A single mom. A Middle Eastern man. A drag queen. And a Black activist. These varied individuals—plus five others—share the spotlight in a new HIV prevention campaign by Michigan’s health department titled “MIPrEP. MIChoice.” Specifically, these diverse spokespeople share their reasons for taking pre-exposure prophylaxis (PrEP) to remain HIV negative. The goal is to promote the use of PrEP, notably among Black and brown communities and other populations with high rates of HIV and low rates of PrEP uptake.
An initiative of the Michigan Department of Health and Human Services, “MIPrEP. MIChoice” debuts as Michigan was ranked 41st in the nation for PrEP coverage based on data from the Centers for Disease Control and Prevention, according to a Michigan health department press release.
Mirroring national trends, Michigan has seen greater PrEP use among gay white men ages 25 to 44 than other populations at increased risk for contracting the virus. “Black and Latino communities have been affected significantly by HIV with new diagnosis rates nine times higher for Black residents than white residents, and Latinos diagnosed at three times the rate of white residents,” explains the press release. “PrEP utilization in these communities remains far lower than among whites for a number of reasons, including stigma, low perception of risk, medical mistrust, lack of awareness about PrEP and insurance status. The ‘MIPrEP. MIChoice’ campaign will work to close these gaps; people from these communities who have chosen to take PrEP are featured in the campaign.”
“I am a single mom of three boys,” explains campaign participant Tiffani. “I got a job and was talking to others about how PrEP helps prevent HIV, and I thought I should be taking this myself. It’s an extra step of protection. You think you know your partner, but you never really know. It’s a daily reminder of your choices and to take care of yourself.”
You can check out photos and read quotes from all “MIPrEP. MIChoice” participants here. And look for social media campaigns featuring these individuals in the near future.
Monica, a ballroom house mother, founding board member of the Trans Sistas of Color Project and a cochair of Michigan HIV/AIDS Council, says: “I have been losing so many of my friends and loved ones to the HIV epidemic. My main goal is to stay protected, live a long, happy, healthy life and to still have healthy sex. When you’re on PrEP, you can do all of those things. Being trans, we are already stigmatized and have labels on us. I choose to be healthy. I choose to live my truth. PrEP gives me that sense of choice.”
“PrEP empowers me,” explains campaign participant Doran. “I’m making choices for my personal health to do what is best for me. It gives me a boost of self-confidence, which being queer and a Middle Eastern man, you tend not to have as much. A big part of the queer Middle Eastern experience is shame. That shame leads people to not talk about things or look for help and just to continue behaviors without the knowledge of what they are doing. Taking PrEP gives me a sense of safety, protection and self-care.”
Currently, the Food and Drug Administration (FDA) has approved two daily pills and a long-acting injectable as PrEP. For more details see “A PrEP Primer,” which reads in part:
PrEP refers to antiretroviral pills or injections taken regularly to prevent HIV. Although PrEP is highly effective, it has yet to reach its full potential: Less than a third of people who could benefit from PrEP are using it.
There are currently three approved PrEP options:
- Truvada (tenofovir disoproxil fumarate/emtricitabine, or TDF/FTC) was approved for PrEP in 2012. It is indicated for all populations at risk for HIV. It is usually taken once daily, but using it “on demand” before and after sex (known as PrEP 2-1-1) also works well. Studies of cisgender gay men and transgender women showed that daily Truvada is around 99% effective if used consistently. Truvada PrEP is also effective for cisgender women, but they may need to maintain better adherence. Truvada is generally well tolerated, but it can cause minor side effects, such as nausea, that usually resolve over time. TDF can cause kidney problems and bone loss in susceptible individuals.
- Descovy (tenofovir alafenamide/emtricitabine, or TAF/FTC) was approved for PrEP in 2019. It is indicated for cisgender men and transgender women, but, due to a lack of evidence, it is not yet approved for people exposed to HIV via vaginal sex. Descovy is taken once daily. The DISCOVER trial showed that daily Descovy PrEP is as effective as daily Truvada for cisgender gay men and trans women; studies of cisgender women are underway. Descovy is also generally well tolerated. TAF is easier on the kidneys and bones than TDF, but it has been linked to elevated blood fat levels and weight gain.
- Apretude (long-acting cabotegravir) was approved for HIV prevention in 2021. It is indicated for all populations at risk for HIV. It is an injection administered by a health care provider every other month. The HPTN 083 trial showed that Apretude was even more effective than daily PrEP pills for cisgender gay men and transgender women, while HPTN 084 found that it was substantially more effective for cisgender women in Africa. Apretude is generally well tolerated. The most common side effect is temporary pain, redness or swelling at the injection site.