Black market for PrEP may undermine treatment adherence in marginalised people living with HIV


The increasing demand for pre-exposure prophylaxis (PrEP) is likely to increase the likelihood that some marginalised individuals living with HIV sell some of their prescribed medication to pill brokers and drug dealers, according to a study presented to the Conference of the Association for the Social Sciences and Humanities in HIV in Stellenbosch, South Africa last week.

Steven Kurtz told the conference that several reports have documented street markets for diverted antiretrovirals (ARVs) in the United States. His own research focuses on south Florida, where he recruited 147 HIV-positive men who have sex with men (MSM) who regularly use cocaine, crack or heroin. He purposively sampled (over-recruited) individuals who had sold or traded their antiretrovirals, so that he could better understand the factors associated with doing so.

Economic vulnerability is the key explanation. Within this sample, men who had recently sold ARVs were more likely to have an income below $1000 a month, to have traded sex for money or drugs and to be dependent on drugs. Age, race and education were not relevant factors. Unsurprisingly, men who had sold their HIV treatment had poor levels of adherence to it.

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Intervention improves HIV med adherence Black and Latino men


A counseling-based intervention has succeeded in improving adherence to antiretrovirals (ARVs) among HIV-positive blacks and Latinos who are reluctant to start treatment. Publishing their findings in AIDS and Behavior, researchers recruited 95 HIV-positive, treatment-naive African-American and Latino adults whose CD4 counts were below 500 and randomized them into either an intervention or a control arm.

The intervention included three individual counseling sessions, up to five support groups with other study participants, and personalized patient navigation for 12 to 24 weeks, depending on their needs. This “pre-adherence” intervention was designed for people who have refused to start ARVs or who believe they are not ready to take them. The control group was assigned to receive HIV treatment under standard protocol.

Eight months into the study, 60 percent of the intervention participants were adhering to ARVs seven days a week, according to drug concentrations in hair samples, compared with just 26.7 percent of the control participants. Additionally, the intervention participants had, on average, a nearly 10-fold lower viral load than the controls.

The researchers concluded that future study of this intervention is warranted.

To read the press release, click here.

To read the study abstract, click here.