Contents lists available at ScienceDirect Preventive Medicine journal homepage: www.elsevier.com/locate/ypmed Discussion Medical students reflect on the future of Pre-Exposure Prophylaxis use among adolescents and young adults Ivie Eweka, Jean Fleuriscar, Jacqueline Fleuriscar 1 , Adenike Adeyemi-Jones, Brianna Dillon, Tashuna Albritton ⁎ City University of New York (CUNY) School of Medicine, City College of New York, 160 Convent Avenue, New York, NY 10031, United States ARTICLE INFO Keywords: Pre-Exposure Prophylaxis HIV Adolescent Prevention Imagine a world in which HIV/AIDS no longer decimated popula- tions. As medical students, that is the world we envision with the in- creased use of Pre-Exposure Prophylaxis (PrEP). PrEP is a recent HIV prevention method for individuals who do not have HIV but are at a high risk for infection. This method includes taking a daily pill com- prised of a combination of drugs, traditionally used to treat HIV, to lower the chances of becoming infected even after exposure to the virus (Baeten et al., 2013). Clinical trials have shown the biological effec- tiveness of PrEP among adherent individuals. Bisexual and gay men and men and women in HIV discordant relationships with detectable levels of tenofovir have shown 92% and 90% reductions in risk of HIV, re- spectively (Grant et al., 2010; Baeten et al., 2012). For people who inject drugs, efficacy was 74% among those with detectable tenofovir concentrations (Choopanya et al., 2013). Given these findings, we un- derstand the importance of PrEP intervention and its potential impact in the U.S. and other nations. As we strive to help build healthy com- munities through primary preventative care, we want to see PrEP use implemented across high-risk populations, including among adoles- cents and young adults. Ultimately, prevention is key. However, only 3% of the national budget for HIV/AIDS is allocated for domestic prevention while 61% covers care and treatment (U.S. Federal Funding for HIV/AIDS, 2017). That HIV/AIDS prevention funds remain flat is troubling and costly. A paradigm in which prevention is emphasized will subsequently reduce treatment expenditures. More importantly, it will prevent high risk individuals from ever contracting the disease—and should that not be our main objective? To avoid illness and promote wellness? A well- known aphorism states, “an ounce of prevention is worth a pound of cure.” We are optimistic that PrEP use will expand to include younger high risk groups soon. Youth, especially those in underrepresented minority groups, are disproportionately affected by HIV/AIDS. In 2014, adolescents and young adults aged 13–24 years accounted for an estimated 22% of all new HIV diagnoses in the United States (Center for Disease Control, 2015). Similar to adults, young people engage in sexual practices that put them at increased risk for HIV and other sexually transmitted dis- eases. In 2015, the Youth Risk Behavior Surveillance System indicated that 30% of U.S. high school students had sexual encounters during the previous 3 months and, of these, 43% did not use a condom at their last sexual encounter; furthermore, 21% reported drinking alcohol or using drugs before their last sexual encounter (Center for Disease Control, 2016). These behaviors put young populations at risk for HIV, yet only 10% of sexually experienced students reported ever being tested for HIV (Center for Disease Control, 2016). Making PrEP widely available can significantly reduce new HIV diagnoses among adolescents and young adults, but there are barriers to accessing the drug. One barrier is the ambiguity in guideline language among federal health administration agencies, such as the U.S. Food and Drug Administration (FDA) and the Centers for Disease Control and Prevention (CDC) regarding the safety of PrEP use in younger popula- tions (U.S. Department of Health and Human Services U.S. Food and Drug Administration, 2012; Center for Disease Control and Prevention, 2014). In 2012, the FDA approved PrEP in combination with safer sex practices to reduce the risk of sexually acquired HIV-infection among https://doi.org/10.1016/j.ypmed.2018.05.020 Received 6 July 2017; Received in revised form 18 May 2018; Accepted 21 May 2018 ⁎ Corresponding author. 1 Jacqueline Fleuriscar is presently at the New York Medical College, 40 Sunshine Cottage Rd., Valhalla, New York 10595, United States. E-mail addresses: ieweka000@citymail.cuny.edu (I. Eweka), jfleuri000@citymail.cuny.edu (J. Fleuriscar), jfleuri00@citymail.cuny.edu (J. Fleuriscar), aadeyem000@citymail.cuny.edu (A. Adeyemi-Jones), bdillon000@citymail.cuny.edu (B. Dillon), talbritton@med.cuny.edu (T. Albritton). Preventive Medicine 113 (2018) 122–123 Available online 22 May 2018 0091-7435/ © 2018 Elsevier Inc. All rights reserved. T