Pre-exposure Prophylaxis for HIV Infection: Preventing Disease or Promoting Sexual Health?

  • Ronald O. ValdiserriEmail author
  • David R. Holtgrave

Practitioners of public health recognize that disease prevention and health promotion occupy the same continuum of activities that are aimed at improving individual and population health. Closely related as they are, however, these two domains are not identical—either in concept or in practice. Their differences owe to the widely-accepted definition of health as a state of “complete physical, mental and social well-being and not merely the absence of disease or infirmity” [1]. Namely, while the absence of disease brought about by prevention activities is a laudable goal and an important component of health, it may not be the only condition necessary to achieve and sustain overall health.

This observation is especially pertinent when considering the domain of sexual health. Admittedly, definitions of sexual health have evolved over time and will continue to develop as our understanding of human sexuality grows [2]. Nevertheless, the following elements are currently recognized as...


Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    World Health Organization. (1946). Constitution of the World Health Organization. Retrieved Oct 25, 2018, from
  2. 2.
    Edwards, W. M., & Coleman, E. (2004). Defining sexual health: A descriptive overview. Archives of Sexual Behavior, 33(3), 189–195.CrossRefGoogle Scholar
  3. 3.
    World Health Organization. (2010). Developing sexual health programs: A framework for action. Retrieved Oct 29, 2018, from
  4. 4.
    Ford, J. V., Ivankovich, M. B., Douglas, J. M., et al. (2017). The Need to promote sexual health in America: A new vision for public health action. Sexually Transmitted Diseases, 44(10), 579–585.CrossRefGoogle Scholar
  5. 5.
    Grant, R. M., Lama, J. R., Anderson, P. L., et al. (2010). Preexposure chemoprophylaxis for HIV prevention in men who have sex with men. New England Journal of Medicine, 363(27), 2587–2599.CrossRefGoogle Scholar
  6. 6.
    Smith, D. K., Grant, R. M., Weidle, P. J., Lansky, A., Mermin, J., & Fenton, K. A. (2011). Interim guidance: Preexposure prophylaxis for the prevention of HIV infection in men who have sex with men. Morbidity and Mortality Weekly Report, 60(3), 65–68.Google Scholar
  7. 7.
    Smith, D. K., Thigpen, M. C., Nesheim, S. R., et al. (2012). Interim guidance for clinicians considering the use of preexposure prophylaxis for the prevention of HIV infection in heterosexually active adults. Morbidity and Mortality Weekly Report, 61(31), 586–589.Google Scholar
  8. 8.
    Smith, D. K., Martin, M., Lansky, A., Mermin, J., & Choopanya, K. (2013). Update to interim guidance for preexposure prophylaxis (PrEP) for the prevention of HIV infection: PrEP for injecting drug users. Morbidity and Mortality Weekly Report, 62(23), 463–465.Google Scholar
  9. 9.
    Food and Drug Administration. (2012). FDA approves first drug for reducing the risk of sexually acquired HIV infection. Retrieved Oct 31, 2018, from
  10. 10.
    Centers for Disease Control and Prevention: US Public Health Service. (2014). Preexposure Prophylaxis for the Prevention of HIV Infection in the United States: A Clinical Practice Guideline. Published May 14, 2014. Note: 2014 PrEP Guidelines are no longer maintained by CDC.Google Scholar
  11. 11.
    Ryan, B. (2018). FDA Approves Truvada as PrEP for Adolescents at Risk for HIV. POZ. Retrieved Nov 1, 2018, from
  12. 12.
    Office of National AIDS Policy. (2015). National HIV/AIDS Strategy for the United States: Updated to 2020. Retrieved Nov 3, 2018, from
  13. 13.
    Jenness, S. M., Goodreau, S. M., Rosenberg, E., Beylerian, E. N., Hoover, K. W., Smith, D. K., & Sullivan, P. (2016). Impact of the Centers for Disease Control’s HIV preexposure prophylaxis guidelines for men who have sex with men in the United States. Journal of Infectious Diseases, 214(12), 1800–1807.CrossRefGoogle Scholar
  14. 14.
    Sullivan, P. S., Giler, R. M., Mouhanna, F., et al. (2018). Trends in the use of oral emtricitabine/tenofovir disoproxil fumarate for pre-exposure prophylaxis against HIV infection, United States, 2012–2017. Annals of Epidemiology, 12(12), 833-840.Google Scholar
  15. 15.
    Huang, Y. A., Zhu, W., Smith, D. K., Harris, N., & Hoover, K. W. (2018). HIV preexposure prophylaxis, by race and ethnicity—United States, 2014–2016. Morbidity and Mortality Weekly Report, 67(41), 1147–1150.CrossRefGoogle Scholar
  16. 16.
    Harawa, N., McBride, S., Leibowitz, A., Pulsipher, C., & Holloway, I. (2018). Examining PrEP Uptake among Medi-Cal Beneficiaries in California: Differences by Age, Gender, Race/Ethnicity and Geographic Region. California HIV/AIDS Policy Research Centers. Retrieved Nov 5, 2018, from
  17. 17.
    Green, L. W., Ottoson, J. M., Garcia, C., & Hiatt, R. A. (2009). Diffusion theory and knowledge dissemination, utilization and integration in public health. Annual Review of Public Health, 30, 151–174.CrossRefGoogle Scholar
  18. 18.
    Smith, D. K., Mendoza, M. C., Stryker, J. E., & Rose, C. E. (2016). PrEP awareness and attitudes in a national survey of primary care clinicians in the United States, 2009–2015. PLoS ONE, 11 (6), e0156592.CrossRefGoogle Scholar
  19. 19.
    Misra, K., & Udeaugu, C. C. (2017). Disparities in awareness of HIV postexposure and preexposure prophylaxis among notified partners of HIV-positive individuals, New York City 2015–2017. Journal of Acquired Immune Deficiency Syndromes, 76(2), 132–140.CrossRefGoogle Scholar
  20. 20.
    Eaton, L. A., Kalichman, S. C., Price, D., Finneran, S., Allen, A., & Maksut, J. (2017). Stigma and conspiracy beliefs related to pre-exposure prophylaxis (PrEP) and interest in using PrEP among black and white men and transgender women who have sex with men. AIDS and Behavior, 21(5), 1236–1246.CrossRefGoogle Scholar
  21. 21.
    Calabrese, S. K., Dovidio, J. F., Tekeste, M., et al. (2018). HIV pre-exposure prophylaxis stigma as a multidimensional barrier to uptake among women who attend planned parenthood. Journal of Acquired Immune Deficiency Syndromes, 79(1), 46–53.CrossRefGoogle Scholar
  22. 22.
    Eaton, L. A., Driffin, D. D., Smith, H., Conway-Washington, C., White, D., & Cherry, C. (2014). Psycho-social factors related to willingness to use pre-exposure prophylaxis for HIV prevention among black men who have sex with men attending a community event. Sexual Health, 11(3), 244–251.CrossRefGoogle Scholar
  23. 23.
    Lelutiu-Weinberger, C., & Golub, S. A. (2016). Enhancing PrEP access for black and latino men who have sex with men. Journal of Acquired Immune Deficiency Syndromes, 73(5), 547–555.CrossRefGoogle Scholar
  24. 24.
    Cahill, S., Taylor, S. W., Elesser, S. A., Mena, L., Hickson, D., & Mayer, K. H. (2017). Stigma, medical mistrust, and perceived racism may affect PrEP awareness and uptake in black compared to white gay and bisexual men in Jackson, Mississippi and Boston, Massachusetts. AIDS Care, 29(11), 1351–1358.CrossRefGoogle Scholar
  25. 25.
    Smith, D. K., Van Handel, M., & Grey, J. (2018). Estimates of adults with indications for HIV pre-exposure prophylaxis by jurisdiction, transmission risk group, and race/ethnicity, United States, 2015. Annals of Epidemiology, 28(12), 850-857.CrossRefGoogle Scholar
  26. 26.
    Calabrese, S. K., Earnshaw, V. A., Krakower, D. S., et al. (2018). A closer look at racism and heterosexism in medical students’ clinical decision-making related to HIV pre-exposure prophylaxis (PrEP): Implications for PrEP education. AIDS and Behavior, 22(4), 1122–1138.CrossRefGoogle Scholar
  27. 27.
    Pathela, P., Jamison, K., Braunstein, S. L., Schillinger, J. A., Varma, J. K., & Blank, S. (2017). Incidence and predictors of HIV infection among men who have sex with men attending public sexually transmitted disease clinics, New York City, 2007–2012. AIDS and Behavior, 21(5), 1444–1451.CrossRefGoogle Scholar
  28. 28.
    Marx, G. E., Bhatia, R., & Rietmeijer, C. A. (2016). An opportunity too good to miss: Implementing human immunodeficiency virus preexposure prophylaxis in sexually transmitted diseases clinics. Sexually Transmitted Diseases, 43(4), 266–267.CrossRefGoogle Scholar
  29. 29.
    Hoover, K. W., Ham, D. C., Peters, P. J., Smith, D. K., & Bernstein, K. T. (2016). Human immunodeficiency virus prevention with preexposure prophylaxis in sexually transmitted disease clinics. Sexually Transmitted Diseases, 43(5), 277–282.CrossRefGoogle Scholar
  30. 30.
    Leichliter, J. S., Heyer, K., Peterman, T. A., et al. (2017). US public STD clinical services in an era of declining public health funding, 2013–2014. Sexually Transmitted Diseases, 44(8), 505–509.CrossRefGoogle Scholar
  31. 31.
    National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. (2018). New CDC analysis shows steep and sustained increases in STDs in recent years. Retrieved Nov 28, 2018, from
  32. 32.
    U. S. Office of Disease Prevention and Health Promotion. Healthy People 2020: Public Health Infrastructure. Retrieved Nov 29, 2018, from
  33. 33.
    Liu, A. Y., Cohen, S. E., Vittinghoff, E., et al. (2016). HIV pre-exposure prophylaxis integrated with municipal and community based sexual health services. JAMA Internal Medicine, 176(1), 75–84.CrossRefGoogle Scholar
  34. 34.
    Parisi, D., Warren, B., Leung, S. Y., Akkaya-Hocagil, T., Qin, Q., Hahn, I., & Stevens, L. (2018). A multicomponent approach to evaluating a pre-exposure prophylaxis (PrEP) implementation program in five agencies in New York. Journal of the Association of Nurses in AIDS Care, 29(1), 10–19.CrossRefGoogle Scholar
  35. 35.
    New York State Department of Health. PrEP Assistance Program (PrEP-AP). Retrieved Dec 4, 2018, from
  36. 36.
    Patel, R. R., Mena, L., Nunn, A., et al. (2017). Impact of insurance coverage on utilization of pre-exposure prophylaxis for HIV prevention. PLoS ONE, 12(5), e0178737.CrossRefGoogle Scholar
  37. 37.
    Morgan, E., Ryan, D. T., Newcomb, M. E., & Mustanski, B. (2018). High rate of discontinuation may diminish prep coverage among young men who have sex with men. AIDS and Behavior, 22(11), 3645–3648.CrossRefGoogle Scholar
  38. 38.
    McKenney, J., Chen, A., Hoover, K. W., et al. (2017). Optimal costs of pre-exposure prophylaxis for men who have sex with men. PLoS ONE, 12(6), e0178170.CrossRefGoogle Scholar
  39. 39.
    United Nations General Assembly. (2016). Political declaration on HIV and AIDS: On the fast track to accelerating the fight against HIV and to ending the AIDS Epidemic by 2030. Retrieved Dec 6, 2018, from

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Health, Behavior & SocietyJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  2. 2.School of Public Health, University at AlbanyRensselaerUSA

Personalised recommendations