What Are People Learning About HIV/AIDS In The PrEP Era? What Are Serosorting, 'Inevitable’ Transmission, and U=U?

Out of sight, out of mind. HIV/AIDS is not in the news, it is not mentioned as much as it used to be, and is considered a non-issue for many. So why do we care?  Why are we not caring as much anymore?  It seems the closest discussions our community has around HIV/AIDS is the debate about PrEP, But is PrEP more about not halting the  spread of HIV, but so people can believe they don't have to wear condoms? Are we fogetting why we are wearing condoms in the first place? PrEP = no condoms, oh yeah, and that things about AIDS.

Do we need a shot in the arm to remember that HIV/AIDS is out there? I recall the one time a former partner told me he was HIV positive. While waiting for my test results, I had some of the longest hot showers ever, just standing there, thinking, wondering, worrying.

Most of us don't stop and think about 'IT' as much as we used to. But some of us are still fighting the fight personally, while others are fighting the fight so others do not have to think about it as much as before.  Gareth Johnson, from MainlyMale.com, caught up with Chase Ledin to talk about his research into HIV and AIDS.

What drew you to the study of HIV in the UK and US?

I come in contact with HIV every day — when I log onto Grindr, when I talk queer theory with my colleagues, and when I explain the historical trends of sexual health, wellness, and queer culture to my students. Though I am seronegative, I’m asked to negotiate behaviours within the realm of serosorting.

I came out in a time period distinctly after the first-wave HIV epidemic. This period has saturated most spheres of my life with the message that HIV is treatable. This narrative is part of my shared-community history of queer kinship — it’s uniquely removed from the devastation of the ‘lost’ generation.

My inquiries started with undergraduate studies exploring queer literary history, especially invested in MSM socioeconomic histories, their queer community histories, and their sexual encounters before and during the first-wave epidemic. I was drawn into HIV studies when exposed to the works of Sarah Schulman, Tim Dean, Samuel R. Delany, Christopher Castiglia, and Christopher Reed. These scholars expressed concern about an ideological shift of social contact and the subsequent ‘gentrification’ — alteration, forgetting, erasure, departure — of queer history.

Introducing deeply unnerving case studies about perceptions of the HIV epidemic, many of these authors responded to public discourses constructing the AIDS epidemic as an ‘isolating event’ that estranged social practices and altered localities within queer history — such as bathhouses, sex clubs, bars, literary salons, and queer camping. I found myself attracted to the arguments because they pointed at a social juncture and existential dread that many gay men experience even today — the legacy of HIV and its perpetual complication of queer life.

I probed the archive for specific examples of ‘departure’ in queer history during my master’s coursework. I was drawn to the work of Andrew Sullivan — especially his 1996 article in The New York Times, When Plagues End. Sullivan spoke of a rupture within the primary AIDS narrative. He most likely sought to construct a departure of medical categories — HIV/AIDS — providing unique foresight to the ‘end of AIDS’ as a widespread and deadly disease which could be replaced by the chronic wonders of anti-retroviral therapies. Instead, his article was received as a premature and swift departure from the memorialisation that hung over US and UK communities. Sullivan’s proclamation permeated cultural discourses about HIV. His work colluded with larger structural changes, such as international efforts to provide HIV medicine to countries in Africa, and allowed for a larger dismantling of the AIDS=Death narrative.

My professional and doctoral work looks closely at the changes in queer health and period immediately following the epidemic — 1996–2012. Part of contemporary thinking about the epidemic and continued transmission relates to a narrative that says young queers ‘lack’ empathy. Whether or not this is true, this mode of thinking says that the HIV epidemic at large derives its power from insufficient standardised settings — such as education systems, and accessible and appropriate forms of queer consumerism.

The ‘lack’ of queer-initiated and sub-cultural norms — as LGBT folk are mainstreamed — is the absence of queer-specific tactics for managing sexual, emotional, and mental health, instead directing individuals to private, corporate, or national entities that manage queer care ‘outside’ of the queer sphere. An important other narrative within this mode of thinking suggests that the ‘lack’ within the ‘post-AIDS period — after 1996 — is an inability to speak candidly about the devastation and the unwillingness to signify sexual practices largely at play during the epidemic period. As this public narrative suggests, HIV and STIs can be managed and suppressed by highly-effective contemporary medicine — the urgency to tackle issues of gonorrhoea, syphilis, and chronic HIV is reserved for specialists, and community members are free to focus on social issues and developing a new status quo.

The ‘lack’ or ‘gap’ in historical empathy is sometimes mistakenly written in popular media as a wilful rejection of queer history and the differentiation of queer generations. The ‘gap’ in empathy for queers who do not have direct access to mentors who maintain oral histories before, during, and after the epidemic is not a fault of their own but a larger systemic ‘lack’ that can’t be solved by establishing a narrative of generational difference. In order to understand how we can resolve the ‘epidemic pain’ endemic to generational difference, and how we can provide a foundation of care within digitally-facilitated sexual interactions, we need to uncover how the epidemic has positively impacted queer contact in the twenty-first century and how queer markets can expand to better educate queer demographics.

My research analyses how this epidemic event, and its subsequent waves in the US and UK, continues to serve as an underlying informant that threads every booming neo-liberal sexual market. Every market item, including PEP, PrEP, and advanced sexual devices, is informed by the ‘epidemic pain’ turned into possibility for an easier sexual, social, romantic, and cultural life for queers. Sexual markets are saturated by viral discourses. Forgetting the pain of the epidemic period is not erasing the agentic and forward-thinking tactics of those brave ACT UP and Queer Nation activists, and does not remove the virus from our queer realities. Instead, these markets integrate the ‘pain’ from lessons learned and enable the proliferation of systemic change, even when such change cannot be reflected in each queer individual.

Is it important that young gay guys, who are beginning to learn about sex in the era of PrEP, have an understanding of what the medical and social history of HIV has been?

Young queers have an obligation to learn about viral history because it pertains to their sexual well-being, and because queer history provides extensive examples and opportunities for developing empathy and experiencing psychological ‘likeness.’ Both sexual well-being and empathy help to build a healthy queer individual.

Learning about the extent of the devastation is not necessary inasmuch as understanding the social and cultural tactics for confronting a ‘plague’ that was denigrated to gay men. When we learn from positive reactions to negative situations — such as ACT UP’s activism against the CDC ignoring requests for rapid anti-retroviral approval — we inculcate tactics to develop queer community.

Perhaps the number-one reason why generational tensions emerge is failure to engage with others’ life experiences. When handed an opportunity to reflect upon the past, especially a sexual past arguably all queers share, young queers should, in the least, cultivate a critical awareness of physical, psychological, and ideological barriers rampant during the 1980s and 1990s that, perhaps more covertly, continue to thrive today.

In the least, young queers must learn that HIV doesn’t discriminate based on sexual orientation. Young queers should integrate sexual history into their daily lives especially because serosorting and HIV stigma are common practices within the queer community. Stigma is derived from lack of social and medical contexts in addition to cultural and historical contexts. One systemic solution to HIV stigma emerges from the standardisation of queer life in educational settings, providing plain-fact science in addition to multiple cultural contexts for queer life across human existence. Even if young queers are to integrate this information from outside of institutions, they must, in the least, learn communication methods for introducing, analysing, and ‘unpacking’ these big ideas with their friends and partners.

I was quite moved by Matthew Hodson’s recent article, which reminded me that the ‘lack’ of our post-AIDS period is defined by a lack opportunities for practising cultural acculturation. Young queers hardly ever have opportunities to critically respond to queer messaging, especially since they’re not taught anything significant about queer life in standardised educational settings — and especially because queer adult life rarely mandates the exchange of ideas between experienced and inexperienced queers.

The myth of the ‘gay disease,’ for example, is substantiated by skewed numbers — queers who align with such a theory must continue to explore the vast archive of HIV and queer history to understand that queer life is not defined by a ‘gay’ disease. Importantly, by accessing these resources, young queers can build safe and respectful communities having learned from those who have come before them.

Is there a unified and consistent queer narrative regarding the experience of gay men with HIV and AIDS, or are there competing narratives?

There are competing narratives and will always be competing narratives regarding HIV. Today’s increasingly popular narrative is U=U, or undetectable equals untransmittable, which emerged in recent years. We also continue to have narratives that find their roots in the first-wave epidemic, such as serosorting. Serosorting is a common practice for many queer men. Many use serosorting to reject seropositive partners as a prevention tactic. Naturally, the problem created by this social narrative of exclusion, in order to prevent, ignores science and begs an updated understanding of HIV transmission and safer-sex tactics.

Another widely held narrative is the belief in ‘inevitable’ transmission, which, though less common than the former two, also derives its significance from the first-wave epidemic. This narrative suggests that, whether or not HIV is treatable, a large portion of gay male populations partaking in ‘risky’ sex are liable to acquire HIV, so it’s better to receive the virus as quickly as possible in order to start anti-retrovirals and continue with sexual practices. These three are not an exhaustive list but certainly some of the most prevalent in contemporary public discourse.

What are some of the current areas of focus for your study?

My current focus is on chronic medicine and how anti-retroviral technologies — before PrEP — changed queer life. For instance, I’m exploring perceptions of ARV adherence during the treatment era, and narratives that explore the boundaries of life ‘after’ HIV. There are a number of authors who continue to toe the line between ‘chronic’ narratives and ‘life without HIV’ speculation, which introduces a new element of ‘anticipation’ or ‘future’ unlike in AIDS discourse defined by terminal illness. My research focuses on the historical development of HIV in the UK, but is by no means isolated from the global expansion of HIV treatment and technologies.

I’m also working on a monograph about the representation and disclosure of HIV through body modifications and tattoos.

Follow Chase Ledin on Twitter

Content republished with permission from Gareth Johnson, from MainlyMale.com

Originally from Australia, Gareth now lives in London. A non-smoker who loves to laugh, Gareth writes about all aspects of the LGBTQ experiences, with a particular passion for travel, sport, and films.

NYU Study Suggests Tops And Bottoms Prefer Different Methods For Taking PrEP

Add this one to the list of interesting study findings. It looks like tops and bottoms like to take PrEP different ways.

When most people hear the words PrEP, they most likely think of the drug in its pill form. But, that’ll so be only one way in which the drug can be taken. Clinical trials are currently ongoing for long-acting injections of PrEP where getting a single shot every 8-12 weeks will suffice as support. In addition, there are studies going on for PrEP creams which can be applied to either the anus or the penis.

Curious about how these different methods would be applied by gay men, PhD student William Goedel gathered together a team of researchers from New York University and the University of Chicago.

The team collected data from 482 HIV-negative MSM (men who have sex with men) and published the data in the Archives of Sexual Behavior.

The study titled, “Are Anal Sex Roles Associated with Preference for Pre-Exposure Prophylaxis Administration Modalities Among Men Who Have Sex With Men?” surveying how the men would like to take their PrEP. The options were daily use, event-driven use (in which MSM use PrEP during seasonal times when they have sex and think they are at risk), PrEP shots, or PrEP cream.

The study’s results found that 31.7% of respondents would prefer whichever method was most effective. Then, 21.8% of respondents chose the injection, 11.0% chose event-driven pills, 8.3% chose the cream applied to the penis, 6.6% chose the cream applied to the anus, and 4.8% chose the daily pills.

But that’s not all. Geodel and his fellow researchers wanted to know if sexual roles had any affect on the data. They  then decided to split and categorize the data by three groups (tops, bottoms, and versatile men).

Those results found that tops preferred the cream applied to the penis with 19.6% choosing so over 4.6% bottoms and vers men. Meanwhile, 32.9% of bottoms preferred the injection and only 15.4% of tops and vers men agreed.

That said, most of these PrEP methods are far from becoming accessible to the general audience and even further from being affordable for them. As such, we’ll only have to guess whether this study's data is correct or not.

Report: First Known U.S. Case Of HIV Infection With Verified Adherence To PrEP

A 21-year-old Latinx man in San Francisco, California, has contracted HIV despite adhering to a daily PrEP regime.

According to TheBodyPro.com, he is the first known HIV seroconversion with verified adherence to PrEP in the United States,

Medical experts were informed of the news at the annual IDWeek conference, run by the Infectious Diseases Society of America, this past weekend in San Francisco.

Reports show the man began PrEP through a city health clinic in San Francisco in late 2016. At the time, he was confirmed to be HIV negative.

Repeat testing during return visits at the three, six and ten month marks showed he had been consistent in taking the medication and he remained HIV negative. By analyzing samples of his hair, doctors were able to confirm he had adhered to the PrEP regime on a regular basis for the previous six months.

In early 2018, during a followup visit, he tested negative through a rapid test, but a more comprehensive RNA test came back positive. Further testing showed he was indeed HIV positive.

He was immediately placed on HIV medications and his viral load was suppressed where it has remained since treatment began.

Health care experts were able to identify that the man had acquired a particularly resistant strain of HIV usually identified with those who have begun treatment with HIV medications but stopped.

Researchers were able to determine that the man’s primary male partner had been diagnosed with HIV, used medications for a period of time but had stopped. His viral load was found to be very high and matched the 21-year-old’s strain. He has since returned to treatment.

This marks the sixth reported case of HIV infection while using PrEP.

Four cases, two in 2016 in New York and Toronto, and two in 2017 in North Carolina and Australia, are believed to be due to exposure to high viral loads of resistant strains of HIV.

Medical experts believe the fifth previous case, in Amsterdam, was the result of a gay man having “unusually high number” of sexual partners - an average of 56 partners a month - which may have repeatedly exposed him to HIV, according to aidsmap.com.

Even in light of this new report, health care professionals insist PrEP (currently being taken on a regular basis by over 350,000 people around the world) is extremely effective in combating HIV infection.

"We know PrEP is greater than 99% effective," Robert Grant, M.D. of the University of California San Francisco told TheBodyPro.com. "There are some cases where HIV will break through. We only have a handful of cases now, and next year, we'll probably have a handful more. Fortunately, these cases are caught early, treated, and suppressed quickly. The person goes from taking one pill a day to one pill a day. The biggest difference is stigma."

NBC News recently reported that while 1.2 million in the United States would be considered appropriate candidates for PrEP, only 120,000 prescriptions have been filled between 2012 and 2017.

(h/t: TheBodyPro and aidsmap)


CDC Announces Gonorrhea Diagnoses Have Doubled Since 2013

At the National STD Prevention Conference in Washington yesterday, the Center for Disease Control released preliminary figures showing, for the fourth straight year, sexually transmitted diseases are on the rise.

In fact, 2017 saw a record 2.3 million cases of STDs in the United States.

The CDC described the increase as “steep” and “sustained” between 2013 and 2017.

At the top of the list was Chlamydia, accounting for a whopping 1.7 million diagnoses.

Additionally, Gonorrhea has jumped 67% and syphilis increased 76% in the four year time period. The CDC notes that 70% of those cases are among gay/bisexual men.

Guys - are you paying attention?

Dr. Jonathan Mermin, director of the CDC’s national STD agency, warned “We are sliding backward.”

“It is evident the systems that identify, treat, and ultimately prevent STDs are strained to near-breaking point,” he added.

Of great concern is gonorrhea’s increasing resistance to antibiotics.

For years, folks have felt that solving a gonorrhea infection could be as simple as a quick treatment with antibiotics. But medical experts say gonorrhea is becoming resistant to even the last remaining antibiotic used to treat the disease, ceftriaxone.

“We expect gonorrhea will eventually wear down our last highly effective antibiotic, and additional treatment options are urgently needed,’ said Dr Gail Bolan, director of CDC’s Division of STD Prevention.

David Harvey, executive director of the National Coalition of STD Directors, blames the steep rise in STDs on cutbacks in federal resources describing the STD prevention engine as “running on fumes.”

Some folks look to a rise in the use of PrEP (Pre-exposure Prophylaxis) as partly to blame for the increase in STD diagnoses.

A recent analysis of studies shows that while men on PrEP definitely see drop in HIV studies, chlamydia and syphilis increased by nearly 25% in first six months on PrEP.

But back in June, Matthew Hodson of Gay Star News opined that PrEP alone isn’t to blame. He named check dating apps, increases in chemsex, and even changing social attitudes towards sex.

What do you think is causing the steep rise in STDs, readers?

Less condoms? More PrEP? Perhaps dating apps? Or recreational drugs?

Sound off in the comments.

Reminder - the CDC recommends all sexually active gay and bisexual men to check in with their doctors regarding sexual health at least once a year. And get tested for STDs every 3-6 months if you’re playing with multiple partners.

(h/t Bloomberg.com)

Insurance Companies Are Rejecting Gay Men Because They're Using Truvada

American gay men are being denied certain types of insurance because they are taking PrEP.

The New York Times reports that a Boston urologist, who’s gay and was taking Truvada, was rejected for lifetime disability insurance. This urologist then applied with a different company and was accepted… after he stopped taking Truvada.

This seems to be a growing problem in the world of insurance as several American gay men have reported being denied life, disability, or long-term care insurance because of their drug regimen.

It seems that many insurance companies have a bias against pre-exposure prophylaxis or PrEP, which is used to prevent acquiring HIV.

Scott Schoettes, the HIV Project Director for Lambda Legal in Chicago, spoke to CNBC, and said this problem has been around for a few years now. When PrEP became more widely used in the U.S., insurance companies became wary of it.

“It popped for them because if someone is taking Truvada, they were taking it because it is used for HIV-positive status,” Schoettes said.

While PrEP is a drug available to everyone engaged in sex, and was even recently approved for use by teens, its gay men who are being singled out by insurance companies.

While several states have laws banning health insurance discrimination based on sexual orientation, the vast difference in policy between insurance companies makes it hard to call out all companies on this act.

That said, New York and California are both investigating the situation. California’s insurance commissioner, Dave Jones, said in a statement that these denials could count as illegal discrimination under California law.

As for what victims of these policies can do, Schoettes says they should contact organizations like GLBTQ Legal Advocates and Defenders (GLAD) or Lambda Legal in order to come up with a defensive strategy.

After all, “It’s a serious anti-public-health problem,” says Schoettes.

“People should step forward and raise their voices,” Schoettes said. “The insurers think they are getting at some kind of risk factor that they should be able to take into account, but they are not. They are punishing people who are actually reducing their risk.”

h/t: CNBC

New Campaign Wants Men To "Lose The Shame" When It Comes To Sex

Check out this sexy new PSA from medsEXPERT Pharmacy based in Toronto, Canada.

Featuring a handsome young urbanite named “Bradley,” the short vid follows his adventures before and after picking up his prescription for PrEP.

Taken on a regular basis, PrEP (Pre-exposure prophylaxis), also marketed as under medication name Truvada, can reduce the risk of HIV infection by over 90%.

It certainly seems to set Bradley free.

Produced by Bulldog Productions and featuring Sofi Tukker’s “Awoo,” busy-boy Bradley’s social calendar gets turbo-charged once he's in the PrEP swing of things.

“There is still a lot of stigma out there around the sex gay men have, it’s not always easy to find friendly or knowledgeable doctors and healthcare providers for LGBTQ+ folks,” Micheal Fanous, the owner and pharmacist at medsEXPERT told INMagazine. “Through this campaign, medsEXPERT wants to acknowledge the sex that men have and for all of us to be proud of who we are.”

The video ends with this message: “Don’t hate the player or the game itself. Take pride in your health!" 

Oh - "And never apologize for who you are.”

For more info about PrEP, click over to the CDC's site. Watch the sexy video below.

FDA Approves PrEP For Teens

In 2012, HIV medication Truvada was approved by the Food and Drug Administration (FDA) for use by adults as pre-exposure prophylaxis (PrEP) against HIV.

The results have been excellent to say the least as studies show the use of PrEP reduces the chances of HIV exposure by over 90%.

Now, the FDA has expanded the approval of Truvada as PrEP to include adolescents. The new approval will now include teens at risk for HIV who weigh at least 77 pounds.

The decision was based on the ATN113 study, which enrolled 78 high-risk adolescents ages 15 to 17.

Over the course of 48 weeks, the participants checked in on a monthly basis for the first three months, and then moved to clinic visits every three months. 

Adherence to taking the drug on a daily basis was fairly high during the first three months. But once the study moved to checking in only every three months, researchers found the teens were more likely to skip a dose. 

That drop off in adherence led to the conclusion that teens may need monthly monitoring in order to achieve the best results on PrEP.

The side effects reported among the adolescents were similar to those observed in adults on Truvada, the most common being weight loss, headaches and abdominal pains.

In a press release from Gilead Sciences, which manufactures Truvada, Sybil Hosek, PhD, clinical psychologist at the Cook County Health and Hospital System’s Stroger Hospital in Chicago and lead investigator of the study wrote, “Study ATN113 has demonstrated that Truvada for PrEP is a well-tolerated prevention option for adolescents who are vulnerable to HIV.”

“In addition to traditional risk-reduction strategies, health care providers and community advocates are now equipped with another tool to help address the incidence of HIV in younger at-risk populations,” she added.

(h/t Poz)

PrEP Is Great But There's Something You Should Know

Pretty much everyone can agree in this day and age that the use of Pre-Exposure Prophylaxis (PrEP) is a good thing. 

Studies show that when taken daily PrEP can reduce the risk of HIV infection by 92 percent.

But - yes, there’s a but - PrEP doesn’t take the place of a condom when it comes to being protected from sexually transmitted diseases like Syphilis.

And there’s not much less sexy than syphilis. Symptoms can include a sore on your mouth, rectum or genitals, fatigue, itching, rash and more. And that’s the early stages. Late stage syphilis can lead to serious health issues like blindness, brain damage and harm to organs.

The disease is transmitted through semen, blood, and skin contact with open sores, unprotected anal and vaginal sex, or sharing needles.

This may be information you've seen before. But, according to NBC affiliate KMIR, there is currently a syphilis outbreak among gay men underway in Palm Springs, California. 

The rate of syphilis in Palm Springs is 185 cases per 100,000 people, which is more than 10 times the rate in California overall.

Marcella Herrera-Carpenter, the program coordinator for the Riverside University Health System, told KMIR the county is still sourcing the reason behind the outbreak, but they do know that men who practice sex with men make-up most of the cases. 

And we know there’s a large gay population in Palm Springs.

Dr. Christopher Foltz who works with the Desert AIDS Project says that men who are using PrEP should be doing it in conjunction with condoms.

He also stressed that men who feel they may be at risk should not be afraid to ask their doctors about syphilis and get tested for it.

One more thing you should know: IF you test positive for syphilis your local health department will have to be notified by law. And the health officials there will have to contact you for an interview to confirm that you got treatment for the infection and to ask who you believe may have passed the infection on to you.

I live in Las Vegas and this has happened to a friend of mine. When he got the call, he decided he was a little embarrassed and didn’t want to talk to a stranger about it. After several follow-up calls, the health official showed up at his door asking for the short interview. 

Now this is all an effort to contain the spread of syphilis, but it doesn’t sound like a fun chat to have.

So gentlemen, first and foremost, for very real health reasons, consider how you play - even if you’re on PrEP.

And, if you don’t want a knock on your door asking some pretty personal questions (“Do you know who exposed you to the infection? What is their name? What is their phone number?"), consider how you play - even if you’re on PrEP.

Are there more risks to PrEP we don't know about?

A man in King County, Washington has been diagnosed HIV after having been on PrEP (Truvada) for months prior to his positive test. An extremely rare case in individuals who take Truvada for prevention, the drug has proven to be resistant to the infection.

PrEP can lower risk of HIV transmission by 90%, if taken properly—although this is skewed with numbers as low as 86% and as high as 99%. Needless to say, like many drugs, it is not 100% effective.

According to Outbreak News Today, Matthew Golden, MD, who is Director of Public Health’s STD/HIV program said the patient likely became HIV infected while taking PrEP.

This is the fourth incident in which patients on PrEP have been diagnosed with HIV.

While it was reported that approximately 136,000 Americans were taking Truvada as of 2017, this number falls short of the CDC’s recommendation for 1.2 million gay and bisexual men (1 out of 4) to be on PrEP.

PrEP Use Is On The Rise In the US... Except For One State

PrEP is becoming more and more accessible here in the United States of America, but one state is lagging behind the rest.

An expansion of ADISVu, an interactive map that tracks HIV prevalence, new diagnoses, and mortality, has revealed that the state of Georgia is getting left behind by the rest of America.

New data was released on ADISVu and shows a 880 percent increase in PrEP since 2012 with 73 percent increasing each year.

Patrick Sullivan, the head scientist for AIDSVu and a professor at Emory University, commented on the numbers by saying they’re impressive.

"This is so important because PrEP really is a key part in prevention campaigns. For the first time, there are numbers available state by state to give us a sense of how things are going with PrEP across the country," Sullivan added.

Unfortunately, however, Georgia is not doing as well as the rest of the country.

Georgia is ranked fifth in the list of US states with the highest number new of HIV diagnoses.

"Georgia routinely ranks in the top of new HIV diagnoses. Certainly, we'd like to see Georgia have one of the highest rates of PrEP uptake given that it has one of the highest numbers of new diagnoses. There is a lot of opportunity for an increase in PrEP use given Georgia's epidemic," Sullivan said.

On top of that, Georgia is not alone. Most Southern states have the highest number of new HIV diagnoses and the lowest proportional use of PrEP.

Because of that, researchers like Sullivan and some politicians are working to find a solution.

In January, Representative Park Cannon, one of the four openly gay lawmakers in Georgia’s House of Reps, introduced House Bill 755. If passed, that bill would create medical services and PrEP accessibility for people at high risk of HIV contraction. Unfortunately, the bill has stalled on the House floor.

That said, Sullivan appreciates the effort.

"When health departments are engaged in those states, when they have health department web pages talk about their programs for PrEP, those are areas we look to. Those are certainly state that are above the averages in their regions – for sure," Sullivan said.