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: While the overall incidence of HIV infections in the United States (US) has decreased in recent years, certain populations remain particularly vulnerable, including racial/ethnic minorities, adolescents/young adults, and people in the southern US [1]. The Centers for Disease Control and Prevention (CDC) stated strategy to combat new infections includes a combination of "cost-effective, scalable interventions based on current science" [2]. In July 2012, the US Food and Drug Administration (FDA) approved daily oral combination tenofovir/emtricitabine ("Truvada") for pre-exposure prophylaxis (PrEP) in at-risk uninfected adults, with subsequent endorsement as blanket policy by the CDC in May 2014 [3].These decisions occurred despite calls for more deliberate consideration based on concerns raised by some experts, including AIDS Healthcare Foundation (AHF), the largest global nonprofit provider of HIV prevention services, testing, and medical care. While AHF was/is painted as ardently anti-PrEP [4], this is an inaccurate oversimplification of its voiced concerns that PrEP would: be difficult to implement due to healthcare barriers, have limited efficacy due to poor adherence, and increase risky sexual behaviors and transmission of other sexually transmitted infections (STIs).What do the first five years of Truvada PrEP reveal regarding these issues? The data are incomplete and subject to caveats and biases, but suggest that this approach has not had the positive impact anticipated by the CDC.

Were we prepared for PrEP? Five years of implementation