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Vulnerable infected populations and street markets for ARVs: Potential implications for PrEP rollout in the USA.
AIDS Care. 2014 Apr; 26(4):411-5.AC

Abstract

Widespread diversion of antiretroviral (ARV) medications to illicit markets has recently been documented among indigent patients in South Florida. The recent approval of ARVs for pre-exposure prophylaxis (PrEP) has the potential to broaden these illicit markets, as high-risk individuals seek ARVs without a prescription or medical supervision. Nonadherence among diverters and unsupervised use of ARVs for treatment or PrEP increase risks of treatment failure, drug resistance, and disease transmission. We report the scope of ARV diversion among substance-using men who have sex with men in South Florida. Structured interviews (N = 515) queried demographics, HIV status, mental distress, substance dependence, and sexual risks. HIV-positive participants answered questions about medical care, treatment, and ARV adherence and diversion. Median age was 39. Of 46.4% who were HIV-positive, 79.1% were prescribed ARVs. Of these, 27% reported selling/trading ARVs. Reasons for diversion were sharing/trading with friends, sale/trade for money/drugs, and sale/trade of unused medications. ARV diverters, compared to nondiverters, were more likely to be substance dependent (74.5% vs. 58.7%, p = 0.046) and have traded sex for money/drugs (60.8% vs. 32.6%, p < 0.001), and less likely to be adherent to ARVs (54.9% vs. 73.9%, p = 0.012). ARV diversion should be a particular concern in communities of high-risk men who have sex with men as uninfected men in such communities are likely to benefit most from PrEP but unlikely to have access to PrEP and necessary ancillary services through the health-care system. The implications of diversion for increased risks of treatment failure, disease transmission, and PrEP failure should be carefully considered in developing policy and behavioral supports to scaling up treatment as prevention and PrEP.

Authors+Show Affiliations

a Center for Applied Research on Substance Use and Health Disparities , Nova Southeastern University , Miami , FL , USA.No affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

24033118

Citation

Kurtz, Steven P., et al. "Vulnerable Infected Populations and Street Markets for ARVs: Potential Implications for PrEP Rollout in the USA." AIDS Care, vol. 26, no. 4, 2014, pp. 411-5.
Kurtz SP, Buttram ME, Surratt HL. Vulnerable infected populations and street markets for ARVs: Potential implications for PrEP rollout in the USA. AIDS Care. 2014;26(4):411-5.
Kurtz, S. P., Buttram, M. E., & Surratt, H. L. (2014). Vulnerable infected populations and street markets for ARVs: Potential implications for PrEP rollout in the USA. AIDS Care, 26(4), 411-5. https://doi.org/10.1080/09540121.2013.837139
Kurtz SP, Buttram ME, Surratt HL. Vulnerable Infected Populations and Street Markets for ARVs: Potential Implications for PrEP Rollout in the USA. AIDS Care. 2014;26(4):411-5. PubMed PMID: 24033118.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Vulnerable infected populations and street markets for ARVs: Potential implications for PrEP rollout in the USA. AU - Kurtz,Steven P, AU - Buttram,Mance E, AU - Surratt,Hilary L, Y1 - 2013/09/16/ PY - 2013/9/17/entrez PY - 2013/9/17/pubmed PY - 2014/4/8/medline SP - 411 EP - 5 JF - AIDS care JO - AIDS Care VL - 26 IS - 4 N2 - Widespread diversion of antiretroviral (ARV) medications to illicit markets has recently been documented among indigent patients in South Florida. The recent approval of ARVs for pre-exposure prophylaxis (PrEP) has the potential to broaden these illicit markets, as high-risk individuals seek ARVs without a prescription or medical supervision. Nonadherence among diverters and unsupervised use of ARVs for treatment or PrEP increase risks of treatment failure, drug resistance, and disease transmission. We report the scope of ARV diversion among substance-using men who have sex with men in South Florida. Structured interviews (N = 515) queried demographics, HIV status, mental distress, substance dependence, and sexual risks. HIV-positive participants answered questions about medical care, treatment, and ARV adherence and diversion. Median age was 39. Of 46.4% who were HIV-positive, 79.1% were prescribed ARVs. Of these, 27% reported selling/trading ARVs. Reasons for diversion were sharing/trading with friends, sale/trade for money/drugs, and sale/trade of unused medications. ARV diverters, compared to nondiverters, were more likely to be substance dependent (74.5% vs. 58.7%, p = 0.046) and have traded sex for money/drugs (60.8% vs. 32.6%, p < 0.001), and less likely to be adherent to ARVs (54.9% vs. 73.9%, p = 0.012). ARV diversion should be a particular concern in communities of high-risk men who have sex with men as uninfected men in such communities are likely to benefit most from PrEP but unlikely to have access to PrEP and necessary ancillary services through the health-care system. The implications of diversion for increased risks of treatment failure, disease transmission, and PrEP failure should be carefully considered in developing policy and behavioral supports to scaling up treatment as prevention and PrEP. SN - 1360-0451 UR - https://www.unboundmedicine.com/medline/citation/24033118/Vulnerable_infected_populations_and_street_markets_for_ARVs:_Potential_implications_for_PrEP_rollout_in_the_USA_ L2 - https://www.tandfonline.com/doi/full/10.1080/09540121.2013.837139 DB - PRIME DP - Unbound Medicine ER -