial factor that could result in decreased HIV incidence in this key population. The World Health Organization has recommended PrEP for MSM since 2014. These recommendations were updated in 2019 to include event-driven PrEP, also known as the 2:1:1 approach: two pills taken two to 24 hours prior to sex, one taken 24 hours after sex, and another taken 48 hours after.

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