PrEP Journey: Sweet Home Chicago

The effect of HIV is really sobering when the statistics are talking about your home town. I live in Chicago and the data points to young, Black men who have sex with men to be at the highest risk.

PrEP use of MSM in Chicago

The Chicago Department of Public Health conducted a study in 2015 using a survey of sexually active, HIV-negative MSM (men who have sex with men) who were older than 18 years and living in Chicago.

Only 18 people had a prescription for PrEP

Of the people surveyed, 130 folks were aware of PrEP. But of those, only 18 (14 percent) had prescriptions for it. The Department of Health broke it down even further by demographics and, sadly, not one person surveyed who had a PrEP prescription was Black. This points to problems with getting PrEP to the patients who need it.

Why weren't men taking PrEP?

One of the most interesting parts about this presentation was that the majority of people who heard of PrEP still hadn’t tried to obtain it once they were made aware. When asked the reasons why, participants overwhelming choose other reasons beyond being able to afford the medication, access to prescriptions, or insurance coverage. The researchers honed in on this key aspect.

Other reasons

In a lot of cases of those who would benefit from PrEP, there seems to be a barrier to getting PrEP beyond just knowing about it. There could be a lot of other factors at play like stigma, concern over side effects, and underestimation of their own risk behaviors.

People in mixed-status relationships

This study also pointed out another significant group of PrEP users: people whose partners also live with HIV. Of those studied, this group of people was the most likely to get PrEP and take it regularly.

Potential influence in their communities

I feel like, with a focus going toward community-based interventions, that this group of individuals could be key in driving more people at risk to give PrEP a try. These individuals typically have an intimate and accurate knowledge of HIV medications and know how PrEP has been a tool in their personal relationships. Empowering this group of people in creative ways could spread the word, but also reduce the stigma around HIV as a whole.

Engaging partners of people who are living with HIV represent to others a willingness to love their partner regardless of the stigma they may face. These individuals have an authority within their circles that others may not. In terms of environment, they are also able to navigate their circles of influence and become links to healthcare services offering PrEP.

Evolving conversations about PrEP

Putting the burden on just one small population won’t solve the problem of getting the word out about PrEP alone. Initiatives like PrEP4Love were also launched at the same time and shows that the city’s commitment to PrEP was real.

I believe investigating the barrier to access is key, but we also have to be willing to face systemic issues with workable solutions. PrEP is very much a social experiment and one that will have a major impact on society.

As other forms of PrEP become available, this conversation will evolve and shift and may even leap forward as technologies like injectable PrEP options are starting to be tested.

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