Elimination prospects of the Dutch HIV epidemic among men who have sex with men in the era of preexposure prophylaxis

Abstract

Objective:Preexposure prophylaxis (PrEP) is a promising intervention to help end the HIV epidemic among men who have sex with men (MSM) in the Netherlands. We aimed to assess the impact of PrEP on HIV prevalence in this population and to determine the levels of PrEP coverage necessary for HIV elimination.Design and methods:We developed a mathematical model of HIV transmission in a population stratified by sexual risk behavior with universal antiretroviral treatment (ART) and daily PrEP use depending on an individual's risk behavior. We computed the effective reproduction number, HIV prevalence, ART and PrEP coverage for increasing ART and PrEP uptake levels, and examined how these were affected by PrEP effectiveness and duration of PrEP use.Results:At current levels of ART coverage of 80%, PrEP effectiveness of 86% and PrEP duration of 5 years, HIV elimination required 82% PrEP coverage in the highest risk group (12 000 MSM with more than 18 partners per year). If ART coverage increased by 9%, the elimination threshold was at 70% PrEP coverage. For shorter PrEP duration and lower effectiveness elimination prospects were less favorable. For the same number of PrEP users distributed among two groups with highest risk behavior, prevalence dropped from the current 8 to 4.6%.Conclusion:PrEP for HIV prevention among MSM could, in principle, eliminate HIV from this population in the Netherlands. The highest impact of PrEP on prevalence was predicted when ART and PrEP coverage increased simultaneously and PrEP was used by the highest risk individuals.

Introducing pre-exposure prophylaxis to prevent HIV acquisition among men who have sex with men in Sweden: insights from a mathematical pair formation model

“…The benefit of targeting high-risk individuals for PrEP has been found by other studies 8 21–24. Our analyses add to these findings by including additional parameters.…”

“…Second, they address mixing through a different method using an OR among male heterosexuals, while we use data from the MSM population under study. Rozhnova et al 24 use four risk groups, however, they do not estimate mixing between the groups but assume intermediate mixing.…”

Words Matter: Putting an End to “Unsafe” and “Risky” Sex

“…A search on PubMed in September 2019 yielded over four thousand articles with "unsafe sex," "risky sex," "risky sexual behavior," "highrisk sexual behavior," or "sexual risk behavior" in the title or abstract alone, including papers recently published in STD and other leading journals. [1][2][3][4][5][6][7][8][9][10] We propose that the language we use to describe sexual behavior should be updated to reflect the current landscape of sexual health and sexually transmitted infections (STIs). In 2014, at the request of HIV advocates, the Centers for Disease Control and Prevention agreed to discontinue the use of the phrase "unprotected sex," opting for the more precise "condomless sex."…”

The continuing HIV epidemic among men who have sex with men and transgender women in the ASEAN region: implications for HIV policy and service programming

“…Whereas consistent population-based decreases in HIV/AIDS case reports have been observed among MSM residing in urban areas of the Western world, [1][2][3][4][7][8][9] no such pattern emerged from our review of the HIV epidemiology among MSM in Southeast Asia. Although a decrease in HIV prevalence was found among MSM in Bangkok, prevalence in the other cities was stable or increasing.…”

“…5,6 Their successful roll-out among MSM and other key populations in Western countries has led to hopes and speculations about the possibility of eradication of HIV, an example of which is the Joint United Nations Programme on HIV/AIDS (UNAIDS)'s mantra of 'Getting to Zero'. 1,[7][8][9][10] This refers to a global campaign to achieve zero new HIV infections, zero HIVrelated discrimination and zero HIV-related deaths by 2030. 10 Although results observed among urban MSM in Western countries are encouraging, it is unknown to what degree these apply to the HIV epidemic among MSM and transgender women (TGW) in Southeast Asia.…”