Impact of Disparity
Research has shown that the prevalence of HIV diagnoses and the rates of new HIV infections are highest in the southern US, including North Carolina.7 In the state of North Carolina:
- Male-to-male sexual contact represents the mode of transmission for almost 70% of men living with HIV8
- Almost 6% of transmissions for men living with HIV were the result of dual exposure through injection drug use and male-to-male sexual contact8
- Almost three-fourths of total HIV transmission in the state are the result of male-to male sexual contact8
- Among new diagnoses, these numbers only seem to be increasing, closer to 84%8
- Black men in the state of North Carolina are also 6 times more likely to be living with HIV than white males8
- The Durham-Chapel Hill, Winston-Salem, Greensboro-High Points metropolitan areas were also identified within the top 25 metropolitan areas for prevalence of HIV diagnoses and rates of new infections7
Causes of Disparity
Pre-exposure prophylaxis offers many opportunities to prevent the spread of HIV; however, stigma surrounded the drug itself may be preventing many gay and bisexual men from seeking out the drug and many medical providers from prescribing the drug to their gay and bisexual patients. This could partially be a result of general stigma about asking patients sexual health questions or questions about sexuality. Simply prescribing PrEP to all gay and bisexual men would result in overuse. Hence, discussions about sexual risk behaviors is important for assessing an individual’s need for the drug. However, medical provider stigma might represent a larger barrier to accessing PrEP, especially for black men who have sex with men. Further, the population of medical providers has been less of a focus for current public health interventions to increase the use of PrEP.
- Duran, D. Truvada Whores? Huffinton Post. 2012. https://www.huffingtonpost.com/david-duran/truvada-whores_b_2113588.html
- Addison, V. Larry Kramer, Truvada Whores and the Angry Divide Between Two Generations. HIVEqual. n.d. http://www.hivequal.org/homepage/larry-kramer-truvada-whores-and-the-angry-divide-between-two-generations
- Logo. Revisiting “Truvada Whore” Three Years Later. NewNowNext. 2016. http://www.newnownext.com/revisiting-truvada-whore-three-years-later/02/2016/
- Emory University Rollins School of Public Health. North Carolina. AIDSVu. n.d. https://aidsvu.org/state/north-carolina/
- Calabrese SK, Underhill K. How Stigma Surrounding the Use of HIV Preexposure Prophylaxis Undermines Prevention and Pleasure: A Call to Destigmatize “Truvada Whores”. American journal of public health. 2015;105(10):1960-1964.
- Calabrese SK, Earnshaw VA, Underhill K, Hansen NB, Dovidio JF. The Impact of Patient Race on Clinical Decisions Related to Prescribing HIV Pre-Exposure Prophylaxis (PrEP): Assumptions About Sexual Risk Compensation and Implications for Access. AIDS and behavior. 2014;18(2):226-240.
- Rosenberg ES, Grey JA, Sanchez TH, Sullivan PS. Rates of Prevalent HIV Infection, Prevalent Diagnoses, and New Diagnoses Among Men Who Have Sex With Men in US States, Metropolitan Statistical Areas, and Counties, 2012-2013. JMIR Public Health Surveill. 2016;2(1):e22.
- Britz JJ. To Know or not to Know: A Moral Reflection on Information Poverty. Journal of Information Science. 2004;30(3):192-204.