14 VOL. 7, NO. 1 acHI eVe transgender women from six countries who were at high risk for HIV. They took either a placebo pill or Truvada (a combi- nation of two approved HIV meds, TDF and FTC). The study showed that the rate of HIV infection was reduced by 44% in people taking Truvada. But it is important to know that not all people who were given PrEP actually took the drugs. Based on tests of the level of medication in their blood, only 9% of people who became infected after being assigned to PrEP were actually taking it. Further analyses showed that people who took their pills consistently were more protected against HIV – up to 92%. Later studies, including the Partners PrEP and TDF-2 studies, have confirmed these results, including in injection drug users. It is important to note that in all these studies, people were also offered condoms, comprehensive risk reduction counseling, and STI treatment. But two studies, FEM-PrEP and VOICE, failed to show any reduction in HIV infections with PrEP. In both, rates of HIV infection were similar among those who received PrEP or pla- cebo. Blood tests showed that people in these studies had very low adherence to PrEP, and this was thought to be responsible for the negative results. by Anita Radix, MD and Sarit Golub, PhD D eandre is 26, African American, and gay. He worries about HIV, especially since several of his friends have tested positive over the years. “I try to be safe and use condoms most of the time, but sometimes they just get in the way.” Each year, about 50,000 U.S. adults and adolescents are diag- nosed with HIV. The rates are highest among men who have sex with men (MSM) and they are climbing, especially among young African American MSM, like Deandre. Condom use has been the main focus of HIV prevention campaigns, but this message is not being heard, especially among those at highest risk. Studies in adolescents and young adults have shown that almost 25% of men and almost 40% of women had not used condoms during sex in the last month. The NYS Plan to End AIDS aims not only to diagnose more people with HIV and improve their access to care and treatment, but also includes a goal to improve prevention of HIV using pre- exposure prophylaxis (PrEP). For this new prevention approach to be successful, there will need to be a major scale-up of resources by state and city health departments, as well as buy-in from leg- islators, other health sector partners, and communities at risk. What is PrEP? PrEP is a daily pill that HIV-negative people can take that greatly reduces their risk of becoming infected. In 2012, the FDA approved Truvada for use as PrEP. Although it made headlines at the time, using anti-HIV meds to prevent HIV transmission was not a new idea. Over 20 years ago, the ACTG 076 study proved that giving AZT to mothers with HIV and their newborns dra- matically reduced HIV transmission, by about 67%. HIV meds have also been used to reduce transmission after workplace exposures like needlesticks, and after sexual or injection-drug use exposure. This is known as post-exposure prophylaxis, or PEP. In these situations, the drugs must be given within 72 hours (preferably 36 hours) and taken for 28 days. Studies of PrEP in people began with the iPrEx trial. Starting in 2007, it enrolled 2,500 HIV-negative gay men and A Magic Pill to End AIDS?